Why Do Physios Prescribe Exercises Differently?

Why Do Physios Prescribe Exercises Differently?

You may wonder- why do physios prescribe exercises differently?

Every physiotherapist will prescribe exercises differently for each individual not only based on their personal goals and physical limitations.

Exercise selection is also influenced based on your type of injuries, your current tissue tolerance and capacity, as well as which part of the tissue healing process you may be in.

The aim of this blog is to provide examples of how exercises are designed and prescribed based on various factors and variables:

1. Bone vs tendon

When it comes to exercise prescription for bone vs tendon pain or injuries, progressive loading is key for both types of issues. This is because bone and tendon cells sense and respond to mechanical loads, and in turn undergoes tissue remodelling and healthy adaptations.

In addition, load management is a critical aspect of rehab for both tendon and bone-related pain and injuries. These injuries tend to occur when the applied loads exceed our bodies’ ability to adequately respond in specific contexts. Tendons or bones that are chronically over or under-stimulated can be predisposed to overloading injuries.

The difference between physiotherapist exercise prescription for bone and tendon injuries:

TENDON:

We have 2 main types of tendons- positional and energy storage tendons.

• Positional tendons: These include the rotator cuff tendons, which are responsible for stabilizing and positioning our limbs for optimal function.
• Energy storage tendons: Examples include the Achilles and patella tendon. These tendons are primarily responsible for storing energy and amplifying force with running and jumping activities.

In regards to exercise prescription for tendons, we need to not only improve the load tolerance and capacity of the tendons. We also need to restore the normal tendon mechanics by increasing stiffness and tensile strength. This can be achieved via isometric exercises for pain control initially. This provides us a window of time frame to incorporate heavy slow resistance loading, which serves to improve general capacity and load tolerance of our tendon.

In addition, we also need to restore the energy storage function of our tendons to tolerate higher speed and more force-absorption and production tasks.

BONE:

There are many different type of bone-related injuries, ranging from minor bone bruising to partial or complete fractures.

Exercise prescription is largely influenced by the degree of trauma or insult, as well as the load tolerance of the individual.

In bone, there are cells (osteocytes) which convert physical forces applied to the bone and integrate them eventually into cellular responses. This plays a crucial role in bone repair and regeneration. Therefore, graded exposure to loading and stress is an integral key in bone injury rehabilitation. In regards to types of exercises prescribed, your physiotherapist may prescribe progressive strength training to impose strength adaptations of your bone and supporting muscles.

2. Eccentrics and concentrics

Your physiotherapist may also prescribe different exercises based on what type of muscle contraction they are aiming for.

A concentric contraction refers to muscle action which produces a force to overcome the load being acted upon. Concentric contraction occurs, for example, during the upward thrust in the bench press or squat. On the other hand, eccentric contraction occurs during the downward phase.

Reasons why we prescribe concentrics.

• To improve force output of specific muscle group action.
• To improve rate of force production and power of specific muscles.

On the other hand, eccentric contraction refers to muscle action in which the muscle force yields to the imposed load. The muscle acts to slow a specific joint throughout a range of motion or control the repositioning of a load.  For example, as you lower your arm down during a bicep curl, the biceps is undergoing eccentric contraction as it lengthens.

Reasons why we prescribe eccentrics?

• To improve tendon health & stiffness, which helps with repetitive landing impact.
• Restore the muscle’s ability to absorb force, as well as the ability to tolerate greater magnitude and intensity.
• Improve range of motion of tissues, via reducing resistance to passive stretching from improved muscle tendon unit compliance.
• Improves mind-muscle connection and neural adaptations.

If you would like some guidance with your rehabilitation physiotherapy, book an appointment at Pivotal Motion and get a personalised treatment plan from our experienced physiotherapist. Call on 07 3352 5116 or book online today.