Often introspecting my strengths and weaknesses within the realm of the rehab world, I had realized that one area that I needed to put some extra work into was to innovatively select and prescribe exercises for my patients. For a very long time all my attention and energy was focused upon learning new manual therapy techniques and improving my diagnostic skills. However, it didn’t take me too long to realize when I first started working as a physical therapist in NYC that simple SLR’s, knee extension and back extension exercises etc were not going to cut it when dealing with a relatively active clientele. I had to be able to prescribe progressively challenging exercises and to give clear cues and master the nuances of proper exercise execution. I was also in awe of some of my american physio colleagues that I worked with. They were so easily able to progress or regress an exercise, tweak it to their patients needs and provide alternative exercise options to train a certain body part. I wanted to be able to do all of this and not be restricted to being just a ‘manual therapist’.
While on this path I came across RNT. It stands for reactive neuromuscular training. I have found it very beneficial and find myself prescribing it often. So lets start by describing the main principle behind it. We often find our patients falling into a dysfunctional movement patterns when performing exercises. To correct them, we rely on verbal or visual cues. Often these cues are enough to correct the dysfunctional pattern. However, sometimes even though our patients understand these cues, the body is still unable to correct itself. We are so used to moving in a certain way that its hard to break that dysfunctional neuro muscular pathway that is embedded in our brain. This often manifests itself when our patients might say something like ” I understand what you are asking of me, but I just can’t seem to be able to do it” or “my body just refuses to move that way”. This can often lead to disappointment and frustration for both you and your patients. If you have found yourself in this position, RNT can be extremely useful.
Instead of relying on cues that might not work or may sometime be too complex and confusing, we can use external force to push the body even more into that dysfunctional pattern! Yes, you read it right, physios and trainers often describe this as “feeding into the dysfunction”. By doing that, you now let the body figure it out on its own what it needs to do to get out of that dysfunctional movement pattern. The body reacts to this external force by self correcting itself by firing the right set of muscles to seek stability and control. What a novel way to retrain a movement patterns and neuro muscular pathways. The external force can be applied either manually, using elastic therabands etc. They are plethora of possibilities and it gives you many opportunities to get creative. Below are two examples of applying RNT to two popular exercises- the lunge and the over head squat (OHS). Ok, so less writing, more watching. Here goes-
The Over head squat-
These are just two examples to begin with. I’ll cover more exercises in a following blog post. What are your thoughts on this form of training? Do you incorporate this in your practice? If you are interested to send some of your own videos of using RNT in your practice and would like them to be featured on this blog in the following post, please leave a comment and we can talk more.
Keep the dialogue going, I like where this whole thing is headed! I have interesting thing lined up for you in the next few blog entries. Stay tuned and if you like the content, subscribe to get the next post to your email.
Abhijit Minhas PT
(BPT, MS, CMP, FMT)