Functional Exercises
by Howard A. Knudsen, PT
Doctor of Physical Therapy

Functional exercises are prescribed to help reduce unnecessary stress and strain on the lower back during daily activities.  For example, findings of a recent medical study--on pressures within the intervertebral disc during specific daily activities--show that pressures can be at their highest during the sit-to-stand movement. 

A patient is taught proper body mechanics by a physical therapist to improve overall functional activity level.  Functional exercises may include: sitting with proper posture, sit to stand, functional squat, lunge, box lifting, etc. 

There are other aspects to functional exercise pertaining to the progression of a lower back stabilization program.  In the case of training the recruitment of deep stabilizing muscles during normal function during work, play, and sports, it is important to follow serial progression of increasingly demanding tasks. 

The patient is taught to pre-contract the local (inner unit) muscles prior to the activity and maintain the contraction throughout the activity.  Recruitment of the local stability muscles must integrate with the global stability muscles under low-load for normal function.  Activation must `feel' easy (low perceived effort) and be confident at each level before progression to the next level.  There must be no substitution, fatigue or pain during the exercise programme. 

Comerford says: “This type of movement is performed until it starts to feel familiar and natural.  It is important to remember that direction control movements can also be used to unload pathology, decrease mechanical provocation of pathology and assist in symptom management. This is important for early symptom control.” 

Functional exercises test the integration of local and global stabilizing muscles.  But, your goal is to strengthen the leg muscles (gluteals, quadriceps, adductors and hamstrings) while maintaining activation of local stabilizer muscles of the trunk.  Particular functional exercises may also be therapeutic for patellofemoral knee pain as the patient works on minimizing ankle movement and maximizing hip movement so as to minimize total number of degrees knee has to move.