The Role of Strength & Conditioning in Restrictive Movement Disorders

Introduction: Beyond Rehabilitation. A New Paradigm.

For too long, restrictive movement disorders (RMDs) such as cerebral palsy (CP), multiple sclerosis (MS), stroke, and Parkinson’s disease have been framed solely through a rehabilitation lens, treatment focused on damage control rather than progression. Traditional therapy aims to preserve function and mitigate decline, but what if we reframed the conversation? What if we looked beyond simply maintaining ability and instead pursued strength, resilience, and independence?

Strength and conditioning (S&C) is typically associated with elite athletes, but its principles, progressive overload, neuromuscular adaptation, and functional movement, hold immense potential for those navigating neurological and movement disorders. S&C can be a game-changer, not just physically but psychologically, restoring dignity, confidence, and a sense of belonging to individuals who have been sidelined by their conditions.

This article explores how S&C can be integrated into the management of restrictive movement disorders, the physiological and psychological benefits, and the protocols that can be employed to drive real, measurable improvements in quality of life.

Section 1: Understanding Restrictive Movement Disorders

Restrictive movement disorders arise from damage to or dysfunction of the nervous system, impairing voluntary movement, coordination, and muscular control. These disorders present unique challenges: spasticity, atrophy, balance deficits, fatigue, and compromised motor control. Yet, despite their diverse origins, all share a critical commonality, progression can often be slowed, and in some cases, function can be improved with the right intervention.

Neuromuscular Pathophysiology & Functional Impairments

Each condition impacts movement differently:

• Cerebral Palsy (CP): A non-progressive disorder caused by early brain damage, leading to spasticity, muscle weakness, and impaired coordination.

• Multiple Sclerosis (MS): An autoimmune disease-causing demyelination of nerves, resulting in muscle weakness, fatigue, and impaired balance.

• Stroke: Disrupts blood flow to the brain, causing paralysis or weakness, typically on one side of the body (hemiparesis).

• Parkinson’s Disease: A progressive neurological disorder characterised by tremors, rigidity, and bradykinesia (slowness of movement).

Despite their complexity, these conditions do not preclude strength gains. The nervous system retains an ability to adapt, neuroplasticity. And this is where S&C can make a difference.

Section 2: The Case for Strength & Conditioning in RMDs

1. Strength Training and Neuroplasticity

Strength training is often overlooked in neurological conditions, but research suggests it can drive neuroplasticity, the brain’s ability to reorganise and form new connections. Studies on stroke patients show that resistance training improves motor function and compensatory movement strategies. In MS, progressive resistance training has been found to reduce fatigue and improve mobility.

Why does it work?

• Resistance training promotes cortical reorganisation, strengthening alternative neural pathways.

• It enhances motor unit recruitment, improving voluntary muscle activation.

• Strength training triggers myokine release, which has neuroprotective and anti-inflammatory effects.

2. Breaking the Cycle of Learned Helplessness

Many individuals with RMDs internalise a narrative of physical decline, one reinforced by medical professionals focused solely on disease management rather than strength development. Training reframes their relationship with their body. When a stroke survivor deadlifts for the first time post-injury, or a person with MS builds muscle mass, they redefine their limitations.

Strength training is not just about muscle, it is about agency, autonomy, and reclaiming control.

3. Psychological and Social Reintegration

The gym is often an exclusive space, perceived as the domain of the able-bodied. S&C programs designed for individuals with RMDs create an environment where they are not patients, they are athletes. This shift in perception fosters inclusion, motivation, and adherence.

Section 3: Practical Strength & Conditioning Protocols for RMDs

A structured approach to S&C must balance progressive overload with adaptability, ensuring that intensity, volume, and exercise selection align with individual capabilities.

General Training Principles

• Strength First: Prioritise compound movements over isolated rehabilitation exercises.

• Motor Learning Emphasis: Integrate unilateral work and proprioceptive drills.

• Fatigue Management: Adapt intensity based on neurological recovery capacity.

Condition-Specific Approaches

Stroke Rehabilitation

Primary focus: Rebuilding unilateral strength and neuromuscular control.

Key exercises:

• Unilateral deadlifts, farmer’s carries, sled drags.

• Constraint-induced movement therapy (forcing use of the weaker limb).

• Bilateral work (to re-establish inter-hemispheric communication).

Multiple Sclerosis

Primary focus: Strength maintenance while managing fatigue.

Key considerations:

• Avoid overtraining, focus on low reps, high rest periods.

• Temperature control, cooler environments improve function.

• Use of accommodating resistance (bands, chains) to match strength curves.

Cerebral Palsy

Primary focus: Improving motor coordination and reducing spasticity.

Key exercises:

• Isometric holds to improve stability.

• Plyometrics (low impact) to enhance neuromuscular response.

• Assisted locomotion (sled pushes, resistance bands).

Parkinson’s Disease

Primary focus: Enhancing movement speed and countering rigidity.

Key interventions:

• Power training—medicine ball throws, speed deadlifts.

• Boxing drills, improving reaction time and coordination.

• Balance work—unstable surface training, lateral movement drills.

Section 4: Changing the Industry’s Mindset

The fitness industry must evolve to accommodate individuals with movement disorders, integrating adaptive training into mainstream strength and conditioning programs. This requires:

• Interdisciplinary Collaboration: S&C specialists should work alongside neurologists and physiotherapists.

• Education and Certification: More coaches need specialised training in adaptive S&C.

• Accessibility in Fitness Spaces: Gyms must become more inclusive, with adaptive equipment and specialised programming.

S&C is not just for the able-bodied. It is a universal tool for human resilience.

Conclusion: Strength as a Form of Reclamation

Strength training in restrictive movement disorders is not about “fixing” individuals, it is about empowering them to live with strength, confidence, and dignity. When a person with CP deadlifts their body weight, when an MS patient moves pain-free, when a stroke survivor regains balance, these are victories that redefine the limits imposed by diagnosis.

This is the new paradigm: Not just rehabilitation. Not just maintenance. Strength.

Call to Action

Strength and conditioning specialists must step up—to challenge outdated rehabilitation models, to integrate adaptive training into mainstream fitness, and to redefine what strength means in the context of neurological conditions.

Strength is not exclusive. Strength is a human right.