In short yes. But not always. In this article we’ll look to honestly critique what most people assume is physiotherapy. The exercises. We’ll look at when they’re effective, when they’re not and what alternatives there are when the exercises don’t work or problems return when you stop doing the exercises.
Before we dive into the physiotherapy exercises let’s consider what we’re up against. Placebo. Placebo is particularly useful for pain. As this article states ‘around one third 1/3 of people benefit from placebo. So we need to be aiming for way more than 33% effectiveness from exercise based physiotherapy or any other intervention.
What Is Exercise Based Physiotherapy?
Exercise based Physiotherapy and Sports Therapy is the practice of trying improve injuries through performing a series of exercises. It is very popular in the NHS. After an initial assessment of your condition this guides recommendations of exercises to try to make it better.
Is There Anything Wrong With Exercise Based Physio?
No. It can be a very effective way of helping people get out of pain. It’s a great generic catch all for helping people to get better. My personal and professional issue with it is that many times it is not tailored to the individual. In the NHS there is unlikely time or resources to do this. But in private practice exercise based physiotherapy should always be tailored to the individuals needs, how their body uniquely works, and how much time they have dedicate to their recovery.
As all experienced therapists know, we don’t treat conditions, we treat people.
Being treated as an individual is more encouraging from the outset. If we’re handed a sheet of exercises that is handed out to lots of people with similar conditions it doesn’t particularly makes us feel special. It can make us feel not listened to. In our practice we know when we truly listen to our clients they will actually tell is exactly what they need to get better.
This research on back pain backs this up in concluding that ‘individualized exercise therapy on chronic low back pain compared to other active treatments is approximately 38% more effective’
Another issue I have with exercise based physiotherapy is that traditionally it doesn’t consider the whole body picture. For example if the back of your neck is tight and painful because your whole body leans forward we need to give exercises or stretches or awareness to stop the body leaning forward. Instead of simply looking at exercises or stretches for the neck. They may give symptomatic relief but they’re not addressing the underlying reason. If we give advice to bring the whole body back into better alignment we stand a much better chance of a resolving the problem for good.
At the clinic we use hands on treatment to help test and guide what our rehabilitation advice will be. Here’s a practical example of what this might mean. In treatment if we find that releasing your obliques (the muscles in the side of your body), reduces your knee pain – we do before and after tests to check this – then your rehab focus needs to be on keeping these regions loose and working properly. Not on simply strengthening the muscles around the knee.
How long does it take to see results from Physiotherapy?
Talking physiologically if takes about 6 weeks for muscles to adapt to a new exercise. You may see improvement before then as the nerves ‘remember’ what they should be doing. But it’s 6 weeks for full adaptation.
My concern is with his approach is what if the exercises you’re doing don’t make any difference? You’ve wasted 6 weeks in your recovery time. To a lesser degree if the exercises do work yet they only address the symptoms this can be like a sticking plaster. We need to consistently do the rehabilitation exercises for evermore.
The results I like to see are when people can go out and live their lives care free.
Is It Worth Seeing a Physiotherapist?
Absolutely. But as the owner of Brighton Physiotherapy & Sports Therapy I would say that! In the interests of balance I’d also say it’s worth seeing any therapist in any discipline who you trust and have faith in their methodology.
The research I cited above also goes on to question the sustainable effects (after 12 months) of even individualised rehabilitation programmes. This is why any experienced physiotherapist, sports therapist or other therapist will be look at all aspects of mind and the whole body.
Another interesting piece of research here suggests experienced exercise based physios can predict who will fare better from an exercise based approach. I would say that ties in with my practical experience. I get a sense of what kind of treatment and what follow up advice will work best for the person in front of me.
How Many Times Should You See A Physiotherapist?
How many sessions will I need is a question we get asked a lot. My flippant response would be I have no idea! My more useful and measured response is that I’m able to give my clients a better idea at the end of each session. Flippancy aside the reason for this is that everyone is completely unique. Everyone responds differently to the hands on treatment that we do. Everyone responds to the exercises differently. Each person is able to dedicate different amounts of time to their rehab and also their wellbeing. Wellbeing work being especially important for persistent conditions.
