One of the foundations of physical therapy is exercise prescription. While every PT school is required to teach their students the fundamentals of exercise physiology and prescription, many would agree that what should be an expertise of the profession is often a weakness. More and more research is showing that exercise is likely one of the best interventions we can provide as health care professionals, for both tissue healing and addressing biopsychosocial factors.
A common mistake many are prone to (myself included) is insufficiently challenging the patient. Whether truly focusing on strength, proper tissue loading, or for psychological benefit, it is our duty to properly load our patients. One aspect we should consider is if we are having our patients exercise on a table too much. While there is a time and place for some exercises there, it is not the only place our patients should be challenged. Getting exercises into closed-kinetic chain movements simulates more daily motions that table-based ones. Additionally, we can progress the load our patients are having to move off the table. While those aspects are likely pretty obvious, I believe it can also be motivating to the patient psychologically. I often try and have my patients perform exercises like goblet squats, deadlifts, and others that they may have never thought possible for themselves. It can be extremely exciting! The additional load can also help to desensitize the affected tissue both locally and centrally, meaning the individual isn't overly focused on the area.
While challenging our patients with more advanced exercises has its benefits on improving function and mental health, it is still essential that we recognize the foundations of exercise physiology. If we are truly looking to strengthen a muscle, we must focus our efforts on the proper fuel system and rep scheme. If a patient is performing 20 repetitions of an exercise without any struggle, they aren't strengthening. I'm not saying there isn't a place for an exercise like that or even that there isn't a benefit, but if we are truly wanting to strengthen them, the load must be increased.
-Dr. Chris Fox, PT, DPT, OCS