People are often referred to physical therapy by their doctor and wonder just what it is that they will be doing. Every course of physical therapy begins with a thorough examination. During the examination, the physical therapist reviews the person’s medical history, current medications and asks them to describe the onset of their current symptoms and functional impairments or difficulties.
People are often referred to physical therapy by their doctor and wonder just what it is that they will be doing.
Every course of physical therapy begins with a thorough examination. During the examination, the physical therapist reviews the person’s medical history, current medications and asks them to describe the onset of their current symptoms and functional impairments or difficulties. A physical therapy examination is performed, goals and an individualized plan of care are established and then treatment is initiated.
A physical therapy examination will include assessment of the following: mobility, flexibility, movement patterns, posture, strength and review other body systems. There are typically four categories into which things that are discovered fit: weakness, tightness, inflammation and compensations.
Many times, it is difficult for a person to understand, let alone "feel," weaknesses. This is because our bodies have an incredible ability to compensate for our deficiencies. We compensate by altering how we move, which tends to bias the stronger muscles. Strong muscles override the weak, and the weak muscles grow progressively weaker through disuse.
People typically struggle initially with "prescriptive exercise" for a variety of reasons. Prescriptive exercises are: patient specific, subtle, nuanced individualized movements that address a specific problem. This is why the patient is very challenged by them. Some of the most common reasons for the struggle are: weakness, compensation, substitution, inflexibilities and pain.
Weakness speaks for itself; weak muscles typically stay weak unless they are targeted by a specific exercise pattern. An unused muscle group will weaken unless it is exercised or strengthened in some way.
A second cause of frustration with exercise prescription is that they are training to overcome long-standing, well-established movement patterns or compensatory habits. Over time, sometimes gradually over many years, strong muscles have over-ridden the weak. The patient has established compensatory movements and inflexibilities that prevent the correct muscles from doing their intended function, and it hurts. Sometimes referred to as compensatory/adaptive movements, as a "limp" of sorts, compensatory movements can be driven by factors including, but not limited to, pain avoidance, posture, habit, absence of muscle length and joint tightness (or looseness) to name a few. Another analogy is when you are driving on a well-used road with deep tire ruts. The tires tend to fall into the ruts and predetermine your direction of travel. A compensatory or painful movement pattern can be just as difficult to move out of.
The demand of training and exercising muscles prescriptively can be varied depending on the position that the exercise is performed in, for example: standing, sitting, side lying or even on an exercise ball. The type of resistance or method of loading can challenge the person’s ability to perform an exercise pattern. There is a saying that "practice makes perfect," but is more accurate to say "perfect practice makes perfect."
Perfect practice may seem unrealistic, but there is significant importance that the patient performs the exercise (in the rehabilitation setting and at home) in a manner that does not aggravate pain or worsen their condition. Therefore, intensity and the technique of the exercise are critical.
What many people find frustrating, challenging and remarkable is when a muscle weakness or imbalance is made know by actually "feeling it." This is not unusual. People can be counseled by their physical therapist during this phase of their recovery as to the mechanical implications of this problem within the context of their impaired function. At first, the person tends to need more feedback or corrective assistance because they do not have a good sense as to how the exercise should "feel." As their exercise technique improves, they are able to correct their technique themselves with greater ease until, over a period of time, the movement becomes automatic.
Sometimes in rehabilitation, a substitutive movement is all that can be realistically expected given a particular condition, trauma or circumstance. However "function" is the name of the game with exercise prescription and rehabilitation and pain free function is the ultimate goal.
Jeff Smith PT, DPT, MS, M.Ed is an Expert Clinician Physical Therapist at Spaulding Outpatient Center Framingham where he specializes in the management of patients with musculoskeletal disorders.