As a more practical guide you should see a physiotherapist as many times as you feel you are gaining benefit. It may be initially to get some advice and reassurance. It may be that you find the hands on work very beneficial to help you change your movement pattern. It may be useful to help you stay on track with what you’re trying to achieve and progress the plan to something more challenging.
If you find you are getting frustrated with a lack of progress always report this back to your therapist. It may be that they can use a different approach or come at things from a different angle. Honest, open and frank discussions are paramount when searching for long term resolutions.
What Happens If Physiotherapy Doesn’t Work?
We have of course seen many people over the years for whom exercise based physiotherapy hasn’t work. And in some cases the exercises have made the condition worse. We actually see this quite a lot our clinic. I should point out that it’s not us getting people to this state. It is, I think, because we offer an alternative approach so people seek us out if previous treatment has failed.
Possible causes of exercises making things worse can be as simple as it’s the wrong choice of exercise. Whoever has given you the exercise has missed something and the exercise is not right for you right now. It’s important to realise this early and change it. Many people plough on despite this response. If something is making it worse, stop it. At least for the time being.
The correct amount and intensity of the exercises in exercise based physiotherapy is of course essential. Sometimes referred to in the trade as dosage. Not wanting to sound like broken record, this is different for each person. More common than the exercise being the wrong choice is the person being over zealous with the exercises. Either doing too many exercises or progressing exercises on too quickly. This is usually out of frustration and impatience. That’s why we use the hands on work to help us short cut this process. We understand the frustration, we’ve had injuries too.
Is There A Better Way Than Exercise Based Physio?
Yes. Using exercise based physiotherapy allied with a host of whatever works will get you further down the line. This is backed up nicely by this piece of research which concludes:
“Multidisciplinary approaches including physiotherapy should be implemented to provide long-term improvement in pain”
So what else allied with physiotherapy exercises will help conditions. As I’ve already mentioned whatever works or sounds good. Keep you mind open to try different things until you find something that works well for you and makes sense. If you’ve taken this as far as you can. Then look for something else. This can be variations on themes within physiotherapy or different disciplines…
What’s The Alternatives To Exercise Based Physio?
Anything goes as far as I’m concerned! I’ll talk about things outside the physiotherapy and sports therapy umbrella below. But first I’ll give you an idea of the kind of options we use at the clinic ranging from the kind of thing you’d expect from us, to perhaps some that you wouldn’t:
Exercise Based Physiotherapy – of course! Been there, done that, got the t-shirt. As a clinic we try to minimise the amount of homework we give you. We carefully select what we ask you to do based on what our hands on sessions have suggested will help the most. This is very much a whole body approach so if you come in with a knee problem, whilst you may be given some knee exercises you could also be given side body, chest, neck stretches.
Fascial Release – different to Sports Massage and my experience a lot more effective and long lasting. Fascia holds us in position. It maintains our posture. By releasing fascia we can change the way we hold ourselves and so make our muscles work in a more optimal way. Fascial tension builds up slower than muscle tension so I find it gives us all more of a chance to adopt the changes that are so important for long term solutions.
Sports Massage – an old favourite works well for the right person at the right time. When releasing the fascia or assessing the body sometimes it becomes clear that a muscle or muscles are holding a protective pattern. Sometimes releasing the right muscle can be just what the body needs.
Joint Mobilisation – encouraging the joints to move more freely in their natural planes. When the joints move freely muscles do not have to compensate and so start working more effectively and efficiently, taking pressure off those all-important painful areas.
Muscle Activation – founded in kinesiology muscle activation uses special points on the body that have profound effects on other muscles around the body. Like secret little switches you can use to switch muscles back on to their full strength in a matter of moments. Not having to wait 6 weeks to see if we’ve had any impact on the pain. It’s a handy shortcut to help guide our advice to you to resolve the problem for good.
