Training for Stroke Recovery and Returning to Sport

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1. Introduction
2. Strokes and their Impact on Muscle Recovery
3. Rehabilitation Following a Stroke
4. Rehab In Action: A Case Study
5. Exercise Examples
6. Conclusion
7. References

Introduction

Recovering from a stroke can feel like navigating an entirely new world, especially for young, active individuals eager to reclaim their lives and return to sports or other activities they love. While stroke recovery often focuses on regaining strength and mobility, true progress lies in understanding the interplay between muscle activation, movement patterns, and skill relearning. This blog explores the science behind effective stroke rehabilitation and shares insights from a real-life case study to inspire and guide your recovery journey. Whether you’re rebuilding from scratch or refining your approach, you’ll find actionable strategies and a deeper understanding of what it takes to recover with resilience and strength.

After reading, if you still need help, you can contact us or get some free advice.

Strokes and Their Impact on Muscle Recovery

A stroke occurs when the blood supply to part of the brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients. This can lead to cell death or damage in the affected area, resulting in a variety of symptoms depending on the location and severity of the stroke. One of the most immediate and visible effects of a stroke is on motor function, particularly the muscles and coordination of movement.

After a stroke, individuals often experience:

• Muscle Weakness or Paralysis: Known as hemiparesis or hemiplegia on the side opposite to the brain damage, affecting the ability to move or perform tasks with one side of the body.
• Changes in Muscle Tone: Spasticity, where muscles become tight or stiff, or flaccidity, where muscles lose tone, can emerge, leading to difficulties in initiating or controlling movement.
• Loss of Coordination: Movements might become clumsy or uncoordinated due to damage in areas responsible for fine motor control and balance.

These physical impairments can manifest as difficulty in walking, using an arm, or performing activities of daily living, significantly affecting an individual’s independence and quality of life.

Additionally, there are often common themes to how strokes affect motor patterns, though individual responses can vary based on the location and extent of brain damage. Here’s a general overview:

• Flexor Predominance: In the upper limb, there’s often a flexor pattern where the arm is pulled into flexion (bent elbow, flexed wrist, closed fingers). This is sometimes described as a “hemiplegic posture” where the arm is internally rotated at the shoulder, elbow flexed, wrist and fingers flexed.
• Extensor Predominance: In the lower limb, there might be an extensor pattern where the leg is in extension at the knee, with the ankle often in plantarflexion (foot pointing down). This can result in a stiff, extended leg that is difficult to bend.

Understanding these patterns is important in physical therapy and strength training, where we might focus on strengthening one group over the other to correct movement patterns or to aid recovery from injury.

Rehabilitation Following a Stroke

Rehabilitation following a stroke aims to restore function, improve mobility, and enhance quality of life. We view that process of rehabilitation not just as traditional muscle training but as a process of learning and skill acquisition with a focus on both varied and repetitive/invariant practice, reviewed here:

Repetition (Invariant Practice)

• Memory Consolidation: Repetition helps in consolidating information into long-term memory through a process known as “overlearning.” This is crucial for basic facts, vocabulary, or simple procedural tasks where accuracy and speed are necessary.
• Skill Mastery: For simpler skills or when learning something new, repetition allows for the development of muscle memory or automaticity. This is seen in typing, playing a musical instrument, or memorizing multiplication tables.
• Foundation Building: Initially, repetition can lay down a strong foundation, making complex learning easier once the basics are mastered.

Variety (Variable Practice)

• Transfer of Learning: Varied practice, where contexts, methods, or problems change, enhances the ability to apply learned knowledge or skills in new situations. This is vital for problem-solving skills, creativity, and adaptability.
• Cognitive Flexibility: Introducing variability forces learners to adapt, make connections between concepts, and think critically. This is particularly beneficial in subjects like mathematics, where understanding underlying principles can be more important than memorizing procedures.
• Engagement and Motivation: Variety can keep learners engaged by presenting new challenges, which can prevent boredom and stimulate curiosity.
• Deep Learning: By encountering the material in different forms or contexts, learners are more likely to understand the material at a deeper level, not just memorizing but truly comprehending concepts.

A common example of invariant practice in sports would be shooting [basketball] free throws from the same spot without variation. Whereas the varied version would be shooting from various spots on the court, with different defenders, or under different game scenarios. Both have value.

Rehab in Action: A Case Study

Our client Carter suffered a stroke in the summer of 2022, just 3 days after his elopement in Portugal, while mountain biking.

