Repetition is the key to recovery, the comments of this blog post says so.  My cousin reads my blog and she is having some shoulder issues.  I just emailed her to ask how she was doing and she said she’s still having some major shoulder pain.  Then she said in the email “Repetition right!?!?!”  Craploads of repetitions is the way to recover from a neurological injury, but not an orthopedic injury.  Doing too many repetitions might be counterintuitive for an orthopedic injury.  So what do you do when you have an orthopedic problem because of your neurologic injury?  Well… be careful, that’s what you do.  You know your body better than anyone else on the planet, listen to it.

Categories: Brain stuff, Recovery, Rehab, Stroke stuff

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37 replies

  1. I’m not to sure of the ‘repetition theory’. While repetition is good for memory, focus and detail, I think a good mixture will cause the brain to rethink and search for alternatives. We will always ‘find’ the easiest & quickest way to accomplish something, while we will ‘cheat’ with repetitions. My theory and training plan ………..

    • Hmm, I agree that we will intuitively always try to figure out easier ways and cheat(compensate) but the idea with repetitions is to be very conscious of what you’re doing and not let the cheating occur during the repetitions.

  2. Repetitions of what? The mere movement through space? Against a fixed resistance? Against a variable resistance, or does the variance make the resistance not a true repetition? To what extent does speed / range of movement constitute a repetition? Will precision of placement of anatomical elements (hands, legs, arms, spine, head, etc.) affect how fecund are repetitions? Mindful (as in mindful meditation) repetitions? Mindless (or “falling asleep at the wheel”) repetitions? In conjunction with breath work? Meditation? Visualization? Evidence-based nutrition? As you indicated, neurological vs. orthopedic repetitions? How do any one or more additional physical problems or age or athletic / kinaesthetic awareness and skill affect the extent or power — or number desired — of repetitions? Ad nauseam,

    I more than suspect that all these factors, and more, will affect the impact of “repetitions”. In other words, repetitions are not a blind mantra which ensures if you do them that you will maximize rehabilitative results,

    • Billy I detect some anger in that comment, we’re all on the same team here trying to figure out the best way to get back to life. You need to meditate more.

    • Sorry for the 3rd reply in a row but I have to say something. If I took your comment wrong and it wasn’t supposed to convey anger, please let me know. But if it was written out of anger like I think it was know this….I am a stroke survivor too. I went through this HELL too. I went through this devastating, nearly life-ending, life-altering thing too. I am a stroke survivor first and a physical therapist second. You have done “extensive research,” well so have I. Possibly more than you. For future reference, don’t piss me off and don’t engage in a battle of wits with me.

      • Amy, from me, no anger. Your first response, a direct one, was to the point and, I think, accurate: “All good questions.” [The only reason I have taken a couple of days to respond was that I have been working on an unrelated project which has involved a lot of time lately.]

  3. 100% correct on all counts, and thank you for re-emphasizing these points. I wish I had been more CAREFUL before at least a dozen painful injuries. Beyond that, sheer repetitions work. They do something nothing else seems to do, and that’s to do the job. I speak from experience. After four years and billions of repetitions, I will fully recover. Unfortunately, until something better comes along, however you want to do them, you just gotta do ’em.

  4. I think therapists should just hand out manual clicker counters and tell the patients to start counting repetitions. After they have broken 6 of them for a single movement they should be close to recovery. I heard from my OT that 1000 was enough, off by at least 3 factors.

  5. repetitions take approx. 2,500 to 3,000 to ingrain, which equates to around a month or so ? If you look at something like CrossFit training it changes every 2 months, this challenges the mind and body to adapt. Something I have taken anyway….. I don’t put much stock in traditional methods as they tend to err on the side of safety to much.

  6. I’ve heard the term to learn a movement, it takes 35,000 times executing it correctly for body to learn it or as some say develop muscle memory. As you know recovering from a stroke is a whole other ball game. I enjoy reading the discussion.

  7. I have been thinking about the issue of repetitions a lot. I think there are probably no hard and fast rules about the number. I’ve found that I been able to relearn some movements with relatively few repetitions, while others seem impossible even after many repetitions. I wish I knew what the difference was. Has anyone else experienced this?

    • I would say getting those partially damaged neurons working again might only take a few repetitions. Relocating from a dead area may take millions to establish a new location and millions more to establish a base of working neurons. But then I know nothing.

  8. Nope, there are no rules at all. You’re exactly right. Wait, in my experience there is one: keep the movements as simple and straightforward as possible, except for walking. After that, it’s just one after another after another, etc., until you’re done—perhaps years later.

    • Dean – Your explanation makes sense, but how do you explain relatively late recovery of a particular movement with only a few repetitions? I think of partially damaged neurons as being responsible for subacute recovery, not chronic. Am I wrong here?

