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Proper Progression of Therapeutic Exercise

Often times, I come across patients who believe that exercise has not helped them or has even made their pain worse. When this happens, I question what they did in the gym, at home, in formal physical therapy, or simply what exercise program they attempted. Many times, they were in too much pain to realistically progress in their given program. They would be sent to physical therapy in so much pain that they could not progress. As a result, the therapy would be perceived as a failure. I will, in many cases, hold off on therapy until their pain becomes more manageable after undergoing procedures, getting medications adjusted to reduce the pain, or waiting until the acute inflammatory period subsides. One may even consider aquatic therapy before land therapy.

I encourage all patients to listen to their body. Our bodies are different every day for a wide variety of reasons. Some days, we can push ourselves a little harder. Other days, we need to stretch and strengthen much more gently. For example, when we stretch, we can cause micro-tearing of our muscle fibers. This tearing needs time to heal, repair, and lengthen thus improving our flexibility. If one stretches maximally every day, there will be continuous inflammation and pain. This will make it less desirable to continue doing.

Teaching patients to exercise at home is often desirable due to high therapy copay costs, transportation difficulties, etc. Therefore, we have to look at our parameters of frequency, intensity and duration. These parameters should not be increased all at once. For example, if you start with three exercises, one may increase by a few repetitions each exercise. However, if you add a new exercise, you may reduce repetitions say from twelve to ten. When beginning a home exercise program, I advise only starting with a few because you can always progress. If too many exercises are done at once, your pain can really flare up. It will then be difficult to figure out which exercise you may need to postpone from doing or build up to.

Just as we all have different pain tolerances, some people may have to start out at a very low level and build gradually. It is not unusual for it to take a month or so to start seeing results. Also, if you experience sharp pain or radiating pain while doing that exercise, discontinue it. Again, remember the simple piece of advice of listening to your body. Always consult a medical provider before beginning any exercise program.