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How strength training improves walking in neurological conditions?



Muscle weakness is commonly found in patients with neurological conditions. Some of these conditions include Cerebral Palsy, Stroke, Multiple Sclerosis and Spinal Cord Injuries. This weakness results in slow walking speeds, reduced mobility and loss of independence. However, limbs can be strengthened so you can walk easily and independently. You will just need guidance how to do it.


What makes me walk?




It is important to understand the biomechanics of walking to know how we will propel ourselves forward. Your calf and Achilles tendon are key components to push off from the ground to move your leg forward. The Achilles tendon generates power and provides energy storage for this motion. This action occurs 0.15 second. From this we can conclude that speed is important to utilize the correct gait mechanics. Speed along with force provides power. Hip extension and hip flexion power in standing are two other aspects of strength training for gait that needs to be included.




Strength vs power


Strength training helps you to achieve the ability to overcome resistance when you focus on moving as much weight as possible for the given number of repetitions.


Power training helps you to achieve the ability to overcome resistance but focuses on the ability to overcome the resistance as quickly as possible. Changing resistance constantly is the key to improve strength. Ballistic strength training incorporates speed while strengthening lower limbs. Using your body weight to load and unload joints at an increased speed will produce power generation. Applying this to gait reeducation while help improve gait speeds and reduce risk of falling.


How do you perform these exercises?






The three exercises viewed above are safe positions to target calf, hip flexors and hip extensors strengthening.


Below are a few principle's for progression to consider:

  • Ensure the accuracy and quality of movement is achieved during every repetition

  • Once movement is accurate, consider increasing number of repetitions for a particular speed. Example: how many calf raises can you do in 30 seconds?

  • Rest between training sessions to ensure recovery

  • Ensure movement is controlled

  • Progressively load muscle once speed is achieved


Please contact your physiotherapist for more information on progressive strength training and safety when retraining walking.


1. Williams G, Strength Training in Neurological Rehabilitation Course, Physioplus 2019

2. ↑ Royal College of Physicians Intercollegiate Stroke Working Party. National Clinical Guidelines for Stroke. 3rd ed. London,UK: Royal College of Physicians; 2008.

3. ↑ Olivetti L, Schurr K, Sherrington C, et al. A novel weightbearing strengthening program during rehabilitation of older people is feasible and improves standing up more than a nonweight-bearing strengthening program: a randomised trial.Aust J Physiother. 2007:53:147-153.

4. ↑ Ada L, Dorsch S, Canning CG. Strengthening interventions increase strength and improve activity after stroke: a systematic review. Australian Journal of Physiotherapy. 2006 Jan 1;52(4):241-8.

5. ↑ Morris SL, Dodd KJ, Morris ME. Outcomes of progressive resistance strength training following stroke: a systematic review. Clinical rehabilitation. 2004 Feb;18(1):27-39.

6. ↑ Dodd KJ, Taylor NF, Damiano DL. A systematic review of the effectiveness of strength-training programs for people with cerebral palsy. Archives of physical medicine and rehabilitation. 2002 Aug 1;83(8):1157-64.

7. ↑ Van De Port IG, Wood-Dauphinee S, Lindeman E, Kwakkel G. Effects of exercise training programs on walking competency after stroke: a systematic review. American Journal of Physical Medicine & Rehabilitation. 2007 Nov 1;86(11):935-51.

8. ↑ Schwartz MH, Rozumalski A, Trost JP. The effect of walking speed on the gait of typically developing children. Journal of biomechanics. 2008 Jan 1;41(8):1639-50.

9. ↑ Huijben B, van Schooten KS, van Dieën JH, Pijnappels M. The effect of walking speed on quality of gait in older adults. Gait Posture. 2018;65:112-6.

10. ↑ Sawicki GS, Lewis CL, Ferris DP. It pays to have a spring in your step. Exercise and sport sciences reviews. 2009 Jul;37(3):130.

12. ↑ Van Vulpen LF, De Groot S, Rameckers E, Becher JG, Dallmeijer AJ. Improved walking capacity and muscle strength after functional power-training in young children with cerebral palsy. Neurorehabilitation and neural repair. 2017 Sep;31(9):827-41.

13. ↑ American College of Sports Medicine. American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Medicine and science in sports and exercise. 2009 Mar;41(3):687. Available from:https://www.ncbi.nlm.nih.gov/pubmed/19204579 (last accessed 7.2.2020)

14. ↑ Williams G, Morris ME, Schache A, McCrory P. Observational gait analysis in traumatic brain injury: Accuracy of clinical judgment. Gait & posture. 2009 Apr 1;29(3):454-9.

15. ↑ Williams G, Schache AG. The distribution of positive work and power generation amongst the lower-limb joints during walking normalises following recovery from traumatic brain injury. Gait & posture. 2016 Jan 1;43:265-9.






 
 
 

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