Updated: Feb 1, 2021
By Ana Soulia, PT, DPT |Inertia Physiotherapy Missoula, MT
This is a very common and important question from my clients. Spoiler alert, it doesn’t have a universal answer. A strong belief at Inertia Physiotherapy is that each person is unique with their own unique story and goals. This means that the exercise you can do during your rehab will be unique to you as well. When answering this question, it is important to consider things like:
What stage of injury are you dealing with?
What kind of exercise program did you have before you initiated Physical Therapy?
What kind of movement practice do you enjoy?
What kind of exercise program would you like to have when this all over?
When working with clients who have an established exercise program suddenly experience an injury, I try to find an alternative that does not exacerbate their pain. It’s frustrating to be taken out of your favorite activity, but in the acute and sub-acute stages of injury, you can’t rush healing. You need to respect the injured tissue to create the best possible environment for full recovery. I can’t make you heal faster, but I can help you heal as fast as possible. An example might be a runner with an acute ankle sprain. I would suggest you avoid running, but maybe biking is ok. Or maybe it’s time to sign up for a gentle yoga or Pilates class and focus on restorative movement. I would also work with you to understand what kind of objective markers would indicate that you are ready to resume running.
When working with clients that have more chronic problems, the first question we (you and I) need to answer is:
Is exercise the biggest priority for you right now?
Clients often come to physical therapy with the assumption that they just need to be prescribed exercises and that the reason they still have pain is because they just haven’t been exercising enough. These same clients have often participated in other treatments including exercise based physical therapy and they are now sitting in my office blaming themselves for their lack of follow through. I don’t blame my clients, nor do I blame the previous practitioners. They prescribed what they thought was best at the time with the knowledge they had. What I do find is that in complex, chronic cases, the biggest reason that your old home exercise program has been long forgotten is because it didn’t make you feel better (may have made you feel worse) and you didn’t really understand why the exercises were chosen for you.
This is where we circle back and answer the question, “Is exercise the biggest priority for you right now?” Often times initially the answer is actually, no. What we need to start with in these cases is techniques for settling your mind and nervous system so your body is ready to accept movement and exercise without perceiving it as a threat. A fascinating thing about our brain is that it doesn’t know the difference between physical stress and mental/emotional stress. That means that either one can be perceived as a threat which leads to amplified signal of pain as an output. So, if your body can’t handle the stress, you’ll experience more pain, even if you did the exercises precisely right.
If, through your story and your physical evaluation we have decided that your nervous system needs more time and attention I will not prescribe a specific exercise program to start with. That doesn’t mean stay home and lay on the couch binging Netflix between sessions. It means that I will recommend self-treatment that focuses on things like attention to breath and mindfulness techniques to help you become aware of your body and start to let go of unconscious tension. We’ll discuss lifestyle changes to help you improve your sleep and diet. These techniques help to support and preserve the changes achieved with hands on techniques performed during your sessions. Depending on your area of complaint we may recommend a walking program and/or 1-2 specific re-education exercises. Most of all, I recommend you practice self-forgiveness. The “should-a, could-a, would-a-s” of the past won’t help you move forward.
As your treatment progresses and your body can tolerate more input, we can start developing an exercise program. The exercise you choose needs to be something you enjoy doing. If you don’t like it, you won’t stick with it. It’s also great if we can add variety. Move more ways, more often so that no one body part feels overly stressed.
As you embark on the healing journey, it’s hard to know for sure how long it will take to get to your destination, but there are a lot of interesting points of interest along the way. Rarely is it like hopping on the interstate and zooming straight there at 80 mph. More often it’s like taking the back roads, some are paved, some are gravel, there are a lot of twists and turns and a variety of speeds. But you’ll learn a lot, find out that you are more resilient than you know and when you get to your destination, you’ll have a whole new world of opportunity to try new things.
So, in summary, when asked “what exercise can I do during my rehab program,” my answer is: it depends…….
About the Author- Ana Soulia is a Dr. of Physical Therapy and founder of Inertia Physiotherapy in Missoula Montana. She specializes in treating complex problems and persistent pain issues. She is passionate about helping her clients move well and enjoy an active Montana Lifestyle.
Her Integrative Approach to PT emphasizes the need to evaluate the whole person in order to understand how all the systems contribute to pain and nagging injuries. If you are in the Missoula area and you'd like to know more about Ana and how her practice is different please visit www.InertiaPhysioMT.com and schedule a FREE Discovery Session.
1001 S. 4th St. W Suite 4
Missoula, MT 59801