Why Your Rehab Just Isn't Working!
What I imagine you're expecting me to do as a strong advocate of manual therapy is to condemn exercise referral or rehabilitation exercises, but I'm not.
In fact there is a wealth of information supporting the use of exercise referral in medical management which is why we have a youtube channel stocked full of them (93 videos to be exact) that can be used, for free, to aid your progression to a pain free lifestyle.
However, despite a smorgasbord (Bet you haven't read that word for a while) of free videos to choose from and endless website links to healthcare professionals at a click of a button we still hear EVERY DAY that the rehabilitation exercises they received don’t work.
So let me tell you why.
One reason may be your trying to put a plaster over a bullet wound, figuratively speaking.
Meaning the size of the solution is inadequate to the scale of the issue. We all know putting a plaster on a bullet wound would be ridiculous. But to expect a Joe blogs to understand a few stretches and planks wont fix a disc prolapse isn't the fault of the client but the individual who prescribed them.
The solution must be adequate compared to the size and severity of the issue. This doesn’t just go for exercise referral but any healthcare intervention. The same goes for a week's prescription of naproxen or co-codamol or 6 chiropractic adjustments over 3 months. The solution for a problem such as disc prolapse for example must be equal in size.
The second reason your rehab exercises may not be working is the most obvious, you're not doing them, and I can sympathise with why. They’re boring, tedious and at first a little bit uncomfortable, not exactly a recipe for adherence. But more often than not this is the main reason exercise based rehabilitation isn’t successful. Finding the time each day to do the same 6 or so exercises for 4-6 weeks before you see any significant change is difficult. What's more difficult than that is they are designed to be done all year round not just when the pains are there. The strength or flexibility you gain when you do the exercise is lost 3 times faster than the time it takes to gain it.
Meaning if you’ve successfully adhered to the plan for 12 weeks it only takes 4 weeks of not doing them to lose the benefits you gained. Which puts you right back in the weak unstable position that caused the problem in the first place
The final reason, your exercises aren’t addressing the true cause. You've called a gas engineer to replace a fuse, could they do it? maybe… would it be a lot quicker and easier if the electrician replaced it? Yes. Exercises either strengthen or stretch a soft tissue. This could either be a muscle, tendon, fascia or combination of. They are not designed to resolve joint or nerve based issues. What about exercises that mobilise a joint? I hear you all scream, and this is when I refer to gas engineers fixing plug sockets.
SO, my 3 lessons to learn when exercises aren’t quite cutting the mustard and getting you back to your best.
Don’t plaster over a bullet wound- The size of the solution should fit the size of the issue
Exercises are difficult to adhere to- But doing exercises consistently all year round, even when you're feeling fine, work.
Don’t ask a gas engineer to fix a plug socket- Choose the most efficient and appropriate health care intervention to resolve your specific issue.