Why Your Physical Therapy Exercises Aren’t Working

Exercise is extremely important to our overall health. After all, it has 50% of the old aphorism for anyone seeking wellness: “Diet and exercise”. It is good for our joints, our circulation, and the health of all our tissues.

Why is it then, that exercises don’t always help us recover when we are in pain? The answer may very well be that the exercises (and you) have been set up for failure.

The Need for Mobility

One of the biggest problems in the field in physical therapy is that we are relying too much on exercise and not enough manual therapy in treatment. Exercises have two principal aims: strength improvement, and flexibility improvement. But when the body’s joints are restricted and mechanically dysfunctional, these exercises often fail. Here’s why that happens:

Strengthening Exercises

Your muscles are controlled by nerves. When the nerve sends the message from your brain, the muscle activates. The nerve also dictates the amount of resting tone in the muscle (for more on this, read our post on Why Your Spine Health is most Important of All). When the joints don’t move properly, the body reflexively prevents the muscle from firing strongly. This is called muscle inhibition, or pseudoparesis (“fake weakness”), and is an illusion of weakness because the nerve refuses to fully activate the muscle, no matter how hard you try.

Fortunately, once we improve mobility in the joint(s), the muscle wakes back up and activates more fully. The bottom line here is that things need to be properly mobilized before giving the exercise, not the other way around.

Flexibility Exercises

So if we just stretch, won’t that take care of those areas where we’re tight and restricted?

It’s possible, if you’re not bad off. But often what I see is that stretches alone are insufficient and manual therapy techniques need to be done first to jumpstart the process of getting your joints looser. This, honestly, is what keeps us in business. Having another set of eyes and hands (i.e. a PT) gives you a much more precise identification of the exact restrictions in the body, and the knowledge of the cause-effect relationship between them. Plus, a good PT should also have several different techniques at his/her disposal for the restriction in question, which means better odds of success in treatment.

Flexibility exercises can fail for other reasons, too.

They can be done with improper form, a concept with which we are all familiar.

They can be done too aggressively, which is a common mistake in our instruction to you. Too often stretches go way beyond “the barrier” of restriction. Most times the muscle or joint we’re trying to stretch requires a much subtler technique that is much more exact and targeted than a big, gross body movement.

They are reactive instead of proactive. For example, if your hip flexors are tight, your lower back is also tight. The hip flexors will not loosen and release until the lower spine is loosened first. But if all you do is a hip flexor stretch, the underlying cause hasn’t been addressed. You also need an appropriate low back mobility exercise.

Stretching and strengthening exercises are vital to wellness. But if you are not seeing any improvement, you may need to consult with your therapist to see if any of the above factors may be hindering your progress.