A common piece of advice for preventing overuse injuries in athletes is to cross-train. It's not wise to pitch for 12 months or only do long distance running. Sure there are outliers that can do it, but it does allow the body to recover actively. A runner may benefit from swimming or lifting weights. A basketball player may benefit from playing soccer. There are plenty of other examples for different sports and different athletes.
The same concept applies to work situations and posture. There is nothing wrong with a job that requires lots of sitting or activity that requires repetitive tasks; however, again it may beneficial for a change in activity occasionally. For example, a job that requires lots of sitting may benefit from switching to standing occasionally, or going for a walk, or doing some regular stretching. I spoke with a patient recently about her son that cut firewood for a living. Apparently, he was having some arm and shoulder pain recently from working overtime. While he may benefit from some physical therapy, it may be that he just needs some general strengthening exercises.
Recently, I have heard some discussion about research that shows general strengthening can be just as effective as specific exercise. While this may be true, I believe that depending on the activity of the individual, there may be more some beneficial general exercises than others. For example, an individual with shoulder pain that does repetitive work in front of them may benefit from general back/shoulder strengthening. An individual with repetitive lumbar flexion tasks may benefit from regular lumbar extension strengthening. Some may find it threatening to our ability as PT's that we no longer have to be "experts" with exercise prescription. Instead, we should focus on how this may improve our patient's potential prognosis. The less patient's feel like they NEED us to hold their hand in their recovery and the more we make them independent with managing their injury, the better our care can potentially be.
Overall, the final message I want to give is that a lot of injuries may benefit from a general strengthening approach. We may not need to be as specific with our strength testing in most cases, but there may still be instances where being thorough with an evaluation will pick up some severe pathologies. I typically perform the same base evaluation for upper quarter patients and then lower quarter patients and then add in specific tests as needed. Barring any significant findings, a lot of exercises that I prescribe are similar. This may be due to common pathologies and impairments associated with them or it may be due to a response to general strengthening.
-Dr. Chris Fox, PT, DPT, OCS
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