Having fun with rehab
Rehabilitation meets recreation
Recreation as rehabilitation, and vice versa
When you see physical therapists, occupational therapists, vision therapists, and vestibular therapists, you’re given exercises that should be aimed at helping you rehab your specific issues, challenges, or deficits.
Most of these aren’t exactly fun. Over time, this lack of fun factor can mean a lack of “compliance” in performing the exercises.
While it’s important to do certain exercises in a prescribed way, there comes a point when life can feel like all rehab all the time. There also comes a point, ideally, when you can slowly transition (perhaps over weeks or months) from rehab to regular life, which could mean more recreation and less rehabilitation.
In either case, one might look at certain recreational sports and activities and see embedded within them the things (eye movements, physical movements, and more) that look remarkably similar to their less fun rehab versions.
For example, tennis involves convergence, smooth pursuit, saccades, the about-face turns often involved in vestibular therapy, etc. (Obviously, we find sports compelling in part because they are physically and neurologically challenging.)
What to look for in a recreational sport or activity
Here are some general things to look for when considering how to aid one’s recovery with a fun recreational sport or activity.
Compound movements. These are movements that involve both large and small muscle groups working in a coordinated way. Many of your basic strength training exercises are compound movements. So is a basic shot in basketball when you do it properly with your legs involved. Certain moves in yoga qualify. The key is to integrate multiple muscle groups in a single fluid movement.
Small motor activation. While compound movements often involve larger muscles taking over for smaller ones, these movements force the smaller muscles to do all or most of the work. Pilates is especially good for this.
Cortical control. How much are you required to exert top-down control (mind controlling body)? Taking a cold shower or polar bear swim is a good example. The mind has to either suppress incoming information from the body or direct the body based on an intention or thought.
Sensory integration. How many senses need to work in an integrated way to do this? Do you have to process auditory and visual and proprioceptive information simultaneously? Every sport involves different levels and aspects of this. Which ones are connected to what you need to work on?
Complex use of vision. How challenging is it for the eyes? How much do the eyes have to move and track things? How integrated are the eye movements with other movements? Is the speed of visual processing essential? What’s the relationship between movement and visual processing?
Vestibular stimulation. Do you lean to the left and right while moving forward? Are rapid turns of the head involved? Do the eyes move in a different direction than the head? Do you have to balance for period of time with your eyes closed? For example, yoga puts you in many different positions, including upside down, but the transitions are typically slow relative to other activities, and the eyes don’t necessarily need to be that involved (a blind person can do yoga).
Emotional regulation. Will it help with regulating stress and emotion? Can this be done in a scaffolded and escalated way? Table tennis, darts, card games—almost anything has some element of this. Where’s your edge and how does the activity help you expand your capacity and push that edge farther out?
Is it safe? Can one do this thing with zero or near-zero risk of head injury?
Exercises with a surprising variety of benefits
These activities may not fully replace rehab, but by integrating some of them into one’s routine, they can aid recovery while adding a dose of fun, and peace.
Walking. We’re made to walk. Walking helps calm us down by putting us into optic flow. It helps with lymphatic drainage. It’s easy to start slow and slowly escalate distance and time. And you can make it a social thing, maybe even a regularly scheduled social thing.
Table tennis. Involvement of vision, hearing (the important sound of the ball hitting the table), processing speed, small motor, and emotional regulation. Not a lot of vestibular though.
Yoga. Ancient yet current for a reason. A lot of vestibular stimulation, but not necessarily in concert with vision integration (if one needed to retrain one’s vestibular-ocular reflex, that’s not necessarily happening too much with yoga).
Pilates. Pilates started as a form of rehabilitation for injured dancers. Great for small motor control and cortical control. If you take a class, it can be social.
Biking. Our balance system helps us lean forward, lean back, and yaw. Bike riding is particularly good for yaw as you lean left or right while moving forward. Personally, yaw is my happy place.
Tennis. As mentioned previously, tennis involves a wide variety of challenges to vision, along with vestibular, sensory integration, emotional regulation, and cardiovascular stimulation.
Shooting hoops. Can be done in quiet or multi-sensory environments. Can be escalated from easy to hard with a greater variety of movements, pace, cardiovascular involvement, etc.
Obviously, one could add just about any recreational activity to this list, but the thing to keep in mind is how much overlap there is between the kinds of exercises you’ve been prescribed (based on what you need to retrain) and what the activity entails.
Following the 5% rule
If one is still struggling to perform any level of exercise without triggering symptoms, the 5% rule offers a basic guideline for starting slow and escalating from there. In essence, you start with what you can do (perhaps walking for X amount of time and distance) and every couple of weeks you escalate by 5%. Talk to your physical therapist about which parameters to escalate.
A few final caveats
Physical, occupational, and vision therapy exercises have been developed over a 100 year history to achieve very targeted aims. You don’t want to swap out these exercises or activities in favor of merely shooting hoops or playing table tennis.
For one thing, rehab exercises are typically effective when done 4 or 5 times a day, not once a day, and the above activities are something you might do once a day or maybe once every few days.
Rather, it’s more about folding these things (fun things) into one’s regimen throughout the week while continuing to make forward progress with rehab. Again, check with your therapists about these ideas and plans before adding or removing anything from your routine.
Ideally, having more fun on a regular basis will help you stay the course and work toward a future where doing these things is less an obligation than it is a choice—something you move toward intrinsically with joy, like a swing set at recess.
Brainwave is an informational resource for people whose symptoms haven’t resolved after a concussion or mTBI. I endeavor to present this information in a clear and concise way, spelling out what’s backed by science and what remains unknown. Nothing here is meant as a substitute for professional medical advice, diagnosis, or treatment. I am not a physician or a healthcare practitioner of any kind; I’ve simply had a lot of sports-related concussions and had to learn this stuff the hard way. If you found this information helpful or know someone who might benefit from it, please share and subscribe to Brainwave.