The word ‘exercise’ will trigger a plethora of different thoughts that come to mind, depending on who you ask. Some will think of a specific sport that they enjoy that comes to mind, while others might think of the sweaty cardio-bunnies at their local gym, running on the treadmill, or huffing and puffin on the spin bike. Some think of the weights they bought and left in their storage room collecting dust, to be picked up once every six months. Some may even vaguely remember the exercises they were given by a physiotherapist years ago for a pain they had a while back that they stopped doing.
So why do Physiotherapists prescribe them, and is it even useful?
It’s quite common in today’s physiotherapy scene that patients and clients are unsure what is going to compromise of an effective or useful treatment when it comes to dealing with injuries. With the wide range of “treatments”, from electrode units, needles, creams, sports tape, patients are often left wondering- what is that ‘thing’ that I need to fix me?
Is it a cultural/ societal/ traditional practice? Is it that doctors must give medication, chiros crack backs, surgeons cut open and repair, and physios give exercises?
Adam Meakins, a well known, titled sports physiotherapist from the UK provides his own take on how and why exercise is often misused in his blog. He delves into how physios might prescribe them just for the sake of it, how physios often overestimate it’s ability to heal, or apply them incorrectly.
However, there are many reasons as to why physiotherapists prescribe exercises and I’m going to share a few reasons why I provide exercises, how they can be used effectively, why they’re important and how I apply this in practice. I’ll also share a few points on how a physio can be effective in their application exercise prescription
Whether it’s a rehabilitation setting, or fitness setting, it’s really important for you to understand why you’re doing an exercise and why you’re given an exercise by an exercise specialist/ health professional. Unfortunate is the case that many of those with titles and positions of power give exercises to their patients under the guise of “fitness” or “health reasons” without understanding or without a plan. It’s important to have some level of clinical reasoning as to the WHY of your exercises.
A good example would be the basic squat or sit to stand exercise. It’s often considered a great compound movement, and many would argue it’s a great exercise to give people for the sake of maintaining function into their older age. However, when I prescribe this exercise, there’s going to be a reason behind it. Maybe it is to expose my patient to increasing loads at the knee so they can build knee strength. Or they’ve had issues squatting or crouching down to garden, so I might utilise the sit to stand exercise or half squat to progress them in the right direction that they might eventually be able to hold a crouch position to accomplish their personal goals of gardening until an old age. Always have a specific purpose for your exercises.
If you have shoulder pain, and you’re being prescribed bicep curls and tricep pull downs, there needs to be a justification behind that. It just doesn’t make sense to be given exercises that aren’t targeted for you, right? And if it doesn’t make sense- ask why, otherwise, don’t do them.
Now, in some cases, depending on the why, exercises do not always have to be super specific and technical. But, as a broad, general statement, your physiotherapist should give you advice as to how frequent, how many times, an exercise should be done, what to do if you run into difficulties (e.g., It starts hurting, or you start to fatigue and what to expect). A physio should also be able to provide you with proper progressions or regressions, which is, if the exercise gets easier or feels too hard, what do you do instead? Could there be a reason for the difficulty level, or could you be doing something more/less challenging or appropriate?
Gone are the days of just purely using electrical modalities and heatpacks for problems.
ACL injury? You need a robust exercise program with tailored progressions as appropriate.
Rotator cuff injury? You need shoulder rotator cuff exercises. The list goes on. Calf tightness? Stretches and calf raising exercises are probably in order. And although is it debatable whether exercises are going to be a part of every musculoskeletal management plan, the way our research is going, we’re hopeful and confident that exercise therapy, when applied correctly, can be a very effective tool in your arsenal for managing pain and improving function.
Tim Fung
Registered Physiotherapist
Vancity Physio
References:
Adam Meakins ( https://www.thesports.physio/why-use-exercise/ )