      • Julia, My only experience in that regard was that 3 years post-stroke I was able to wiggle my toes with no attempts to move them except in the ER when that was the proof I had a stroke. If I look at my MRI it looks like the control area for toes is not affected(lying up against the corpus callossum) I’m assuming my white matter was also massively affected and the rerouting of signals from the still usable toe control area took thee years to reroute around the dead and damaged areas. My opinion only, but I think its a damn good explanation.

    • Scott – I try to apply the KISS Principle to everything I do but especially rehab. My PT does too, but every OT I’ve worked with just doesn’t and the exercises I’ve been given usually turn out to be impossible to do for many reps or just plain impossible. My PT has given me some good stuff for my arm, but for my hand I’m just making stuff up. Like knitting. I hope it’s a cold winter because all I can knit right now is scarves so everyone in my life is getting one. Also I agree about walking – just do it. That’s working for me. I’m starting to walk without the cane indoors and my brace went into the garbage very early on.

      • Julia, I recommend reading “Stronger After Stroke”, 2nd Ed., the section called “Get Your Hand Back”. It comports exactly with what I found out a year ago. The only thing that seems to work is simple hand clenching, millions and millions of times. All day long. I suggest making a habit of doing it anytime you can, watching TV, standing in line somewhere, etc, etc. In my experience, it wasn’t a straight line progression. From months 9 to 12 the rate of progress accelerated appreciably. OT hand therapy exercises are always far too complex, in my opinion. Maybe that’s why a good majority of long term stroke victims never recover their hand. It’s so great hearing your walking improvement, though! Any idea of when you might start venturing out of doors?

        • Scott – Outdoors on my own seems a long way off right now. Especially with snow on the ground. I do go out once in a while, just not by myself. I love museums for winter outings.
          I agree that OT hand exercises are uselessly complex. “Activate your anterior deltoid now, please. And relax your pec minor. and make sure your wrist doesn’t flex, and while you’re at it discover the cure for cancer”. How the f— am I supposed to do that 35,000 times and why would I even want to? My PT told me to depress the lever handle on the closet door 1000s of times. I couldn’t do it at first so she said to help with my good hand and use mental practice. Three weeks and 3000 reps later I can now do it and I’m working on shutting the closet door without losing my grip on the handle or flexing my wrist. The closet door is, miraculously, still on its hinges. I love my PT. KISS Principle always.
          I’m going to one of Peter’s seminars tomorrow in Bridgeport CT. I will report.

          • Congrats on your hand work successes! For me, I can now press an elevator button starting from two feet away without missing five times. Damn, but they make those buttons small! I haven’t decided what I’m going to conquer next. Perhaps keeping my hand on the stairway railing, but KISS principle always. Have fun at the seminar tomorrow and yes, tell me how one of those seminars are. Wish I could attend!

          • Tell Peter that all of his followers say HI! 🙂

  9. Repetitive movements are indeed the way towards recovery, but without 5 recovery elements, recovery is like an asymptote in analytic geometry — a line such that the distance between the curve and the line approaches zero as they tend to infinity.

    My take — 5 recovery elements lay the groundwork for meaningful repetition: (1) regular mindfulness meditation, (2) visualization, (3) appropriate exercise (aerobic & anaerobic), (4) nutrition (a good evidence-based argument can be made for a vegan diet) including supplemental nutrition, and (5) adequate rest/sleep.

    NOTE: each of these elements can be hyperlinked to many, recent, and compelling evidence-based science of its effectiveness. And what I have outlined is the bare bones of a fully-fleshed out recovery program,

    Without these 5 elements, much of the repetition (make no mistake, repetition is essential) is wasted and its recuperative effects are dramatically slower and less effective in anything resembling transformative healing. Indeed, without ANY of the 5 elements, the would-be recovery is destined to be significantly slower and unnecessarily flatlined.

    • I agree 100%. Stroke recovery doesn’t occur in a vacuum. It’s a full mind and body effort, and nothing less. I would add another element, a positive outlook. Positive psychology does wonders for the mind-body connection.

  10. I agree about repetitions needed but that makes an assumption that there are still some neurons working that control that movement. For those of us who decided to go whole hog and just kill off all the neurons responsible for movement, we have to somehow find a new living place either by force or sweet-talking neurons into helping us. Thats why therapists are useless for those cases, their mantra is movement.

    • Although I’m not a great fan of positivity, I agree with both you, Scott, and with Dean. Scott you call it the mind-body connection and Dean you refer to force and sweet-talking but they’re really the same thing – mental practice. No OT ever attempted to teach me mental practice although I’m using it now (thank you Estelle and Mary). This should be the first therapy you receive after stroke when you’re just lying there in a hospital bed unable to move.

      • For me, positivity helped in one more important aspect. With hard and long stroke recovery exercises I’m always dealing with stroke fatigue and burnout. Positive thinking helps buoy my spirits so this mental strain doesn’t have me spiralling down into depression. By the way, if you want to know what I mean by positive thinking, check out the Motivation boards at They’re great.

  11. You killed off neurons? That’s interesting. What’s the what for of it, and how (I take it it wasn’t excessive alcohol)? Like your avatar icon, by the way.

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