Monday, 15 April 2019

When Do We Need Specific Exercises In Rehab?


                If you’ve followed the physical therapy literature over the last 5-10 years you’ll notice that more and more, the literature is challenging the longheld belief that you need to do X,Y and Z exercises to get out of pain. The ideas of “you need to activate your TVA” or “you need to get your scapula set first” are slowly (sometimes very slowly) becoming a thing of the past.
                With research like this it begs the question – do we need specific exercises in rehab? That is the topic of today’s article.

When are specific exercises needed?

Specific exercises are for specific adaptations in specific tissues and can also be influenced by your clients’ tolerances. Breaking this down by section ….

1) Specific adaptations

If your goal is to build the muscle & tendon strength necessary to withstand sprinting – doing 10 minutes of jump rope probably isn’t going to help. If your goal is to develop neuromuscular control of your knee to prevent a repeat ACL injury – doing bicep curls isn’t the best choice.

Some clients, particularly elderly and/or those with persistent pain, can be so weak and deconditioned that simple tasks like getting out of a chair can be very difficult. As much as I am all for people doing activities that they want – when you don’t have the baseline strength or mobility to do IADLS … that’s a big problem that needs to be addressed.

If your goal is to develop specific adaptations – be it strength, hypertrophy, power, endurance, mobility, and/or neuromuscular control – the exercise needs to be tailored towards that. Plain & simple.

Whether or not those adaptations are relevant to getting out of pain is up for debate as research has shown that improvements in strength, muscle timing, kinematics etc don’t always correlate with changes in clinical symptoms. I look at in terms of what the client needs from an activity demands perspective versus where they’re at.

2) Specific tissues

Over the course of the decade we’ve worked to move away from structural diagnoses – which is a much needed move for the better.

That said – some injuries, such as tendinopathies and muscle strains, do require more specific exercise to allow the area to heal, adapt & recover. Arm curls don’t do much for a hamstring strain nor does your biceps tendinopathy benefit much from calf stretches. Can general exercises help? Most definitely – but to rehabilitate the specific tissue you need specific loading.

It’s important to note that even within the category of “specific” exercises you have a large range of options to work with that can range from strengthening, mobility and neuromuscular exercise all the way to practicing the desired activity with some modifications as needed (i.e. “sprinting” with reduced speed). Again these are all based on the individual.

3) Based on your client’s specific tolerances

Sometimes, in more nociceptive presentations, people may not tolerate specific movements or postures and may tolerate others very well. In those cases, emphasizing exercises in well tolerated directions & postures is a wise decision – at least during the early stages of rehab. This is where approaches like the McGill method make a lot of sense as they take away what hurts and emphasize painfree movement & exercise.

How long painful movements are avoided, if at all, is a controversial topic that depends on numerous individual factors.

When are specific exercises not needed?

For more general pain relief where there are no major structural tissue concerns, and where there are no major physical deficits that need to be addressed, you can incorporate more general exercises and some more valued, leisurely activities such as walking, gardening, skiing, handyman work, whatever you like.

Best of both worlds

And to be honest – an ideal rehab program for most (not all) people incorporates valued activities that people enjoy & want/need to get back to as well as specific exercises to address specific physical deficits.

So there you have it – a very simple explanation of where specific and general exercises & activities fit within the scope of rehab. As always – thanks for reading.

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