As members of the human race we receive various applications of stress throughout our daily activities. This stress may be applied as a state of physical, mental, or emotional strain or tension resulting from adverse or unaccustomed circumstances. This stress may be applied in a physical workout, a project deadline, a final exam, the ending of a relationship, or many other various circumstances. The ability to progress successful through these difficult situations, as well as be prepared in the event that they reoccur in our life is to adapt to them. Stress is necessary for adaptation to take place, and with specific regard clinical environment, appropriate amounts of physical stress must be applied to the patient for adaption and continued progress to occur.
The rehabilitation professional is responsible for the physical enhancement and achievement of the patient’s Activities of Daily Living (ADL) and/or athletic goals. The patient’s pathology and physical condition will assist to determine a safe and appropriate rehabilitation program design. This program design will include a selection of exercises to be executed by the patient, over time (the rehabilitation period) at various applied weight intensities and exercise volumes (repetitions) to assist in the achievement of the patient goals as determined at the time of their initial physical therapy evaluation. One essential component of the prescribed rehabilitation exercises to be performed is the application of appropriate levels of “stress” that must be applied to the patient. These (often high) levels of applied stress are both crucial and necessary for “adaptation” of the body to take place. This adaption is vital for the enhancement of the various physical qualities, including strength, to transpire for the progression to more advanced exercises and eventual discharge from physical therapy.
The fundamental model of training that may also be utilized in the clinical setting is the ensuing adaptation process derived for the “General Adaptation Syndrome” (GAS) initially outlined by Dr. Hans Selye in 1936 and later refined by Selye in 1956. This fundamental model concept is also known in the literature as the “Supercompensation Cycle”. This stress response model (Figure 1) is initiated by means of an Alarm (Reaction) Phase as a (training/rehabilitation) stimulus (application of stress) results in a disruption of the homeostasis of the body. The body then responds to the applied stimulus (Resistance Phase) by recovering and repairing itself while prompting a return towards the initial (homeostasis) baseline. The Resistance Phase is then followed by a period of “Supercompensation”, whereby the body adapts to the initial (stress application) stimulus by rebounding above the previous (homeostasis) baseline in order to better manage the initially applied disruptive stimulus should it present itself once again. The ”Exhaustion” or “Detraining” Phase ensues with a reduction to the body’s initial level, or below the level of homeostasis, as a result of an inappropriate application of a stimulus (i.e. too much, too soon, or inadequate). An in-depth analysis of Selye’s GAS model is beyond the scope of this blog post; however, it is recommended that the rehabilitation professional become familiar with this model of stress application.
The application of appropriate levels of physical stress is important for adaptation to occur as inadequate or unwarranted/excessive levels of stress will result in a waste of valuable treatment sessions or in overuse type injury, respectively. You should ensure that the quality and not the quantity of the exercises prescribed are appropriate for your patient’s abilities for the eventual safe adaptation to these applied stresses. Only through an appropriately prescribed rehabilitation can your patient eventually be discharged with high satisfaction and achievement of their goals.
Robert Panariello, MS, PT, ATC, CSCS
is Professional Physical Therapy’s Chief Clinical Officer and Co-founder. Rob has over 30 years of experience in the related fields of Orthopedic and Sports Physical Therapy, Athletic Training, and the Performance Training of Athletes. He is nationally renowned and lectures throughout the country about Sports Medicine Rehabilitation and the Athletic Performance Training of Athletes