Conventional and mainstream physical therapies treating Multiple Sclerosis, Muscular Dystrophy, and Parkinson’s Disease often produce limited results because they are typically short-lived and lack the range of integrated techniques required for robust neuromuscular reconnection in the body. Using my experience with Parkinson’s as a case example, this paper will outline an alternative, holistic approach that draws from athlete rehabilitation principles and has produced remarkable results in recent therapeutic practice.
How my approach emerged
During ten years as a personal trainer specializing in muscular balance and optimal mobility, I have studied extensively and become well acquainted with the critical need to enhance the neuromuscular link between brain and body—a link that needs even further restoration for those challenged by Multiple Sclerosis, Muscular Dystrophy, and Parkinson’s. I have also learned that exercise therapy for neurological disease calls for a blend of techniques that differs greatly from conventional exercise programming.
In my evolving practice at Canadian Flexibility and Movement Center I have applied precise and progressive exercise techniques that not only minimize symptoms of neurological disorders but also lead to maximum mobility and strength after a relatively short period of time even in advance cases. I am by no means alone in my thinking, however. Researchers, doctors, and clinicians around the world are discovering that targetted exercise is a key element in countering the symptoms of neurological disorders.
Parkinson’s is a fast-progressing degenerative disease that will always entail acute injury and muscle imbalance. However, I have seen that significant progress can happen, particularly when clients work closely and patiently with one, holistically trained practitioner.
Therapeutic Key Principles
The body requires a high level of flexibility to remain mobilized and attain physical independence. To that end, my integrated therapeutic approach strengthens the connections between brain and body with remedial movement techniques aiming to:
- Open the pathways that connect the brain to the nervous and muscular systems through flexibility and strength exercise
- Stimulate greater function in neurons connected to muscle tissue, significantly improving reception of nutrients and signals from the brain
- Incorporate Facial Stretch Therapy to increase joint flexibility
- Approach Parkinson’s clients as we would approach functional athletes with being cautious of too much high-impact exercise
- Alleviate feelings of imprisonment, increase greater self-sufficiency and maximized mobility
- Improve strength and stability to ultimately improve all-around quality of life
Case Example: Parkinson’s Disease
A growing body of evidence-based research confirms that extensive exercise therapy can strengthen the weakening neurons (and even spur reproduction of dead neurons) in those with Parkinson’s Disease. If we effectively treat a client in the early onset of Parkinson’s, we can keep the body flexible and fight against tissue atrophy and muscular imbalance. We can also keep tissue well connected to the nervous system and the brain, keeping that tissue hydrated and rich in nutrients.
One of my clients was diagnosed with Parkinson’s two years after we had started working together. Prior to diagnosis, my initial assessment showed these issues:
- Client’s neck was flexed forward and to the left, with shortening of anterior neck muscles; neck could not extend into normal alignment; issue was very stiff and showing signs of atrophy.
- Posture was kyphotic; left side was slouched over; hips were extremely tight with limited range of motion.
- Years previously, client had endured a shattered femur resulting in extreme stiffness to both sides of the lower body; ankle flexion in either direction was virtually nonexistent.
- Arms and shoulders had very little mobility, creating severe upper cross syndrome and associated challenges.
I determined that for significant increase in range of motion conventional methods of treatment would be of limited use. The client’s tissue was so tight and rigid that no amount of any one treatment would be effective. I felt that only an aggressive, multi-faceted approach would free up the tissue and increase range of motion. The initial and foundational element in my approach was “Facial Stretch Therapy.”
During a 3-year period of treatment we improved mobility and functionality by 80%, which in turn restored independence by 80%. The client is now able to drive on his own and freely move around the house without assistance
The client walks 2km every day and works on movement therapy three-to-four times per week. He cycles in the summer three times per week and swims laps a minimum of three days week. This summer the client cycled 200 km over a period of four days .
Of course not all clients in our practice will see improvements such as this, but we are confident that we can make restore significant movement and independence in all individuals with neurological disorders.
The 5 Tight Tissue Objectives
In my practice and through research I have determined five core objective to apply to more effectively improve range of motion in tight, stiff tissue.
Objective 1: Bring the nervous system and tissue to a relaxed and more parasympathetic state. Letting the nervous system “trust” the facilitated movements done by the therapist brings considerably better results compared to static stretching, either solo or assisted.
Objective 2: Slowly and passively work the tissue in three ways—circumduction, oscillation, and traction—to gradually lengthen the muscle fiber and increase range of motion.
Objective 3: Particularly for clients with Parkinson’s, work and rework areas for a prolonged period of time. We may need to devote an entire 40-minute session on a single joint to marginally increase the range of motion and then spend another 20 minutes strengthening the muscles around the joint. For significant improvement, this routine may need to be repeated three times a week for several months.
