There has been a shift in rehab exercises being given out by physios as more realise that they are not as specific as first thought. For example, we now know we can’t train the VMO in isolation, glutes don’t actually suffer amnesia, and rotator cuff and scapula exercises are really the same things.
This change in thinking and practice is great and a step in the right direction and I fully support, however, reading some blogs and social media discussions recently it feels like the non-specific exercise pendulum has swung a little too far, with some forgetting a key principle of exercise.
This principle is the SAID principle which stands for Specific Adaptation to Imposed Demand and states that the human body will adapt specifically to a demand placed on it. In other words, exposing certain stresses on a human, whether biomechanical or psychological the human will adapt to them.
Many of the so-called exercises that physios and other rehab gurus give out focus way too much on the minutiae of movement or a single muscle during the movement, often coming up with pseudo-scientific sounding bullshit like Gemellus Superior Intrinsics. This codswallop often given out by the FMS, Applied Functional Science, Kinetic Control, Functional Patterns crowd makes my Cremaster cramp up. But there are now those at the other end of the spectrum who also put my Pyramidalis into spasm.
These are the wassocks who claim we can get our patients to do whatever they want, whenever they want, however they want, based on their wants, wishes, and whims. As much as I know exercise for pain isn’t as simple as changing biomechanics, physiology, structure or even strength, just getting a patient with chronic knee arthritis to do some light calf pumps and a few bicep curls is going to do very little, very slowly.
Although we don’t have to be as specific as the functional movement gurus make out and we have many degrees of freedom in how and why we choose an exercise for a patient, we still have to have some common sense and look to create some overload to the area, or the movement, or the task that is the issue for the patient.
For example, doing lateral shoulder raises will not help an Achilles Tendon problem, and doing heel raises will not help a shitty shoulder issue.
Also doing very little in way of exercise intensity, effort, or volume will not get you or your patient very far. Yes ok we can use many different options and varieties of how we load our patients, and its not just 3 sets of 10 reps. But our exercise interventions must be sufficiently challenging for a patient to adapt, either physiologically or psychologically.
Personally, I think under-loading both physically or psychologically is one of the biggest crimes in physio. Pissy little corrective exercises are the bane of my life, a disease in physiotherapy, and why I think a lot of physio appears not to work for patients.
A lot of physios are reluctant to get patients working hard, either due to their training teaching them not to, or fear of appearing harsh, or increasing pain. I understand this, it’s not nice to have to ask someone to do something that hurts, or is difficult, or challenging, but often this is exactly what we should be doing.
Many (but not all) the patients I see have the issues they have due to lack of knowledge, information, and poor lifestyle choices such as lack of exercise and activity. This eventually leads them to have a low tolerance to movement and activity, and why things start to hurt
To rectify this we have to ask them to move more often, with more effort, and more intensity. This often means asking them to do stuff that’s hard, difficult, and they don’t like or enjoy.
There is NO doubt that getting patients to engage with exercise or activity that is not interesting for them is difficult and I don’t have all the answers in how to do this effectively, in fact, no one does! But our role as physio’s within the healthcare system is to try, and we all need to do it better!
We all have to try and be more confident in our abilities to educate, encourage, enthuse, motivate, support, cajole our patients to do exercises and activities that are hard, challenging, and yes sometimes boring and painful until they aren’t anymore.
We also need to be very careful in not letting the non-specific exercise argument be used as an easy opt-out for us giving sloppy, lazy, ineffective exercise. Good rehab shouldn’t just be poor personal training.
As always thanks for reading