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Bodybuilding and the Rehab Connection
Dr. R.M. Kudlak, MD
Exactly what is rehabilitation? Rehabilitation is derived from the Latin adjective "habilis," which originally
meant "to hold onto." Ability is derived from this root. Rehabilitation simply means to restore or increase
ability to function. A patient who has injured their back, neck or other body-part usually has pain and a
decreased ability to function in their normal day-to-day tasks (occupational or recreational activities). In
most cases requiring rehabilitation after injury, the restoration of function (i.e., a return to normal) requires an
actual change of body structure. This means that in order to improve the function of an area of the body,
some kind of structural change must occur. In other words, the body must be physically changed or enhanced
in order to increase performance. These same principles of rehabilitation also apply to bodybuilding.
What is bodybuilding? The very word implies structural change, and this is exactly the goal of the successful
bodybuilder. The bodybuilder strives to improve size of their muscles and quality of their physique. The goal
for an injured patient is improved function (like being well enough to go back to work). Even though the goals
of the bodybuilder and patient appear to be different, the way to success for each of them is the same. The
goals of both patient and bodybuilder are accomplished by eliciting what I call the adaptive response of the
body.
The adaptive response occurs when the body is subjected to muscular overload or hard resistance exercise.
This adaptive response to exercise is an actual cellular or tissue response, and results in a generalized
structural enhancement of the involved bones, joints, and muscles. Structural enhancement comes in the
form of increased muscular strength through muscle hypertrophy (which results from increased amount of
contractile proteins), increased bone density (the bones of some powerlifters are almost like marble in their
structural strength), and stretching of adhesions and scar tissue.
The adaptive response is the body's reaction, or response, to a stimulus. In the case of rehabilitation and
bodybuilding, the stimulus is exercise. If the stimulus is overwhelming, the body's ability to adapt is exceeded
and tissues are destroyed or disrupted. However, if the stimulus is appropriate, the exposed tissues
will adaptively respond to accommodate the imposed stress. Research has shown that to achieve this
beneficial response, the exercise stimulus must be intense but brief. This means that the level of physical
exertion against resistance must be very high, but at the same time last only a very few minutes. When
muscles are forced to contract against a load that is close to their capacity, the adaptive response resulting
in muscle hypertrophy is elicited, but only if the tissues are allowed sufficient time to recover.
We know that exercise, when properly applied, can dramatically improve physical functioning. Actual structural
changes result in improved mechanical function of injured areas; this in turn results in an improvement
of overall function -- in other words, successful rehabilitation! You cannot have an increase in physical
function (e.g., increased strength) without a physical change in the body and the reverse is also true. This is
the basic principle that governs the science of rehabilitation, and is the biological and medical basis for
recommending exercise to help patients.
The goal of science in the area of therapeutic exercise and rehabilitation medicine is to determine the doseresponse
relationship for therapeutic exercise. In other words, what is the best exercise regimen to achieve
the best therapeutic response (increased ability to function)? Another critical question is how do we provide
therapeutic exercise to someone who is injured without causing further injury? These questions need to be
answered before a person continues or beings treatment.