Objective 4: Bear in mind that the larger goal is to return affected areas to a decidedly healthier state, restoring both their purpose and kinetic function as much as possible. In addition to range of motion, tissues need nutrients, blood, oxygen, and nerve connection to support health activity.
Objective 5: Repetition, repetition, repetition. There is no substitute for persistence with difficult and inflexible tissue. Although areas affected by stiffness, atrophy, and scar tissue will never return to perfect health, substantial improvement comes through constant stretching performed in a way that enables tissue repair. In this uphill battle, sometimes results appear to be minimal but by simply slowing the degeneration process and we empower the body to make improvements in mobility, balance, endurance, strength, and stability.
Dynamic Movements: The Critical Remedial Training
In my practice, dynamic movement therapy is essential technique for increasing range of motion. Even when stretched, tight tissue almost always returns to a tight state as a means of protecting the body. To avoid this, dynamic exercises are an effective technique to force the muscle to lengthen and realign, essentially “reprogramming” the tissue so that it will instead revert back to its natural and healthy motor patterns.
Dynamic exercises that complement primal movement patterns (i.e., patterns specific to healthy muscle or joint function) let you slowly put that body back into natural anatomical alignment and balance, leading to healthy joint mobility. The goal is to increase strength and range of motion in movements such as push, pull, squat, and lunge. By focussing on these baseline movement patterns, we can keep joints well lubricated, slow the stiffening process, and build stronger, more balanced bodies with continued progression as the goal.
In Parkinson’s Disease, for instance, a shuffled gait is a common outcome from stiffness in the hips. Once we stretch and open up the hips, the next step is to more aggressively train the more “natural” gait patterns. Retraining these biomechanics requires targeted sessions at least 2 to 3 times per week.
High-impact Exercise Can Be Problematic
Generally speaking, exercise has been proven to increase neurotransmitter synthesis—a positive outcome that can counter the degeneration of dopamine cells associated with Parkinson’s. By combining flexibility therapy with dynamic training, we more effectively break down scar tissue and increase the circulatory process, promoting healthier joints and freer pathways throughout the body.
However, we must use caution when incorporating high-impact exercise. Most individuals with Parkinson’s Disease experience symptoms well before they are officially diagnosed. This means that before treatment begins the body has often undergone physical changes including muscle stiffness, atrophy, and imbalance throughout. Without proper biomechanics, high-impact exercise combined with misaligned gate and posture can accelerate both stiffening and wear and tear on the joints and muscles.
Because Parkinson’s Disease’s works to break down the connection between the brain and the body, we must always ensure strong muscle balance and natural anatomical posture before moving to any form of high-impact exercise. Remember that we are trying to maintain mobility as much as possible when working with Parkinson’s Disease. While high-impact exercise may promote growth and strength of neurons, with proper dynamic and resistance exercises we can bring about an equal or higher level of neuromuscular response.
Psychological Challenges with Parkinson’s
Optimizing mental state is one of the key challenges when treating a client with Parkinson’s. We must remember that dopamine is not only the body’s facilitator of movement, but is also the key neurotransmitter for mood control.
When starting with a Parkinson’s client, my most important function as a practitioner is to immediately instil confidence—physically and emotionally—so that day after day the client is in optimal condition for progress, both mentally and physiologically.
Parkinson’s clients need constant encouragement and education to help them understand and appreciate the progression that is happening with their movement patterns, flexibility, and with the reconnection between the body and the brain. Being constantly upbeat helps clients to understand that the little steps add up to the bigger steps.
Neurological Goal: Remove the Beaver Dams
In my experience, joint stiffness and lack of flexibility are the biggest obstacles to restored brain-body connection. The accumulation of scar tissue weakens neuromuscular connection, creating a gap between what the brain wants and what the body can deliver. Restoring these pathways from the brain to the body is a process I like to call “removing the beaver dams.” This allows the brain’s capabilities—along with the levodopa and any prescribed medications—to maintain a consistent and direct flow through the body.
Critically, clients must thoroughly understand and envision this process of beaver dam removal. To that end, every session I have with a Parkinson’s client is educational-theoretical as well as practical. Constant communication is key: no matter how long I work with clients they inevitably have questions on technique to review from previous sessions, such as:
- How am I supposed to squat properly?
- How am I supposed to turn my body?
- How am I supposed to walk with a proper gait?
In the clinic, we are continually working on these basic movement patterns and discussing them in detail to find ways of making them more effective for individual clients. Such movements may seem very basic to able-bodied individuals but are much more challenging to someone with a degenerative disorder.
