Key things to understand about Exercise Rehabilitation

Progression out of discomfort requires progression of the exercise prescription. The body adapts, that's what it does, you can rely on this fact. In chronic tendon injuries especially, stimulating adaptation is key.

In the following, I'll be saying the kinds of things I focus on relaying onto patients with painful movement due to weakness or injuries.

The first is that you know how to do the exercises you are prescribed independently of the prescriber: you will feel "I can do this exercise". There must be no confusion about how to do it because it needs to be done regularly. A fancy, complex pretzel of an exercise puzzle might look cool but its a waste of time. If it can be nearly as simple as falling out of bed, then that's the better one of the two options.

The exercise also needs to be related to your meaningful movement goals. Movement is specific. Just because a weak muscle gets strengthened, it won't necessarily be used in a given movement pattern. Is the prescription similar to the meaningful goal?

Simple exercises done frequently enough can stimulate the self-healing process of the body. Research for shoulder tendonopathy indicates one or two exercises creates progression because the person does the exercise, while several adds no further benefit, and increasing the chances the person feels overwhelmed, and gives up, or chooses to do it irregularly.

It is critical to realise adaptation processes may involve soreness and pain. You should be aware of two things here. First, the discomfort ideally resolves within 24 hours. Second, you feel adequately prepared for this possibility. 

Pain during exercise is sometimes normal, and for some people, it is crucial to learn how to work skillfully with it. As long as aggravations last less than 24 hours, this is manageable and realistic and useful information - your body is adapting comfortably. If it does go longer, then I think reviewing the movement and dosage is necessary. This can be managed with lower level exercise, generally isometric contractions or passive/low load movements. RICE, and in some cases, pain and inflammation managing prescriptions may also be indicated.

Of course, you should also have access to your practitioner to ask questions when needed - and on this point, be aware that most people need three sessions in quick succession to gain self-mastery in their exercise management prescription.When you realise that at least six weeks of rehab for tendinopathies is common, and for some people they may flare-up over the course of a year, taking three sessions in a row to get you to self-management is realistic and normal.

For some people with difficult extraneous factors, set backs over the course of a year can occur -but when you understand what to do, and expect this could occur, getting engaged with your own self-healing constructively is very relieving.

Remember, in the early part of an irritated region, you will need more frequent contact with the prescriber to adjust the dose and progress/correct movement patterns.

For these reasons patients have access to me for free mini reviews of their exercise to make sure they are confident, and get the advice on management when they need it with phone,  skype or on-site contact.

Exercise rehabilitation can be quite a detailed process for the practitioner to manage. It involves lots of communication and feedback, with patient education and understanding being crucial. For the patient, the process needs to be comprehensible, structured, progressive, realistic and reflect the meaningful movement. That's the main message.


Matthew Fourro