Why all the exercises?

Why do the patients always get so much homework in form of exercises from us physiotherapists? I mean, they're already in pain, and then we make them work as well...

Well, there’s a pretty simple explanation to that… When somebody seeks the help of a Physio it’s usually one of these three reasons:

Somebody fell and got injured acutely; while doing sports, in everyday life, in traffic etc. I.e. some sort of accident,

Because of surgery to some part of the body due to injury,

Or because of pain, without any trauma.

In the first two cases most people understand that you need exercises to rehabilitate the injured body part due to loss of function, strength and stability (these changes depend of course on the severity of the injury and time spent before rehab is begun). These negative changes (or adaptions) depend on inactivity, time for healing and reduced loading (one protects the injured area by resting and avoidance of using it normally).

But in the third case; you seek help because of pain, for example in the back, without any real reason for the pain. Suddenly you’re in pain, or perhaps the pain has crept on you and slowly increased. Why not just get a treatment that reduces the pain? I mean, there’s obviously nothing wrong since you haven’t experiences an injury, right?

No, that’s not really the case… There’s always a reason for pain, you don’t suddenly experience pain in the back for no reason at all. No matter if the pain is due to a disc or a nerve, or pain without any real anatomical change or degeneration. I’ve tried to explain the concept of imbalance surrounding a joint in previous posts. This concept is true to all joints, even those in the spine. So where does the pain come from? If nothing is really injured – why does it hurt? And why do one have to go through all those exercises? Imbalance in the muscles, or in the range of motion will also result in pain – therefore we have to find the reason for the pain.

Let’s continue using the spine as an example. It consists of 7 cervical vertebras (neck part), 12 thoracical (upper back part) and normally 5 lumbar vertebras (lower back part). All of these vertebras consist of the vertebral body and joints to upper and lower vertebra. These joints enable movement between the vertebras. Now imagine that the mobility is limited between two vertebras for some reason – the body will compensate through using too much mobility (hypermobile) in another level of the spine. What then to do if this is a part of the reason for the pain? The physiotherapist can help you increase the mobility in the stiff part; there are many different techniques for that, but at the same time you have to stabilize the hypermobile part.

Often this kind of thing problem affects many different levels or parts of the spine, not just in one place between two vertebras – although that also happens. When suffering from such an imbalance for a long time, often with a bad posture, static work, maybe also training repetitively without variation, the muscles will become affected with stiffness in the stiff joint-areas, weakness in the hypermobile areas, over activity in some muscles and instability in the smaller deeper muscles. This will lead to pain, and in the future; to degeneration of disks, joints, etc.

What about the exercises then… Well, the physio cannot do all the work for you, unfortunately for you. The therapist helping you stretch 2/week will not give you a permanency in the shortened and tightened muscles – you have to stretch basically daily, atleast 4-5 times/week to achieve a lasting change. The physio cannot strengthen the weak stabilizing or inactive muscles for you – YOU have to activate and train them your self, etc. Therefore, my friends, we physiotherapists will always give you exercises to work on…

Sure, we can help ease the pain – but it doesn’t help in the long run; the reason for the pain is still there. It’ll only lead to the return of the pain within a near future, and you’ll have to start over from scratch. In my opinion, that feels a bit irresponsible and in the end, it's a waste of time, for both of us...
When I finish treating a patient, I usually say; I hope I don't see you again - at least not for same reason... ;)
Take care of your self!