Exercise? I Thought You Said “Extra Fries”
Therapeutic exercise is the primary method of rehabilitation used in physical therapy. The purpose of exercise is to improve mobility, strength, functionality and overall capacity of a patient or athlete. This is done through controlled loading of healing tissues including muscles, tendons, and ligaments. Tissue healing timeframes are also an important concept to understand, which helps determine the amount of progression and choice of exercise.
Acute injuries typically involve increased swelling, pain, muscle inhibition and loss of mobility. An early rehabilitation program will focus on addressing these limitations by restoring ROM actively and passively, improving pain levels and increasing muscle activation. Timelines of tissue healing are also influenced by the degree of injury. Minor muscle strains (Grade 1) typically resolve within 1-4 weeks, while larger muscle strains (Grade 2) typically resolve within 1-3 months. A grade 3 muscle strain involves full thickness tearing, and often surgical intervention is required. Research shows that Grade 1 and 2 muscle strains improve quite well with properly dosed therapeutic exercises.
Acute ligament injuries are managed similarly, with primary goals to restore motion, decrease swelling, strengthen surrounding musculature, improve coordination and stability of the joint and reduce strain on the ligament while it heals. More involved ligament sprains can take longer to heal than muscle strains, but progressions in physical therapy will be dependent on the patient’s presentation and exercise tolerance levels.
As an acute injury progresses to sub-acute, physical therapy can continue to progress with intensity and loading of these healing tissues. Some methods of functional strengthening involve concentric and eccentric loading. Concentric is the forceful contraction of the muscle that propels the movement, such as stepping up on a step. Eccentric motion is the controlled lengthening of a muscle, such as lowering yourself down from a step. These exercises are meant to challenge the muscle to a level that causes fatigue while keeping pain levels at a 5/10 or below.
Physical therapy is supposed to be challenging! Some good metrics to understand if a therapeutic exercise is challenging enough for you are the RPE scale (Rate of Perceived Exertion), and the RIR (Repetitions in Reserve) scale. Both are highly correlated to each other. The RPE scale is a subjective effort and difficulty scale from 0 to 10. “Whew! That workout was tough!” Great, that’s probably a 7-8/10. Very scientific, right?! Well, the RIR scale is correlated to it. “Whew! That exercise was tough! I could probably only do 2 more reps until failure.” That’s 2-3 reps in reserve, or 7-8 RPE. The aim is to typically live somewhere in the 6-8 RPE scale, or 2-4 RIR in order to maximize tissue loading with good form.
Is the standard “3 sets of 10 repetitions” of a therapeutic exercise boring to you? Good, it is to me too. Luckily, there are ways to spice things up. Supersets, circuits, high intensity interval training, AMRAPS (As Many Rounds as Possible) and EMOM (Every Minute on the Minute) are all great ways to perform your rehabilitative exercises while challenging endurance, have more fun, and be more efficient with your time! A superset is method in which you select multiple exercises, and cycle through them. An AMRAP is basically a superset, but with a time cap. You also don’t have a determined number of sets to perform, but the goal is to go until you run out of time! “Today’s workout is 15 body weight squats, 12 kettlebell swings, 8 curtsy lunges. As many rounds as possible for 12 minutes. Go!” These different methods of program development can be used from early rehab to end-stage rehab, with the difficulty of exercises being taken into consideration.
As you can see, there’s a lot of planning that goes into developing a therapeutic exercise program. Tissue healing timeframes need to be considered, the type of exercise needs to be considered, as well as the dosage of exercise. The goal pf physical therapy isn’t to just get you back to functional, it’s to maximize your physical potential. It’s to increase your comfort with exercise and develop lifelong habits to promote a healthy lifestyle in the future. And after you finish your difficult workout, you can celebrate by eating French fries. To find a therapist near you visit CFAOrtho.com/rehabilitation.