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.
