Patients often say to me “I haven’t done your exercises, but I have done some exercise”. Whilst some exercise is good, often following a prescribed exercise programme will accelerate recovery. This is because each exercise serves a specific rehabilitative function.
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There are 5 main different types of exercises targeted at different parts of the body. These are:
Joint exercises
This is one of the most common exercises and is used to increase a specific joint’s mobility. Joints can become stiff for a number of reasons including arthritis or swelling. If a joint cannot reach maximum end range then often the overlying muscles will tighten slightly and further exacerbate the joint stiffness. This happens commonly in hip arthritis, or neck arthritis. Joint exercises typically involve the patient performing repetitive small gentle movements of a joint.
Soft tissue stretching exercises
Soft tissue mobilisation helps to relax tense and tight muscles. This is important in the acute phase of treatment as muscles are often held in painful spasm, and gently trying to ease this spasm will ease the pain. An example of this is buttock muscle spasm is patients with low back pain – stretching the buttock muscle feels good and reduces the pain.
Muscle stretching is also important in the latter rehabilitation phase as tight muscles can cause subtle muscle imbalances affect normal optimal function. An example of this, following on from the low back pain example, is hamstring muscle tightness. Hamstring tightness is a big risk factor for recurrent low back pain, so lengthening the hamstring muscles will help to prevent the low back pain recurring.
Muscle strengthening exercises
Strengthening exercises can be given for a number of reasons. Sometimes strengthening exercises are given to rehabilitate an injured muscle. For example, calf strengthening exercises for Achilles Tendon problems.
Sometimes they are given to strengthen the muscles around a strained structure to prevent further injury and support good functioning of the muscle. For example, if one of the hamstring muscles are strained then it may be advantageous to strengthen the other surrounding muscles to support the strain. This might be one of the other hamstring group or an adductor group.
Sometimes, abnormal movement patterns cause some muscles to become weak. A good example of this is core abdominal muscles. There is good evidence that weak abdominal muscles is an important factor in low back pain. Strengthening the core muscles will reduce the pain.
General conditioning
General conditioning as its name suggests helps to provide conditioning of the body through various cardiovascular exercises such as walking, swimming and jogging. It helps to increase flexibility of the joints as well as improve overall health.
Proprioceptive exercises
When a ligament is sprained, the nerve endings in the ligaments are also damaged. These nerve receptors are really important as they report joint position, or proprioception. Proprioception means that the nerves sense tension in the ligaments to report where the joint is in space. Balancing exercises help to re-establish this feedback to the brain. Initially, the use of a parallel bar may be required to help you keep your balance but as time goes by, you may progress to walk on an unstable cushion. For example, in a strained ankle the joint position sense if often poor which leads the ankle to tip on unstable ground and potentially restrain. Proprioceptive/ balance exercises which usually involve leaning or squatting on one leg will prevent this.