Adding Function to Rehabilitation with ViPR

ViPR has taken the performance and exercise world by storm. Professional athletes in almost every sport – as well as average gym-goers – are reaping the benefits of this amazing tool during their workouts.

As a corrective exercise specialist helping people in chronic pain, however, I work with many clients who wouldn’t ordinarily see how they could get in on the fun of ViPR. But they could not be more wrong! ViPR is a versatile piece of equipment that can be as effective for people with rehabilitation and correction goals as it can be for even the most zealous athlete. In this article, we will look at how you can use ViPR to correct faulty movement mechanics, reduce musculoskeletal pain, and improve overall function in your personal training clients.

The key to helping people improve their function and decrease their aches and pains is to design exercise strategies that are:

• easy for them to understand and perform
• target the underlying causes of their problems, and
• can be regressed and progressed effectively as needed to ensure that they reach their goals of better, pain-free performance.

As a rehabilitation tool, ViPR can be used to fulfill all of these criteria. Let's break it down.

Exercises Must Be Easy for Clients to Understand and Perform

When a client first comes to see you to address a musculoskeletal issue that is causing pain, it is crucial to remember that they have probably already been feeling a lot of fear and anxiety regarding their pain, injury, and/or dysfunction for quite some time. They may have lost confidence in their ability to perform certain tasks and will generally lack the self-efficacy needed to perform complex motor tasks, especially those that require the use of the affected area(s). As such, it is important in these initial stages to utilize simple exercises that the client both understands and feels comfortable performing. This will increase their confidence in both themselves and your training skills, and in doing so help build long-term adherence to the training program (Feltz, 1992).

Using ViPR as a rehabilitation tool enables you to create exercises that mimic activities of daily living (ADL) as well as play. When people engage in activities that they are used to performing or enjoy doing – such as playing, for example – they tend to be more relaxed (Brown, 2009). As such, when trainers first begin using ViPR to perform corrective exercises with people in pain or with injuries, an ADL/play-like exercise selection that makes sense to clients from a movement perspective (i.e., the exercise they will be asked to perform mimics a movement they use in real-life situations) can facilitate a decrease in their clients’ stress responses and an increase in their overall confidence. Good explanations of how to do the exercises coupled with encouraging clients to enjoy the movements can also help them feel less intimidated by the exercises and less self-conscious when using ViPR.

Exercise(s) Must Address Underlying Causes of Pain

When working with a client in pain, one of the first strategies in a corrective exercise program is to help retrain and correct underlying movement imbalances that cause a person’s painful symptoms. This usually involves the correct activation and sequencing of the muscles that help stabilize the spine/pelvis and ribcage (i.e., “the core”). One of the most effective ways to do this is through abdominal bracing (McGill, 2002). ViPR is a wonderful tool to use for abdominal bracing exercises and can be progressed easily as your client’s abilities improve.

The Split Stance Brace is a great exercise to develop the core through bracing. See below for main exercise, along with a sample regression and a progression.

Split Stance Brace	Regression (kneeling)	Progression (raised arms)

As your clients’ core function, confidence, and abilities improve you can move on to the next phase of their corrective exercise program. Generally speaking, this involves retraining muscles to work effectively in an eccentric, or lengthening, manner. Muscles must learn to lengthen effectively to help prevent excessive stress being placed on the joints by the pull of gravity and the impact of ground reaction forces through the body (Price, 2010). For example, a typical person with chronic back pain may find it difficult to bend over and pick up something off the ground without their lower back hurting or feeling tight. This is because as they bend over, gravity starts to pull their spine forward and their erector spinae muscles (among others) may fail to lengthen effectively to help slow down their spine as it rounds. As such, the spine itself and surrounding tissues experience stress and pain.

