Muscles respond to strengthening, but brains aren’t muscles. So why are we strengthening the body that doesn’t move well when there is a problem with the brain?
When I ask my patients who have suffered a stroke why they think they can’t stand, walk or move their arm, they go:
“Because the muscles are weak!”
“And so, what do we need to do?”, I ask.
“We need to strengthen them!”
This is a common misconception in neurological conditions such as stroke, traumatic brain injury, multiple sclerosis and tumours that there is a problem with ‘weak muscles’ and that they need ‘strengthening’.
If this were the case, is the gym the optimal place for regaining abilities? Before the gym was even evented, how did people ever recover?
What strengthening does
Strengthening has long been a large part of physical rehabilitation, and works especially well provided that the neurological system is undamaged.
In my experience in helping people with stroke, multiple sclerosis and brain tumours, I avoid the word ‘strengthening’ because it implies that the person needs to work on those supposed weak muscles in order to get their abilities back.
Strengthening, physiologically, mostly ramps up everything from the muscle to the spinal cord level. The strength comes from increasing the number and thickness of the muscle fibres that have some neuronal connections, which in turn fires the muscle cells more readily. However, this sort of training doesn’t use much brain power, and so the brain delegates this type of repetitive, monotonous work to the spinal cord to drive the action.
So what is really happening here is unless your brain is truly excited at the prospect of doing the same thing over and over again, chances are not a lot is happening in the brain in terms of recovery, which is where the real recovery needs to happen.
In terms of stimulation, we need to think of it as top down rather than bottom up. (Hence all the excitement about non-invasive brain stimulation).
Brains are like teenagers. They need a lot of stimulation and excitement, gets tired easily and bored very easily. They also give up easily when it doesn’t believe the outcome is achievable. So the trick here is that whatever therapy method we use, it needs to be moderately challenging and very interesting.
Chances are strengthening alone is neither.
Brains are maze solvers, but only if there are tasty breadcrumbs, pitstops and rewards to help it along the way. Stick around for next week’s post to find out what those are…
