Exercise in the Clinic: Myths and Tips

3/23/2013

For those of you who have not seen the google chat video from the AAOMPT student blog you need too. The panel of experts on the chat is excellent. One of the potential downfalls of physical therapy education is exercise and dosage is not involved in the curriculum as much as it should be due to the amount of material that needs to be covered. This chat goes beyond what is taught in school and does focus on sports quite a bit. However, the material and thoughts are sound and backed up by years of experience. I encourage you to take a listen. You might just think of exercise differently.

2 Comments

hiphopanonymous

3/23/2013 08:25:30 am

Cool discussion!

One thing I really identified with was the point one of them made (can't remember now) about load determining dosage. I think in some cases it's too easy to get stuck in the rut of determining dosage by "the numbers," i.e. if the patient/client is performing sets of 3-5 they will be getting stronger. However, if they are performing a set of 5 with a load they can move 20 times that's just not gonna happen. I think Eric's idea of picking a load and giving the patient a window of repetitions to shoot for is a good idea. The patient is tasked with performing to their limit, or their "edge of ability" as those FMS folks like to say, and you can see how they respond to that specific load. You have a better chance of inducing adaptation and the patient is made a bigger part of their rehab. They learn about their limits, their bodies and how they move/perform.

One thing I questioned was the talk about duration of the workout/session. Rob mentioned the eastern bloc idea of quitting after the window of that hormonal cascade induced by exercise starts ramping down (~60 min's) or so. While understand the reasoning, he also mentions he does not count modalities, soft tissue work, flexibility/stretching etc. as pushing the body toward that hormonal response. That makes sense, however, something like soft tissue work/flexibility will be inducing adaptation at the tissue level even if it is not inducing a body-wide/system-wide hormonal response. Should we not also take into account that local tissue level response when considering exercise order or session duration? Rob even said himself earlier in the discussion that volume of activity can be the bigger culprit as compared to intensity/load. Well the volume of stress applied to the body should not only include those stressors that induce hormonal changes (loaded exercise) in my opinion when considering exercise order/duration of work. In the rehab setting, flexibility training and soft tissue work applied to impaired tissues WILL be a stressor and will induce adaptation and will affect how you sequence your workouts. Adding on 50-60 minutes of exercise before or after applying those stressors, even if it does create a valuable hormonal response, may not be appropriate or ideal depending on the patient. I think Rob might agree with that as they all discussed at one point or another during the talk that the patient's individual needs based on their specific pathology, their task specific demands and their level of preparation or their capacity should determine your prescription.

Brian

4/11/2013 11:15:29 am

I agree. I think that soft tissue work should be considered with each patient when determining exercise parameters. However, I have read multiple different research articles and I think the jury is still out on what exact adaptations to tissues are made and how long. For example, one article I read spoke to how tissue temperature rises following mobilizations but only for up to 5 minutes following. In that case would we have to choose the "most" important exercise for following that mobilization? I am not sure. I do think that soft tissue work and other manual work is a stressor on the body though. With that in mind, as much as I hate to say it, I think it depends on what type of response we are looking for. If we are looking to induce a local tissue change and apply an additional stressor such as exercise for a specific result then I think we have to be very specific about how we dose and choose exercises following the manual work. Then again its difficult to be that specific each time we do manual work. Hopefully more research will come out to give us a clearer picture on how long the effects of different manual work lasts for so we can efficiently choose exercise parameters.

Exercise in the Clinic: Myths and Tips

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