Challenge Parkinson’s clients as we do elite athletes
When working with athletes, physical trainers aim to achieve optimum athletic performance by pushing the threshold of their clients in physical, emotional and mental capacities.
I believe we must take this same approach when treating disorders such as Parkinson’s. We must be unrelenting in making small gains every day and think of clients optimistically as functional athletes, not as unfortunate souls whose bodies are shutting down.
When dealing with a functional athlete, we see imbalances throughout the body—flexibility limitations that constantly compromise alignment—though at a much slower rate than what we typically see with Parkinson’s. When trying to help an athlete reach optimal performance we incorporate all the tools at our disposal on a daily basis to see continual gains—and the same holds for Parkinson’s. As practitioners, we must be respond to the aggressiveness of Parkinson’s with even greater energy and with as many tools and techniques as possible.
To this end, consistent observation, interaction, and facilitation are the three integrated keys for measurable and constant improvement with clients who have difficulty controlling their own movements. We simply cannot assume that frustrated clients having a hard time moving on their own will be able to independently learn and execute the precise movement patterns required for neuromuscular control and improved mobility.
Addressing specific Parkinson’s outcomes
A common physical hazard for Parkinson’s clients is a sudden loss of balance that often leads to a backwards stumble that can cause bone fracture. In my opinion, this imbalance is caused directly by stiffness in the joints, specifically ankle rigidity that restricts both dorsa and planter flexion, two big factors in keeping people stable on their feet. The solution is ongoing, aggressive, and facilitated flexibility work followed by range of motion exercises and strengthening work. These exercises must be performed daily with continual progression in mind.
Frozen shoulder is a challenge even without the presence of Parkinson’s, which constantly works to further tighten up the tissue. The solution is precision rehabilitation techniques as well as ongoing remedial strengthening.
Another contributor to the balance issues, binding and tight tissue in the hip capsule and all through the pelvis creates gait issues and forces compensation patterns that make signaling from the brain to the feet incredibly difficult. The solution is stronger neurological signaling from head to toe to help restore balance and muscle activation.
The limitations of traditional therapy approaches
Currently, the Referral Program matches clients with therapeutic practitioners. In the context of Parkinson’s and similar neurological disorders, we must ask the following questions about these practitioners being recommended:
- What is their formal training in programming?
- How well versed are they in strength training?
- How well versed are they in muscle balance techniques?
- Do they use facilitated flexibility techniques?
- What is their understanding about training zones and exercise variation?
- Do they focus on compound movements and bilateral and unilateral movements?
- What techniques are used on joint alignment?
- What kind of remedial work is done that leads into a consistent progression?
- What kind of cardiovascular conditioning is being done and monitored?
- How are the vitals being stimulated for increasing neurological flow and circulatory process through the body? (Keeping the heart rate in proper training zones is a major component to creating a stronger neurological output and connection)
Conclusion: Toward a recasting of Parkinson’s
Based on the above theoretical and empirical knowledge, my goal is to work with the medical community to more fully realize all that progressive movement therapy can do for clients with Parkinson’s and similar disorders.
One practical route would be to envision and operate alternative health care centres. Such centres would provide long-term movement therapy facilitated by well-educated and devoted practitioners who continually support, motivate, and educate their clients. Again, the goal would to approach these clients as we do functional athletes, reinforcing the idea that the more time they put in, the more improvement they will experience in their day-to-day strength and mobility.
On the psychological front, my desire is to break down the barriers often experienced by people with Parkinson’s by showing them with some perseverance and commitment they can live healthy and strong lives—lives that are perhaps of a higher quality compared to pre-diagnosis lifestyle. The hope is to recast Parkinson’s as a very treatable disorder for those who work closely with doctors and movement therapists on a regular basis.
About Fedele Tremmaglia
My education and practical experience have been aimed at attaining proper alignment and structural balance for clients through rehabilitation exercises followed by top-tier strengthening techniques.
With an open mind toward combining therapeutic tools and schools of thought, I’ve developed a holistic and intuitive understanding of the way the body moves and of what can inhibit that movement.
- Algonquin college courses in nutrition and lifestyle management for developmental populations
- Certificates: Personal Trainer Specialist, Facial Stretch Therapist, PICP Strength Coach, Tens/Ems Therapy, Functional Movement Specialist
- More than 200 hours of continued education based around musculoskeletal therapy, rehabilitation and strengthening techniques.
- I have built my practice and philosophy around the ideas of inspiring doctors and practitioners who are research-based and data-driven
- In twelve years I’ve accumulated more than 20,000 hours of therapy practice
- I’ve managed and mentored personal trainers for four years