I believe that there are some misconceptions about the role of prescribed or therapeutic exercise in physical therapy and individual’s treatment. It is never with the idea of punishing someone or a part of their body. No therapist wants to punish you, they don’t even want to give you a hard time if it is difficult to find the time or the motivation to perform the exercises. They really just want to help.
Therapeutic exercise is prescribed for one powerful reason, because nothing else can provide what it does. There is no pill, no surgery, and no quick fix that can provide the wide range of benefits that learning to work with your body can (although these things do have their place).
Is it harder than some interventions? Yes.
Does it require attention, time, and effort? Yes.
But it can literally change lives. Therapists want to help you achieve your goals, and very little can compete with the power of changing tissues, minds, and activities through exercise and education.
For a significant amount of conditions you cannot simply hit the reset button and go back to the way things were before. In the case of progressive or gradually worsening conditions, the status quo wasn’t good enough to begin with. You will need to adapt. Therapeutic exercise gives the opportunity to develop the relationship with that part of your body and get to a better place than you were before. Let me just repeat that, where you were before may not have been good enough. The upside to this is that nearly all tissues can change, grow, and be improved by the application of exercise.
Now, more specifically, what’s the point of the different things you’re being asked to do?
Neural adaptation. This is the first thing that we can typically expect once someone has begun to do any kind of active movement/exercise. The way that we are wired, the more often you use something, the more easily the nerves will trigger and the more coordinated the collection of nerves and muscle fibers will work together. While the first few weeks of any exercise program will not actually make the muscles any bigger, the increased nerve activity can increase the strength or function of an area relatively quickly. Particularly if someone is recovering something they already had. For some people, the symptoms will reduce significantly during this time period. They will be and feel stronger, but mostly because of neural adaptation and the decrease in pain.
Tensile Loading (Post-Surgery/Injury). The loads that we use are sometimes too small to provide the stress necessary for muscle growth. However, following an injury or a surgery the tissues don’t necessarily need to be bigger, they just need to be introduced to stress in a predictable way so that they can get used to being put under pressure. Even a couple of pounds can be very useful in the initial stages of recovery, for the neural adaptation reasons mentioned previously as well as to prepare for the strengthening that can come later. Most people end their therapy at this point, particularly if the symptoms have reduced sufficiently for them to resume their normal activity. In their mind, they have returned to normal and can continue on. This is partially true, but leaves out a significant consideration.
Strength & Hypertrophy. Not as many people take their therapy to this point. As such, it is used less frequently in the rehabilitation setting. This is the amount of exercise and load that it takes to actually grow a muscle and develop its strength beyond what it was capable of doing previously. This can be accomplished with body weight and lighter bands if the repetitions are sufficient, but it is a considerable amount of work. This requires that the tissue undergo enough stress to cause an adaptation. For people who are not familiar with activity and exercise, this can be quite challenging to accomplish, and frustrating to experience without some education/guidance. This is the type of change, however, that can last for years.
Having a New and Positive Experience with your Body. Throughout all of these stages there is this idea. What therapists hope for most of all as you engage in any activity and exercise, particularly with the thought of improving your situation, is that you will take this opportunity to feel something new and notice something that you hadn’t previously paid much attention to. At first this focus is usually on the painful aspects of the condition, but if you invest your time and mental energy into these exercises, you will begin to develop a sense of your limits, a sense of what’s safe, and an ability to adapt to your situation. There is no perfect number of repetitions or technique (although a certain amount is required for anything to change). Instead, consider finding a way to make the exercise more comfortable or find a way to be more consistent through experimentation and curiosity.
Your body is not out to get you, it’s always doing the best it can, but it does require some input.