Carter’s initial rehab included some work such as using a stationary bike with only his affected leg strapped in with the unaffected leg resting off to the side. This forced the affected leg to do the work rather than allowing his unaffected side to compensate and do the majority.

His right (affected) leg showed a typical extensor pattern with overactive quads and calves that tended to keep the leg in a more extended position. This can often lead to toe dragging when walking or running as the leg does not flex enough at the hip and knee while swinging forward to clear the ground. Some individuals resort to swinging their leg wide to reduce the risk of toe dragging. In light of this we did some testing and traditional (repetitive) training of the main flexor muscles of the legs – the hip flexors, hamstrings, adductors, and tibialis anterior.

Throughout this process we would occasionally test and train a variety of typical strength exercises. Carter was quite active and strong prior to his injury and resumed many activities and regular strength training on his own as soon as possible during the recovery process. One day we chose to test his Bulgarian split squat and found he could do 3 reps on each leg with over 80lbs in each hand. While I love pushing the limits of progressive overload I had to ask myself: if he can already do this weight, impressive for anyone, with his current impairments in gait and movement – what are the chances that improving it further would benefit his movement at all? The answer was not likely. Thus his training was heavily biased towards movements that highlighted his weaknesses* *not the case for everyone we train as with some athletes for example, it can be developing their inherent strengths as far as possible that edges them past the competition.

In terms of those inhibited flexor muscles of the leg, while we were seeing improvements in the traditional, repetitive, isolated strength exercises – those did not always produce a visible improvement in movement quality in his gait either. That leads us to the question of If we can activate the muscles in question in an isolated fashion, but they don’t seem to activate appropriately during running, what exercises can we do to  make the muscle activation more contextual similar to what is happening during running.

In other words, rather than a single muscle, can we train a pattern of activation – that involves several muscles working together- in a way similar to running but allowing more conscious focus than running itself might.

Can we modify running in a way that makes the “correct” pattern easier, allowing his joints to travel in the appropriate path more easily and reinforcing the pattern that way?

Can we modify running in a way that makes the “correct” pattern more difficult, so that the muscle effort and activation must be increased further to attempt it and reinforce the pattern that way?

Can we modify exercises and running in ways that may not be contextually appropriate, just different or random, and force his brain and body to learn how to coordinate itself better under changing and varied circumstances – having some carryover to improved coordination when those differences are absent as well?

Exercise Examples

Conclusion

Stroke recovery is as much about re-learning and adaptation as it is about regaining physical strength. By combining repetition to master foundational movements with variability to develop flexibility and coordination, you can make strides toward better mobility and quality of life. Carter’s story illustrates the importance of tailoring rehabilitation to an individual’s needs, challenging not only the muscles but also the patterns and coordination that drive functional movement.

If you or someone you know is navigating stroke rehabilitation and striving to return to sport or active living, remember: progress isn’t linear, but every step, every repetition, and every adaptation brings you closer to your goals.

References

Chua, L. K., Dimapilis, M. K., Iwatsuki, T., Abdollahipour, R., Lewthwaite, R., & Wulf, G. (2019). Practice variability promotes an external focus of attention and enhances motor skill learning. Human Movement Science, 64, 307–319. https://doi.org/10.1016/j.humov.2019.02.015

Kim, Y., Kim, J., Kim, H., Kwon, M., Lee, M., & Park, S. (2019). Neural mechanism underlying self-controlled feedback on motor skill learning. Human Movement Science, 66, 198–208. https://doi.org/10.1016/j.humov.2019.04.009

Landin, D. K., Hebert, E. P., & Fairweather, M. (1993). The effects of variable practice on the performanceof a basketball skill. Research Quarterly for Exercise and Sport, 64(2), 232–237. https://doi.org/10.1080/02701367.1993.10608803

Porter, C., Greenwood, D., Panchuk, D., & Pepping, G. J. (2020). Learner-adapted practice promotes skill transfer in unskilled adults learning the basketball set shot. European Journal of Sport Science, 20(1), 61–71. https://doi.org/10.1080/17461391.2019.1611931

Raisbeck, L. D., Regal, A., Diekfuss, J. A., Rhea, C. K., & Ward, P. (2015). Influence of practice schedules and attention on skill development and retention. Human Movement Science, 43, 100–106. https://doi.org/10.1016/j.humov.2015.07.004