Therapeutic Exercise: Where Does It Fit?
Weakness is a fitness problem, not a health problem.
Therapeutic exercise works. This article is not saying we should not be doing therapeutic exercises. There is plenty of research to support the use of therex. But it should only be used in conjunction with other things and should not be considered the answer to a rehab problem. If exercise alone could solve pain problems and movement dysfunction, personal trainers and strength coaches would put physios out of a job. They are infinitely better at exercise prescription than most therapist.
Unfortunately, people don’t have pain because of weakness. If you have been to rehab and were told that you have pain because you are weak, I am sorry! The truth is that weakness is not a health problem. It is a fitness problem. I have worked with 90 year old women who were weaker than skim milk who did not have pain. I have worked with people who were strong as an ox but still had crushing pain. So where does therapeutic exercise fit in to the rehab process?
Things to consider:
When we talk about taking someone who has been injured back to sport or normal life there are a few things to consider:
- When someone gets injured they can no longer handle as much load as pre-injury.
- Secondarily, their movement and athletic capacity is decreased.
- All activity requires a certain amount of capacity to perform injury free.
- To return to normal life of sport, tissue has to have a certain level of resiliency to withstand whatever the task is without getting re-injured.
This is where therapeutic exercise really shines! People need joint mobility work. People need muscle mobility work. Therex does not do either of those things. If a joint is stiff, and muscles have poor length/tension relationships, therex alone will only teach a patient how to compensate around those problems. In other words, the patient might feel better, but they still have super dysfunctional movement patterns.
But once joint capacity is normalized, and muscle mobility and control is normalized, therex can begin to redevelop movement tolerance at the lowest levels and start to rebuild tissue resiliency. If therex is being used to solve joint and muscle problem the results are probably slow and minimal at best. But when combined with manual therapy and neuromuscular re-education it is a recipe for success.
Therex is also 100% required if we are going to transition an athlete to strength and conditioning for return to life, or return to sport. We have to rebuild those lowest levels of movement tolerance and tissue resiliency so we can begin to further challenge an athlete with loads, metabolic demands, and speed demands. If we were to further challenge someone with load, metabolic demand, and speed on top of their pain free dysfunctional movement patterns would would see injury emerge again and again. After all, this is where all non-traumatic musculoskeltal pain comes from anyway.
Check out this short video to go along with this article and keep you eyes out for the next video as a break down the concept of Load Vs. Capacity and how that drives our progressions for return to sport.