Not all rehabilitation programs are created equal. Once you have selected a clinic, been assigned the right care provider and started therapy, getting results may seem like a sure thing.
Regardless of what type of practitioner you choose and how many acupuncture needles, ultrasound machines and manual adjustments you endure, make sure that rehab exercises are part of your plan, unless contraindicated.
Many research studies have identified therapeutic exercise as a key component of pain reduction and increased function in nearly all chronic musculoskeletal injuries. Several studies have also found that although manual therapy is commonly used on its own to manage chronic pain, a combination of hands-on techniques and rehab exercises achieved superior results.
So a combined care approach including exercise is a powerful tool in the rehabilitation process – if it's done right. Here is what is often missed but is crucial to helping you get across that injury tightrope safely so you can do a pain-free happy dance when you reach the other side.
1. No complete secondary assessment
In addition to an initial assessment by the lead health professional, at the end of the acute phase of injury you should get a full kinetic musculoskeletal assessment, which is essential for determining a baseline for the chronic phase of rehabilitation. Every body has a riddle. Many injuries to a specific area are influenced by dysfunction in another part of the body. A proper secondary assessment that looks at, among other tests, postural dysfunction, functional movement patterns, balance and core stability can help solve the riddle and provide a long-term solution.
2. Sloppy exercise technique
Precision is arguably the most critical component of any therapeutic exercise program. The exercises given need to be done perfectly in the clinic and reproduced well at home. Clinical experience tells us that the need for precision increases in importance proportionately to the sensitivity of the injury. In other words, if safe exercise for non-injured people is like walking along a curb and trying not to fall off, then effective exercise for injury should be like tiptoeing on a wire during a wind storm. A study from the Journal of Sport Rehabilitation found that a detail as small as foot position during a side-lying gluteal rehab exercise can make the difference between recovering from back and knee pain versus activating a muscle that can possibly make the situation worse. Remember, details matter.
3. No on-site collaboration at an integrated clinic
Optimal rehabilitation is like a relay race. Each member of the health care team should have specialized talents, unlike the jack of all trades model of one practitioner managing the entire process. Recovery from injury can be broken down into the acute, subacute and chronic stages. The acute phase is known for swelling and loss of range of motion and function. This is where the physician and manual therapist, such as a physiotherapist, chiropractor or osteopath, guide the process. As swelling decreases and range of motion increases, the manual therapist will take over, using a combination of hands-on treatment and basic exercises. In the chronic phase, the area that sustained injury is now well into healing and exercise should be administered by a registered kinesiologist or athletic therapist under the supervision of the manual therapist. At an integrated clinic there should be constant feedback, communication and collaboration to create the smoothest experience possible.
4. There is less progress without progression
Performing countless repetitions of the same three exercises twice daily, with no end in sight, isn't the best path to injury recovery. Strength-training principles and parameters need to be considered when tailoring any rehabilitation program. The progressive overload principle of strength training is simply the idea that for a muscle to adapt there needs to be a small, safe increase in the amount of stress it is exposed to. Over time, many of these small increases will lead to a much stronger muscle. In rehab, this stress needs to come from more than just adding repetitions to the same exercises. As examples, changing the body position or external weight, decreasing rest periods between sets and increasing the speed of contraction, or working from isolated exercises to more functional ones can make a huge difference in getting back to life with confidence and ability.
5. Not staying current with the latest research
With a vast number of exercise rehabilitation studies offering endless contradictory findings and recommendations, it's the rehab professional's responsibility to apply the best and most current evidence-based techniques. An example can be found in new research confirming that bracing the abdominals like a brick wall is a significantly more effective way to protect the spine than the previously popular "drawing in" of the belly button with a hollowing action. Your rehabilitation professional can't tell you what methods of treatment will eventually be replaced or disproved, but they should be on top of what has already been deemed inferior.
6. Not putting in the time
Studies suggest that up to 70 per cent of people don't stick with their treatment regimen and adherence may be particularly poor for unsupervised home exercise programs. Combine this with the supercompensation theory of muscle adaptation and clearly there's a problem. Supercompensation is the idea that we train our muscles, rest and repair, then put them under a slightly greater stress. If the stress is too high or low or the rest between sessions is too long or short, we lose the positive effects. If you are going to physiotherapy and doing rehab exercises once a week, you'll need to do a minimum of two home workouts every other day to achieve long-term results in the chronic phase of injury. Even with the best coaching and direction available, if you don't dip your oars in the water and pull, your boat won't go anywhere.
Health Advisor contributors share their knowledge in fields ranging from fitness to psychology, pediatrics to aging.
Allan, a registered kinesiologist specializing in rehabilitation management and return to sport/life demands, is based out of PhysioPlus Health Group in Toronto.