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  • Jack Macrae

What on Earth is an ERI?

Unless you are familiar with the military rehab setting, most people have never come across the term ERI, let alone what it involves or how it can help them recover from a life changing injury.


ERI stands for Exercise Rehabilitation Instructor and is the delivery of exercise therapy sessions that aim to restore normal function in co-ordination, balance, posture, walking and running re education and overall strength and conditioning. These elements are then carefully planned and tailored to each patient and their specific needs.


I can hear people thinking, how does strength and conditioning (S&C) help my injury, I thought that’s only for professional athletes…


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Strength and conditioning is typically seen as something that only athletes participate in and involves big heavy, Olympic style exercises. However the role of S&C in rehabilitation has become an important aspect of complex rehab strategies over the last couple of decades.


This is because the training principles required to achieve a physical outcome, whether that is in a rehab setting or a pro athlete, is exactly the same!


Training Principles -


The training principles are as following-


Functional-

Best described as exercises that aid activities in everyday life and generally involve improving mobility, strength and performance.


Efficient-

A rehab programme that uses the minimum “dose” but delivers the maximum “effect”

Long gone are the days of more is better, which is now seen as an inefficient training method.


Specificity-

The rehab sessions need to be aligned with the overall goal. What are we trying to achieve? Very little point in strengthening your triceps if the goal is to walk again!


Progressive Overload-

Training adaptations only take place when there is a gradually increase in reps, sets, weight (stimulus), which in turn stimulates muscle growth and strength.


Continuity-

Allowing the body enough time to develop and learn the correct technique and posture for each exercise. Changing the exercise every session doesn’t allow enough time for the adaptations to occur. Rehab programmes should run for at least 4-6 weeks before changing it up.


Reversibility-

All strength and physical improvements made can be lost when you stop training. Unfortunately this can happen in a relatively short period. If you don’t use it, you lose it!



Developing a rehabilitation programme that is just right…


With the training principles in mind, it's now how to implement this into someone’s rehab programme. The Goldilocks Theory. Not to hot (hard), not too cold (easy) but just right for the individual in mind. This is the challenging bit as there is no one programme fits all.




My first thought at this point is. What is the rehabilitation priority?


Setting rehab goals with the patient allows you to work out the direction of your programme.



SMART goals-


Specific- In order for a goal to be effective, it needs to be specific. A goal of wanting to be able to walk again is not quite hitting the mark. However, I want to be able to walk for 10 minutes without stopping is!


Measurable-How are we going to objectively measure this goal? You can use time, distance, reps, sets, weight for example.


Agreed- The goal needs to be a discussion between the patient and clinician. The patient needs to be on board with the goals set. More likely to be achieved this way.


Realistic-You would be surprised on what some patients set as goals. Although I’m all for setting high standards, running a marathon under 3 hours may be a stretch too far.


Timed-Nothing concentrates the mind like a fixed target date.


With the rehab goals established this is where the hard work starts for the patient. ERI sessions will begin working towards those goals and can be achieved by various methods and determined by exercise selection, reps, set and load (and few others but I won’t list them all) which can all be tweaked and fine tuned in order to achieve the desired outcome.



Resistance Training-


This is basically any exercise that requires you to lift a weight. This can be an external weight such as a dumbbell but also any exercise using just your own body weight- squats, lunges, press up and plank for example.


These exercises induce adaptive changes in the morphology and architecture of the muscles as well as leading to adaptive changes in our nervous system.


In simple terms this means the bigger the muscle, the stronger and more powerful which leads to being more functional capable.


How do we get bigger muscles then?


Hypertrophy and Strength training. These are two methods that include a particular set of reps, sets and loads that improve the size and strength of muscles.




Hypertrophy typically uses medium to heavy loads whilst performing between 6-12 reps in a controlled slow movement. Whereas strength training, uses heavier loads with less reps (1-8) but also in a slow and controlled manner.


Although these are the traditional methods of improving muscle size and strength, there is substantial research showing similar outcomes using a method called blood flow restriction (BFR).


In a nutshell this method restricts blood flow to a muscle, allowing you to use a significantly lighter weight whilst still creating a hypertrophy (growth) and strength response. Which is amazing for our cohort of patients where lifting a heavy load to get these responses is not always an option.


To summarise, the role of an ERI at Remedy is to guide the patient through a pathway of exercise to improve their overall functional ability, with clear purpose, goals and structure in mind.


If you have any questions regarding this blog post or would like to learn more about the ERI role, our ERI team members or the wider Remedy Healthcare MDT, please make contact with us via the website.

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