Moreover, when evaluating the performance of your clients’ function when they perform full body movements that involve bending, twisting and reaching, it is very important to consider all of the soft tissue components that may be utilized during that movement. For example, in the Sagittal Plane Reach exercise pictured below the client is stepping forward and loading their right leg. This motion will help activate the muscles that slow down the foot as it pronates (i.e., tibialis anterior, tibialis posterior, flexor hallucis longus, etc.), the knee as it moves forward (i.e, soleus and quadriceps) and towards the midline (i.e., glute maximus via the IT band, glute medius, etc.), the hip as it flexes (i.e., glute maximus), and the spine as it flexes forward (i.e., erectors, etc.). You will also see in this exercise that as weight is accepted on the right foot, the left arm is reaching forward with ViPR. This action will help eccentrically load the latissimus dorsi muscle on the other side of the body. As such, this exercise will help retrain many of the muscles that help make up the myofascial slings (Myers, 2002) that exist throughout our body which can help prevent excessive stress to joints as we perform functionally-based activities. Therefore, by incorporating exercises into your clients’ programs that retrain muscles how to lengthen effectively in all three planes of motion, you can help clients regain function and decrease their pain.

Some examples of ViPR exercises that you can use to train muscles of the hips, ribcage, and back to work eccentrically in all three planes of motion include the Sagittal Plane Reach, Frontal Plane Reach and Transverse Plane Reach, shown below in the video and descriptions below:

Sagittal Plane Reach

Starting and Ending Position	Movement

Frontal Plane Reach

Starting and Ending Position	Movement

Transverse Plane Reach

Starting and Ending Position	Movement

Exercises Must Be Able to Be Regressed and Progressed

The guiding principle of a corrective exercise program is the same as that of a traditional fitness program – gradual progression (Bryant & Green, 2010). Introducing concepts and exercises at a manageable pace for your client will increase the likelihood that they will adhere to the program and reach their goals more easily. As such, it is imperative that you always know how to regress or progress an exercise when needed. When using ViPR for corrective exercise or rehabilitation, you can regress an exercise by simply changing foot positions, the handprint or grip, or even the action that the body is performing. Alternatively, progressions with ViPR can be created by changing the lever length by changing the grip, moving it further away from the body or even moving the upper and lower body in opposite directions. The options are limitless. To provide you with some examples, appropriate regressions and progressions for the reaching exercises described previously are shown below.

Sagittal Plane Reach (Regression)

Starting and Ending Position	Movement

Sagittal Plane Reach (Progression)

Starting and Ending Position	Movement

Frontal Plane Reach (Regression)

Starting and Ending Position – use right hand	Movement

Frontal Plane Reach (Progression)

Starting Position – stand on right leg	Movement

Transverse Plane Reach (Regression)

Starting Position	Movement – smaller lunge

Transverse Plane Reach (Progression)

Starting Position	Movement – change grip for longer lever

Conclusion

By introducing ViPR into your rehabilitation and corrective exercise programs you will find that your clients not only enjoy the exercises, but that these movements can be easily regressed and progressed as you design strategies that target their underlying musculoskeletal imbalances and eliminate their aches and pains. As your clients' ability to move and reach without pain improves, their bodies will begin to function better and enable more fluid motion from one movement to the next. This will have a direct carry-over to activities of daily living, leisure pursuits, and sports.

References

1. Bryant, C., & Green, D. (Editors). (2010). ACE Personal Trainer Manual. San Diego: The American Council on Exercise.
2. Feltz, D.A. (1992). Understanding Motivation in Sport: A Self-Efficacy Perspective. In G.C. Roberts (Ed.), Motivation in Sport and Exercise. Champaign, IL: Human Kinetics.
3. Brown, S. (2009). Play: How it Shapes the Brain, Opens the Imagination, and Invigorates the Soul. New York: Penguin.
4. McGill, S. (2002). Low Back Disorders: Evidence Based Prevention and Rehabilitation. Champaign, IL: Human Kinetics.
5. Myers, T. 2001. Anatomy Trains. Myofascial Meridians for Manual and Movement Therapists. Edinburgh: Churchill Livingstone.
6. Price, J., & Bratcher, M. (2010). Understanding Muscles and Movement. Module 5 of The BioMechanics Method. www.thebiomechanicsmethod.com.