There has been a shift in rehab exercises being given out by physios recently 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 thing.
This change in thinking and practice is great and a step in the right direction and I support it fully, however, reading some blogs and social media discussions recently it does feel like the non-specific exercise pendulum has swung a little too far, with some physios forgetting an important key principle of exercise.
This key 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, by exposing certain stress on to a human, whether biomechanical or psychological the human will adapt to them.
Now as much as I agree that many of the so-called exercises that physios and other rehab gurus give out focus waaay too much on the minutiae of movement or the specific role of a single muscle during movement, often coming up with some pseudo-scientific sounding bullshit like how patients need to activate their Gemellus Superior before their Obturator Internus as they do a squat to prevent counternutation of sacrum that will over activate the ipsilateral latissimus dorsi producing scapula dyskinesis and lower cervical instability!
This overcomplicated, nocebic codswallop often given out by the FMS, Applied Functional Science, Kinetic Control, Functional Patterns crowd makes my Cremaster cramp up, however, there are also those at the other end of the spectrum who now have started to put my Pyramidalis into spasm just as much.
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 abilities, 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 try and get a patient with chronic painful arthritic knees doing some light bicep curls and see how that goes.
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 do 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 it to adapt. For example, doing lateral shoulder raises will not help an Achilles problem, and doing heel raises will not help a shitty shoulder.
Also doing very little in way of exercise effort or volume will also not get you or your patient very far. Yes ok we know 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 either physically or psychologically is one of the biggest crimes in physio. Silly, pissy, little, corrective exercises are the scourge of physiotherapy treatments and why a lot of physio appears not to work for patients, and also in the research.
A lot of physios are reluctant to get patients working hard, either due to their training teaching them not to, or due to fear of appearing harsh, or fear of increasing pain. Now I do 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 or information, or poor lifestyle choices such as a lifelong lack of exercise and activity. This eventually leads them to have a low tolerance to movement and activity, and why things start to hurt, so to correct this we have to ask them to move more for the SAID principle to work, and this often means asking them to do stuff they don’t like/enjoy.
Now there is NO doubt that getting patients to engage with exercise or activity that is not usual or interesting for them is difficult, challenging, and frustrating for us to do, and I don’t have all the answers in how to do this effectively with everyone, in fact, no one does! But this is our role as physio’s within the healthcare system, and we all need to do it better!
Simply put we all have to try and get better and 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 not giving robust rehab if we want to demonstrate our effectiveness in the research and to our patients!
And finally always remember you #CantGoWrongGettingStrong 😜
As always thanks for reading