Whole Body Rehabilitation Exercises – so like the standard physiotherapy type exercises but looking at the whole body. I’ll give you an extreme example to illustrate the point. Let’s just say that in treatment we find that you tend to clench your jaw in anticipation of pain and try to avoid the pain by leaning away from, let’s say, a painful ankle. The rehab exercises could involve ankle movement whilst keeping alignment of your body better above the ankle and keeping the jaw relaxed.
Education – pain is not damage. When we get pain it does not mean we are making things worse. Fear equals pain to grossly over simplify some complex neuroscience. We talk in great detail about this in our previous article what is pain? Reassurance, after checking for actual damage of course, and helping people feel what that means in their bodies can be a massive step to curing the problem. If we walk around not fearing our own bodies we hold ourselves much more relaxed and so feel less pain.
Nervous System Calming – speaking of more relaxed. Even if we don’t realise it most of us will benefit from calming of the nervous system. When our nervous system is on the go all the time we can find ourselves in a state of hyper vigilance without realising. With our treatments we can calm the nervous system down by releasing the muscles and fascia that most commonly hold us in a hyper vigilant state. When this has been done, more often that not, this will alleviate pain anywhere on the body. The calmer the nervous system, the less pain we feel. We’ve put together our favourite wellbeing ideas to aid pain here.
Psychology – amateur psychology is a very dangerous thing and this is not what we’re talking about here. A way out of stressful feelings, or even traumatic feelings, is to notice what it does in our bodies. What sensations it gives. We can’t always control when we are triggered but if we can learn to almost distract ourselves with the bodily sensations that arise when we are triggered those bodily signals become less threatening over time and in so doing can pull us out of highly stressed or traumatised states. Approaching the psychology at the same time as the physical can be an excellent way through long standing pain issue. This research agrees that even some basic cognitive behavioural therapy accompanying more traditional exercise based physiotherapy can alleviate the pain more effectively.
Identifying Postural Habits – interestingly this aspect ties into the psychology more than we might initially expect. Every emotion has a physical posture. Any actor will tell you as much. There is even computer software that can read our emotions. Scary stuff! If we spend a lot of time in an emotion, for example bored at work or over stressed and hyper vigilant at work then our bodies adapt to being in these positions. They can get stuck in these positions even long after the difficult time has gone. This is where the hands on work bringing you out of these positions is invaluable. Once the pattern is identified we can advise and help you notice when you back there and, over time, form a more optimal way of being. It’s important to know this is a nurturing process. This is very much not us dictating to you what theoretical perfect alignment is and expecting you to stay there all the time. It’s more a cased of suggesting ideas and encouraging you to explore how these ideas might work for yourself.
Hopefully you can see it’s not just physiotherapy and sports therapy here. It’s a much bigger than that, simply because our experience has shown us that it needs to be. Above is a rough outline of things we consider to get the best result we can.
Each discipline will have their own models. Chiropractors, osteopaths, reflexologists, reiki healers, Bowen technique therapists to name but a few. The most important thing is that the concept sounds good, you like the therapist and you think it will be of benefit. Or you’re open to give it a go.
Does Exercise Based Physiotherapy Still Have A Role In Modern Treatment?
Absolutely yes. I believe exercise based physiotherapy is a very important part of each clients recovery. My plea is to therapists and clients to not rely solely upon it. There is some fantastic research on how training certain muscles helps certain conditions. But be flexible. Challenge the norms. Why does this muscle affect this symptom? How can I go about getting this to work without having to spend 6 weeks strengthening it? What other regions elsewhere in the body might be causing the muscles to be weak? Should I strengthen or stretch?
When selecting a therapist I suggest you look for one who is adaptable. You need someone who is going to look at all aspects of your injury to give you the best chance of success.
We’d love that to be us for you. If you’d like to understand more about how our multifaceted approach physiotherapy and sports therapy can help you with your injury then please contact us by filling out the form here.