Let’s presume your health professional has made the right diagnosis of your pain or injury and analysed correctly the reasons you got it and still have it. That process is a whole other discussion but let’s just presume that…
A physical rehabilitation program will need to be tailored, well taught and adhered to by the patient in order to regain full and complete function at the level required. This is what physical rehabilitation is all about – function. Structures do get damaged, degenerate and may have to be surgically repaired or even replaced, but the focus of a great rehabilitation program is regaining physical function. Your functional level required may be just being able to get out of bed and get through the day or it may be performing on stage in an acrobatic spectacular! Is doesn’t matter what the individual goals are, a great rehab program has 4 key ingredients.
1. It must make sense to you – stemming from the diagnosis and analysis of your pain, injury and movement patterns, the explanation and education presented to you must make sense. If you understand what is going on you are far more likely to adhere to the program and get the results you need. You have to know why you are doing the exercises you are doing!
2. It must be challenging but achievable – this is my favourite saying. Every exercise you do must challenge both your body and / or brain so they both respond accordingly. Changing movement patterns comes before strengthening in most cases and this is more brain than body. Once an exercise becomes easy it is no longer useful for functional rehabilitation. Even maintenance exercises need to be changed to avoid your brain becoming “bored’.
3. It must be closely monitored and gradually progressed – far too often rehab programs are progressed too quickly and a good foundation is not laid before “building the house” (another favourite!) Injury normally leads to changes in movement patterns (e.g a limp, a shoulder hitch, a twisted back bend) that quite often remain long after the injury is healed. Patterns of movement can be taught or corrected in 10 minutes but then have to be repeated (a lot) for them to become your normal.
4. It must be relevant – there are some basics of ideal human movement that will apply to most people but as rehabilitation progresses the exercises must become more and more specialised to your functional goals. A dancer will not do the same rehab program as a runner for an ankle injury, a builder will not do the same rehab as a violinist for a shoulder injury. This is an area of growing specialisation in sports and performing arts medicine. A Physiotherapist who has worked with elite sport may not be the best clinician to design a dancer’s rehab program. A physiotherapist who works with musicians may lack the specialist knowledge for a cricketer who needs to bowl at 140km/hr. For the majority of everyday patients who sit at a desk at work and have back pain, fancy fitball exercises and complicated gym routines may be fun (or not) but do they really helping you achieve your individual goals and functional needs?