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Toni Talks about PT Today

I Don’t Do Enough Exercise With My Patients

Published October 28, 2009 8:21 AM by Toni Patt
While was doing research for a recent assignment I came across a statement that made me stop and think. In essence it said you can't get functional improvement without strengthening.  My first reaction was "Doh! Everyone knows that." That's one of the first things I learned in PT school. Then I read a little more. The article talked about the necessity of strengthening exercises in treatment. I had to stop and think.  All of my patients do exercises. When I stopped to think about it I realized I rarely do strengthening exercises by themselves.

As PTs we know exercise comes in many shapes and forms. A good argument can be made that a functional activity is actually exercise.  I progress to working in standing as soon as possible to strengthen core muscles and legs. I probably do forced use exercises with half of my patients on any given day. In each of those examples I'll get strengthening, but none of those exercises were done with the goal of strengthening. All were done with some function in mind.

This may be nitpicking. Everything in PT is function oriented. Does it really make that big of a difference what kind of strengthening exercises I do? Yes, I think it does. Muscles are very specific. They must be trained to perform their particular function. At the same time the muscle must have the strength to be strong enough to practice the functional activity. This is like the chicken and the egg question. Except in this case it doesn't matter which comes first. You have to have both to get the job done.

I tell my patients it doesn't matter how strong a muscle is if it can't do its job. This usually happens when I start forced use exercises. I use weight lifters as my example. As strong as they are, they can't do anything with that strength. I never have to explain strengthening exercises. All I have to say is we're going to do exercises to get stronger. Yet if I want someone to be strong enough to stand, I make him stand. Then I have to go back and work on weight shift, eccentric control and whatnot.

That simple statement made me realize I need to rethink some of the things I do. I need to get back to mat exercises. I have my patients for an hour and a half. Time is not a problem. I can do more facilitation techniques on a patient who is lying down. I can make patients bridge to strengthen hip extensors. Weak hip extensors are a bane of my existence. You can't move through stance properly if you can't extend your hip.

Memo to self, do more exercising. Facilitation of movement patterns is just as important as increasing strength. I must remember that.


Nice blog Toni!

simpler and more focused certainly has its place. Take it one step further and be sure you spend some time allowing your patients to "sense" deeply their bodies re: wt bearing, movement in relation to breath and you may be surprised at what "strength" they develop rather instantly as we give credence to the efferent half of the equation of often too full of do and not "be" aware.

...And if we slow down and feel our own experience, the patient entrains to a deeper awareness and movement gains ease.

Keep up the good work ....thanks for the idea.

matthew taylor, PT - Owner, DSR Clinic November 17, 2009 10:13 PM
scottsdale AZ

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