One week ago, not long after recovering from a lower back strain, I was catapulted over the handlebars of my mountain bike and hit the ground hard on my left shoulder. Thankfully, I was able to dust myself off and continue riding, albeit at a more sensible pace. After a self-assessment that evening I was confident I had a low-grade sprain of the AC joint of my shoulder (a common mountain biking injury).
Four days later, one of my strength workouts for the week called for heavy deadlifts. After doing 1 “top set” for five reps, my shoulder was pretty sore for 3 days. Reflecting on this, the nature of that exercise would have stressed my shoulder way too much for Day 4 post-injury. My third strength session for the week, a “medium” session that doesn’t involve heavy weights, went very well and my shoulder felt better for doing it.
What’s my point? Exercise can produce positive OR negative effects and this depends on the care, skill and experience of the professional providing it. There is no substitute for a 1 on 1 session with your health professional where he or she listens, observes, coaches and tweaks your exercise program.
How do I know if am I doing the right exercises, then?
There are many variables to consider when prescribing exercise, especially when you have an injury or painful problem. Here I outline three variables which must be “correct” to get a positive response, plus a fourth consideration that should be addressed in any exercise program:
1. Correct TYPE of exercise
When you go to your physio with a painful lower back, hip, shoulder or knee, part of their job on day 1 is to identify the main impairment you have. The most common impairments we see on a daily basis are movement impairment, strength impairment and motor control impairment (a fancy word for faulty movement patterns). Your exercises must match the impairment your physio can see or test for in the clinic. If you have a movement impairment you should be doing exercises to restore movement. If you have a strength impairment you should be doing exercises to restore strength. Prescribing strength exercises for a patient who has movement impairment doesn’t work well (and vice versa) so the first step is always identifying your primary impairment.
2. Correct INTENSITY of exercise
Once the correct type of exercise has been identified, the next variable to consider is intensity. If the intensity of the exercise is too low, nothing will happen. If it is too high, you will be worse afterwards. Somewhere in the middle is the “sweet spot”. How do we know if we have the correct intensity? Often it means you will feel something – if you are doing an exercise for movement impairment you should feel a stretch, tightness or stiffness to perform the exercise, and often some mild soreness associated with this. If you are doing exercises for strength impairment you should feel effort or a tiredness in the area and your speed of movement should slow down as you complete the “hard reps”. If you feel nothing, then nothing is going to happen.
3. Correct FREQUENCY of exercise
The next variable to consider is frequency – how often should I be doing my exercises? This comes back to your primary impairment. If you have a stiff and painful shoulder (movement impairment) you should be doing your exercises three, four or five times a day. You’re not going to get your movement back doing them once a day. On the flip-side, if you have a weak shoulder, your exercises should be no more than twice a day and they should drop back to once a day then every alternate day over a period of two or more weeks.
4. Remove BARRIERS
Exercise is medicine, but only if you take the prescription yourself – you have to complete the correct exercise, with the correct intensity, at the prescribed frequency. Removing barriers is important and so I ask my patients – “When, exactly, are you going to do these exercises?” If your morning routine involves getting 4 kids ready for school chances are you’re not going to get your physio exercises done then – we need to find another time that works. Setting up a “space” where you will do your exercises also helps – when your weights and exercise mat are set up in the spare room, when the time comes you just do them! Your physio should help you identify any barriers to getting your exercises done and help you remove or minimise them.
We LOVE seeing patients improve with the “right” exercise program and we go the extra mile to make sure we identify the correct type, intensity and frequency of your exercises. If you are in pain and wondering whether the correct exercises could help you, call our front desk team on 6056 6616 – they can help you find a day and time that works for you to come in, see one of our experienced physio’s for an appointment and get you started.
