As most of you would know, if you’ve ever seen a physio, you’ve probably been given some exercises to take home. And yes….it can sometimes feel like “homework”. So why do us physios do it? When you see a GP, a chiro or an acupuncturist, you don’t really get exercises – though sometimes you might be told to “do Yoga” or “make sure you stay active”. But what does this all mean? Don’t we all know you’re busy enough already?
Well…it turns out, if you’ve been in pain, exercise becomes super-critical at ensuring you achieve an ENDURING improvement in your issue. And even though hands-on work feels really nice, it isn’t as effective as when you combine the hands-on work with exercise.
How often have you heard a friend or family member say “Oh, I went and saw practitioner x, and it was really good that day, but the next day, the pain came straight back”? or “my Osteo wants to see me 3 times per week for the next 6 weeks”? Pretty often huh? That’s because something is missing from the treatment algorithm, and this missing link is causing the treatment to not be enduring.
The secret sauce that’s missing is EXERCISE. Targeted, specific exercise that is bespoke to your needs.
Physiotherapy research into pain and rehabilitation over the last 20 years has highlighted the importance of exercise in getting people to recover from having a pain episode. Let me explain.
When we have musculoskeletal pain, as most of us will have at some point in our lives, it’s unpleasant. Feeling and sensing pain is a combination of a neurological input from the body part that “hurts”, for eg, your low back, coupled with an output from the brain, which senses danger. The end-result of what we know as pain, is the final sensation that your brain registers, after it has put together lots and lots of information about what’s happening. Some of this information is important, and some is trivial, but the brain does its best to make sense of it all.
To make things a touch more complicated, exactly where you feel your pain, and where the pain is being generated in the body may not always be one and the same place. Most people have heard about sciatica or referred leg pain. Sciatica is a description of referred pain in the leg, which commonly arises from a disc injury. In this instance, there is absolutely nothing “wrong” with the person’s leg, but the leg pain can be very intense indeed. The pain generator in this case is the lumbar disc, and this is where management of sciatica needs to be targeted to.
So….one of the first things your brain does when it senses pain is tighten up the muscles in and around the area it senses the pain coming from. These muscles that are tightened up (or neurologically upregulated for the medical whizzes in the room!) are our movement muscles. You know these ones, they’ve got names like biceps, triceps, hamstrings etc. These are the muscles that get bigger when you hit the gym and are the muscles that move us through space and allow us to manipulate our environment (for eg open a door or lift a box).
Why does this happen? Well, what the brain tries to do here is protect the body region that it perceives the pain as coming from. It doesn’t want it to move, as it senses that something is “not right”. People can feel this because we have receptors for pain and stretch in our soft tissues and it’s quite clear to perceive – perhaps a muscle feels tight, doesn’t stretch like it used to and maybe causes you to move differently. Patients regularly describe this to us when they come in for treatment.
However, there’s something else going on when your brain senses pain and it happens without your brain even knowing it……what’s that I hear you ask?
Well…. If allowed to go on long enough, there is a neurological downregulation of your deeper core muscles. These are muscles you probably haven’t heard of with names likes rotatores, multifidus and transversus abdominus. These muscles are CRITICAL to you moving and feeling well. The function of your deeper core muscles is to hold up your skeletal frame, despite whatever loads or positions you put it in.
Ever wondered why, when you throw a tennis ball, you don’t just throw your whole body “out” at the same time. Surely, there’s a large force and you really twist your upper body heaps don’t you? Well, the reason is, when functioning optimally, your little core muscles of your neck, shoulder, rib cage, torso and hips all stabilise your body, allowing your big powerful movement muscles to throw the tennis ball. After you’ve finished that task, those muscles control you returning back to your usual skeletal and joint position. Make sense?
Ah…can you see the problem now? Didn’t I say that in the presence of pain, your core becomes down-regulated? Yep – so think of these little muscles getting sleepy and easily becoming fatigued.
So now we have two problems in the system don’t we? We’ve got pain….which is awful and which we can feel…but we’ve also got this down-regulation of our critical muscles which help us move, which we can’t feel. This is because there are no sensors for weakness in the body. Oh oh….”Houston we’ve got a problem”.
Remember my examples earlier in this blog about seeing your chiro or osteo and only feeling better for the day you were treated? And then everything going “out” again ( their language, not ours!)….well…..can you see know how this occurs? If you have a “sleepy” core, it doesn’t really matter if your helpful practitioner, “fixes” you does it? Because by the time you’ve got back in the car, got home, emptied the dishwasher and run around with the kids, it’s all gone problematic again – that’s because your deeper core muscles aren’t firing and so can’t hold whatever changes your practitioner has made to your body.
That’s where exercise comes in…wonderful stuff!
When we ask you to perform a particular core or functional or strength exercise, what we’re REALLY doing is asking your brain to “tune in” to that particular muscle or groups of muscles. Tune in brain, find that muscle, send a message to it – “Wake up!”
And then what’s really common in exercise prescription? Reps and sets right? It might be your ol’ 3 x 10 reps? Or we might ask you to hold this muscle on for 10 seconds? Or 20? Or even 30 seconds? This all depends on lots of factors I won’t get into here. But what we’re doing here is asking your brain to find this muscle once, twice, three times, lots of times again and again so as to make the neurological message between the brain and muscle really “connected”.
When you do this daily, something really interesting happens – somewhere between 1- 3 weeks, the brain/muscle connection seems to kick into gear and start doing it itself – hey presto! You’ve got a optimally functioning muscle!
Once that muscle is working, it can now take the load of your everyday life and allow you to move easier and more optimally.
Of course, you might need one, several or many many muscles to be rehabilitated with exercise when you come and see us. That’s why we take an hour with your first consultation, to understand what’s really going on with your movement and your body. Then we formulate a plan to make you strong again, helping you move better and hopefully reducing your pain. One muscle at a time. And that is why we give those pesky exercises all the time!
Until next time gang, stay safe and keep moving!
© 2021 Evolution Physiotherapy Pty Ltd. No part of this article can be reproduced without express written permission by the author.