The Best Physio Exercise
We all acknowledge that exercise is a key part of physiotherapy, but that is probably where the agreement ends. If you search for information about physiotherapy exercises you will soon realise that it is anything but a simple topic.
So here is my attempt to breakdown some important points, debunk some long-standing myths and fill in a bit of the grey around exercise therapy in physio.
‘What is the best physiotherapy exercise for x?’ Or ‘best exercise to fix y condition?’ Is at the top of many people’s searches when looking for a solution to their problem. However, there is no such thing. There is no ‘best’ physiotherapy exercise to fix pain or resolve a certain condition. Why I hear you ask? It is because we are all different.
Two people with knee pain are not the same. Even if they are similar in terms or age, weight or gender. Even if they both get their knee pain when running and the symptoms sound similar. There is no ‘best’ exercise that is going to fix both of their knee pains. The reason for this is simple but completely overlooked - because it is likely that their pain is caused by different things. They are individuals with different bodies, different strengths and weakness and injury histories. They will have different training programmes and different work and social lives. They are just not the same so do not need the same exercise.
Takeaway - two people with the same pain are not the same, therefore do not need the same physiotherapy exercise
If we remember the key points above and focus on what exactly is designed to achieve we can debunk a second misunderstanding. Pain is the symptom. It is an outcome. An exercise cannot directly make pain go away. There is no such thing as an exercise to fix pain. The job of any exercise is to target a physical issue and change it. If the issue is causing the pain, and the exercise fixes it, then the pain will improve. To illustrate this, lets return to our previous example of a runner with knee pain. If the reason they have knee pain is because of a biomechanical issue in the foot we require an exercise to target the foot, improve what is not working well and this will help the knee indirectly.
Takeaway - we cannot identify pain and then select a corresponding exercise. We need to understand why the pain is present and pick an exercise to address that.
Finally, this is probably the biggest mistake we make when prescribing exercises when dealing with long-term pain (chronic pain). We fail to identify what pain we are trying to resolve and as a result, we completely fail in how we use exercise therapy in physiotherapy. There are two main types of pain - structural and neuroplastic. They are very different and even though they may feel similar we cannot use exercises in the same way in each condition. Structural pain is the one we all know. You hurt yourself, your body then feels pain. It could be due to falling and breaking a bone or any other mechanism of injury. In this context we use exercises to help guide the body through a healing process. Training the structures to repair and return to functioning normal. But neuroplastic pain is different (to learn more about this then click here). This is pain that is being produced by the brain misinterpreting signals it is receiving from the body. Essentially, the nerves that send signals up to your brain are sending false alarm signals that give you the feeling of pain despite there being no physical damage or cause. This can be a really difficult thing to overcome and requires lots of work on how we view, interpret and understand pain but let’s focus on the exercises. Unlike in our structural pain group where the goal is to achieve a physical result, here the goal is more neurological. It is to try and turn the volume down on the false alarm pain signal. This is going to vary hugely person to person. What works for one may not work for another or make them feel worse.
