In this post, we discuss why adding more rehab exercises can lead to worse outcomes, and what to do if you find yourself in this situation.
If you feel like you’re getting more and more exercises from your physio, but you’re actually feeling worse, this post will help explain why using a real-life example.
The client
This particular client has been working with me for the past 5 months. He’s a middle-aged gentleman with a young family and a stressful job.
His favoured form of activity is endurance training. He swims, runs, and cycles.
Last year he started experiencing lower abdominal pain which would get worse with activity, especially running.
Understandably concerned, he underwent medical investigations, which thankfully ruled out anything serious. That’s when he was referred to me.
We began working together in late January and over the following months he was finding a gradual reduction in his symptoms. He was able to do more with fewer repercussions. Outstanding.
That’s when he attended a long-held appointment with a Sports Doctor.
After some prodding a poking and a second look at his scans, the Doctor diagnosed him with Osteitis pubis. This wasn’t a surprise to either of us.
Essentially, Osteitis pubis is an inflammatory overuse condition affecting the pubic symphysis — the joint where the left and right pubic bones meet at the front of the pelvis.
In runners it can be the result of an inability to attenuate the repetitive forces involved. This was certainly how I was approaching it.
Now here comes the interesting bit.
As part of a care package, the Doctor recommended some physiotherapy sessions at a nearby clinic.
Why not? Thought my client. He was receiving this as part of his medical insurance so he wanted to make use of it.
I certainly wasn’t against it and was interested to see what they recommended.
Why more exercises can lead to worse results
It’s worth understanding at this point that most physios will prescribe exercises based on the diagnosed condition, not necessarily your physical limitations.
These exercises are usually backed by research on the condition itself. Where that evidence doesn’t exist, they target muscles that would logically cause problems in the area if left weak.
You can see already there are a few assumptions, or at best, educated guesses.
In addition, physios will generally be short on time and in many central London practices will be working under a heavy schedule.
All this is to say that my client received a very cut and paste set of exercises. Some of which you could see the rationale behind, others not so much.
Being the diligent person he is, he undertook them as prescribed.
Fast forward a couple of weeks and he started to notice a new pain. One that I suspected was directly related to an exercise he’d been given.
We eliminate that particular exercise, made adjustments to a couple of others, and voila, he’s out of pain again.
So what can we learn from this?
More is not always better. In fact just the right amount is ideal. This includes not only the volume of exercise, but what those particular exercises are challenging, and by how much.
What’s rarely assessed is the tolerance of the specific muscles you’re being asked to strengthen.
As I’ve written before, the forces involved in exercise can be misleading. Just because you’re using a resistance band, or the weight of a limb, as is common in physiotherapy exercises, doesn’t mean you can’t cause yourself issues.
Summary
If you’re finding you’re performing more and more exercises, but you’re actually feeling worse, it’s time to reassess.
Start by stripping back the number of exercises you’re performing, focusing on the ones that don’t cause you issues.
Slowly build back from there.
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