Eye On Physical Therapy
When evaluating a new patient, they often tell me that their doctor sent them to physical therapy to help strengthen their knee, or shoulder or whatever body part it is that ails them. Upon first thought one might think that it is fairly easy. With further reflection, one must ask, “What precisely are we strengthening?” Is it muscles? Is it a tendon? How about the cartilage or bone? It is imperative to know what the painful structure is in the joint and to strengthen those things that will either correct the problem or give extra support to the injured tissue.
When a patient has a “tendonitis” it is rehabbed much differently than a muscle strain or ligament sprain. The strain sprain injury requires increased strength to support the joint. A tendon on the other hand usually has had too much stress placed upon it, or abnormal stress and is now “frayed”, for lack of a better term. To strengthen muscle, a program, of low repetitions, usually between 8 and 10 and increasing weights will do the job. When trying to facilitate a tendon repair and proper connective tissue reorganization, the exact opposite is necessary. A program of light or no weights, but with very high repetitions is the order of the day. Some of my patients with tennis elbow may do 5 sets of 30 to 50 repetitions with no weight. Trying to use heavier weights with a tennis elbow is a recipe for more pain, damage and prolonged healing. The tendon is being abused instead of being flushed with increased blood flow, nutrients, and waste removal.
Too frequently I hear patients say, “Oh, I don’t need to come in for therapy, I can do these exercises at home”. While sometimes true, the need for supervision and appropriate progression of the therapeutic exercise program is great. The difference is that an “exercise program” can be fully independent.
A “therapeutic exercise program” with specific tissue healing and strengthening goals require supervision to have a successful outcome.