Neurological physiotherapist guiding a patient through a strengthening exercise.

Getting it Right: Designing Exercises for Strength in Neurological Conditions

Jane Raleigh, our neurological physiotherapist based in Holmfirth, shares her top ten facts about muscle function that guide her approach to designing effective neurological strengthening exercises. Understanding these fundamental principles helps her create neurological strengthening exercises that work with the body’s natural design rather than against it.


1. Muscles Spiral Around Bones

“Many people think muscles run straight up and down, but they actually spiral around bones,” explains Jane. “The biceps, for example, spirals around the humerus. When I design exercises, I incorporate rotational movements that respect these spiral patterns, leading to more functional strength and literally challenging every muscle fibre.”


2. Some Muscles Cross Two Joints

Jane emphasises the complexity of multi-joint muscles. “Muscles like the hamstrings and rectus femoris cross both the hip and knee. This means they’re working at both joints simultaneously. I design exercises that address their dual function, ensuring patients develop strength through their full functional range.”


3. Muscles Contract Concentrically and Eccentrically

“Most people only think about lifting weights, but the lowering phase is equally important,” notes Jane. “Eccentric contractions – where muscles lengthen under load – are crucial for functional movement, for example lowering down into a chair. I always include both phases in strengthening programmes.”


4. Muscles Work as Prime Movers and Stabilisers

Jane explains the dual roles muscles play. “The same muscle can be a prime mover in one exercise and a stabiliser in another. The deltoid drives shoulder movement but also stabilises during reaching tasks. My exercise selection ensures muscles are trained in both capacities.”


5. Muscles Work in Groups and Synergies

“Individual muscle strengthening is outdated,” says Jane. “Muscles work in coordinated patterns called synergies. When designing exercises, I focus on training these natural movement patterns rather than isolating single muscles, leading to more functional outcomes.”


6. The Brain Knows Little About Individual Muscles

Jane highlights this neurological principle. “The brain thinks in movements, not muscles. It doesn’t consciously control individual muscles but rather coordinates movement patterns. This is why functional exercises that mimic real-life activities are so effective for neurological rehabilitation.”


7. Some Muscles Are Remarkably Sophisticated

“The long flexors and extensors of the fingers are incredibly sophisticated,” explains Jane. “They can perform complex movements like playing piano, requiring precise timing and coordination. I incorporate fine motor tasks into strengthening programmes to challenge these intricate muscle systems.”


8. Muscle Memory Is Real and Powerful

Jane utilises muscle memory in rehabilitation. “Once learned, movement patterns are stored in the nervous system. Even after injury or long periods of inactivity, these patterns can be reactivated. I help patients reconnect with previously learned movements to accelerate recovery.”


9. Muscles Adapt Through Progressive Overload

“Muscles only strengthen when progressively challenged,” notes Jane. “I carefully monitor and adjust resistance, repetitions, and complexity to ensure continuous adaptation. Without progressive overload, muscles plateau and cease to improve.”


10. Muscle Timing and Recruitment Patterns Matter

Jane addresses the neurological aspect of strengthening. “It’s not just about how strong muscles are, but when and how they activate. After neurological injury, muscles may be strong but fire at the wrong time. My exercises focus on retraining proper timing and recruitment patterns.”


Why These Principles Matter

By understanding these fundamental facts about muscle function, Jane creates strengthening programmes that are both scientifically sound and functionally relevant. These approaches help her patients in Holmfirth achieve meaningful improvements in strength and movement quality.


About the Author

Jane Raleigh, MCSP, HCPC has 15 years of clinical expertise in neurological rehabilitation and is based in Holmfirth, West Yorkshire.

Jane is a specialist in neurological Pilates, incorporating not only the benefits of increased strength, endurance, mobility and balance, but also integrating mindfulness into successful neuro rehabilitation.

Professional Qualifications

For more information about Jane and her skills and expertise, please click here.


Our Services

At SP Therapy Services we provide home visits across Greater Manchester, Lancashire, South & West Yorkshire, with specialists based in Bury, Blackburn, Stalybridge, Barnsley, Holmfirth and Bradford.

To find out how one of our specialist neurological physiotherapists can support you with neurological strengthening exercises and more in your area, contact us here or call us on 0161 764 3799. 


Editor’s Note

This article was originally published in 2019 and focused on a single case study. In November 2025, it has been significantly updated to reflect developments in evidence-informed clinical practice and service provision by SP Therapy Services.

Reviews

Marie Oxtoby

I am the Chair/Co-ordinator of Bolton Neuro Voices, a small local charity. I first contacted SP Therapy Services in 2012 when I was looking for a neuro physiotherapist to help us pilot a new Hydrotheraoy Course for people with long-term neurological conditions. Since then Susan Pattison and her staff have helped us to deliver ten courses to a total of more than 200 people and to facilitate the progress of many on to ongoing Continuation Programmes. Her expertise and willingness to listen and respond to our needs and those of our very varied participants is hugely appreciated and our partnership has gone from strength to strength. I unreservedly recommend this practice.

Amanda Knight

Andy provided a very thorough and considered physiotherapy assessment of a client with complex needs. His report was to a very high standard and underpinned all immediate and long term therapy needs. Thank you!

Elaine O'Flaherty

Very professional service and high quality of reports and communication to ensure best practice and outcomes for my clients.

Suzanne

SP Therapy Services has supported Greater Manchester Spinal Injury Group for many years. Susan and Rebecca have demonstrated knowledge and skill and been adaptable to working in community settings. I would have no hesitation in recommending SP Therapy Services

Janet Penny

I am delighted to endorse the team at SP Therapy Services. They consistently provide exceptional therapy and support their practice with sound, detailed documentation, which always arrives in a timely manner. The friendly clinicians are a credit to this fabulous company and it is evident that they always keep their patients at the centre of everything they do.