The Problem with Underdosing in Rehab
I hear it a lot when people talk about their prior experiences with physical therapy.
“All I remember is using those stretchy bands”
If this is what people continue to associate this profession with, we have a BIG issue to address. Yes, physical therapists are touted as the musculoskeletal experts in movement and pain management. I believe what is often missed in the spectrum of movement improvement from the sake of just BETTER movement or improving pain, is our professions chronic problem of underdosing rehab.
Let’s dive in!
This is a very common photo that floats around the rehab world in social media groups, but for a simple reason.
It touches on a GREAT point… why are we stuck in our ways of clamshells and theraband rotator cuff exercises??
Now theraband are a brand of those thing resistance tubing or band I was referencing at the beginning of this blog post. The problem here is research continues to support the use of progressive resistance training for numerous diagnoses, yet the healthcare world continues to underdose these plans of care. This isn’t just physical therapists either. When other healthcare providers tell their patients that “this is the worst knee arthritis I’ve ever seen” and “you should never run again,” HOW is that providing any benefit to the individual in front of you? We ALSO know from the research that imaging has lacked correlation to the actual cause of pain, so why are you instilling fear in someone before they even begin a plan of care? The human body is so highly adaptable, there are thousands of people who would have a poor looking X-ray or MRI but have absence of pain. All of us as healthcare providers need to start doing a better job learning proper resistance training principles, educating our clients and colleagues the importance of these principles for plan of care, and then implement them on a daily basis.
One of the most widespread reasons we need to start dosing exercise and rehab appropriately is because of WHO. No, that is not me asking you who, I’m talking about the world health organization. WHO just changed exercise recommendations for adults to 40 minutes a day of moderate intensity activity (5-6/10 RPE scale) and a minimum of two days of heavier resistance training for major muscle groups. As a healthcare provider and musculoskeletal expert, I have the benefit of having a platform to educate and instill this information in my clients plan of care. I believe therapy sessions should certainly have a ‘hands-on’ component to improve confidence in movement and decrease hypersensitivity, but then I save a good amount of time in the appointment to get my individuals actively moving. Not just moving, but HARD moving. Now don’t get me wrong, acute stages of pain may mean hard moving is range of motion drills, isometrics, and potentially the use of bands. These all absolutely have their place in rehab, but as the body adapts, we need to progress with it. If we don’t challenge the body, adaptation potential is being missed and so is maximizing recovery and creating meaningful lifestyle changes. Therabands graduate to dumbbells, and dumbbells graduate to kettlebells and barbells. Don’t have these accessible in your clinic? We can challenge the body in different ways rather than just heavier objects!
Volume
Frequency
Intensity
Range of motion
Tempo
We can modify these above variables to create appropriate dosing for all levels of rehab and fitness for individuals. Resistance training studies have provided helpful information for us stating that we can see similar hypertrophy gains in muscle when working at a lower percent of your one rep max if work is performed to relative fatigue. This is GREAT news for those clinics and individuals without barbells or heavier weights, or for those patients who just have a lower threshold for overall work.
There is no longer an appropriate excuse for why we are under-dosing rehab. Therapy has chronically underdosed exercise interventions and this needs to change. Begin NOW, because otherwise our clients are missing out on more optimal success. Not only will individuals meet their therapy goals, but will ALSO begin to build a more resilient lifestyle. If we can eliminate pain but also begin to create a stronger individual, the sky is the limit for them!
As always, thank you for reading
