Strive for efficiency (not the most possible exercises)

During a conversation last week, we veered onto the topic of exercise prescription in therapy. I remembered the therapeutic exercise class in physical therapy school AND I repeated the mantra, “sets, reps, and how many times per day.” In class, I received a bad grade if the sets and reps were not clearly defined. Well, my opinion has changed.  I told my colleague that I try to give one and only one exercise. She was obviously surprised. I went further and stated I rarely if ever give a set and rep scheme along with severely limiting the amount of exercises.

Why?

  1. Efficiency is critical for compliance. Giving two when one is sufficient reduces the likelihood that either will be performed. Giving three when one is sufficient is guaranteeing non-compliance.  Giving more than three means you are most likely using an extender to allow for billing another unit.
  2. Clarity of purpose. When I give a clamshell exercise, I draw a line in the sand. I am saying that their gluteus medius is not active and needs to be. I make sure they are own this exercise. They go till it burns in the right place. When they come back, there is already a neuromuscular change happening.
  3. Progress is clear.  Either the exercise worked or it did not.  Now I can refine what I am thinking. I have yet to see a patient perform 10 exercises correctly. Sometimes one can be difficult.  For example, I changed up my practice of giving self mobs because patients kept provoking their pain. I knew that this was the case because I did not muddy the waters with other activities.
  4. Removing the negative is more important that adding the positive.  This helps me emphasize that there is likely something in my patient’s day to day activities that is driving the problem. Adding an exercise to counter this will never be as good as eliminating the negative activity.
  5. Sets and reps are less important that tools that they can use to self manage. I will admit that I like the long term development model.  Once pain is gone, I shift my clients to strength training professionals.  Here the sets and reps are critical. For my practice, I like exercises that can be used to manage pain or impairment immediately.

In the end, exercises are useful tool, but the mindless home exercise program that gives a patients 6 pages of things to do just cheapens the value of physical therapy.

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