Some patients that come in to see us at KIMA have been in pain for quite some time; others have more acute presentations. A question we commonly ask both groups of people is “have you done anything for this so far?”, and a common response would be “rest & a bit of stretching”.
Whilst it is true that giving your body’s tissues some time to settle down after an injury or flare-up of symptoms can be greatly useful, there’s often a little more to it. Problems with rest and/or stretching as the primary treatment method arise when one of the goals is to restore normal activity or function to an injured body part. In certain cases, rest can actively make things worse.
The disconnect usually arises because reducing activity levels makes sense when you’re in pain, but most people when they recover want to get back to their previous level of activity, which almost always is more than when you’re symptomatic.
This is where the physical therapist’s unique expertise in rehabilitation exercise comes to the fore. No other medical profession has the combination of training & knowledge of anatomy, pathology and tissue healing with how they relate to exercise, movement and restoration of function than physical therapists.
All your skeletal muscles have a specific role or purpose. None are there by accident. Some produce high forces and purposeful movement, while others are there simply to hold things together and provide stability. Both require different forms of exercise to get the best out of them.
Areas of perceived tightness within the body may feel that way not simply because the tissues are shortened, and therefore need to be stretched out. A feeling of tightness can occur in a muscle that is fatigued, or overused. If a muscle is tired, or has become weak (perhaps because of a period of extended rest??) then training, not stretching, is the most appropriate way of managing it. Alternatively, fatigue or overuse in a particular muscle may be because it is struggling to substitute for another muscle group that is not doing its job properly. The type of training that works best depends on what the particular muscle’s role is. Some exercises are subtle, involving small movements or forces, as this is considered the best way to develop control over a movement. Others will focus on more traditional notions of strength and power, for those muscle groups that need that.
This knowledge lies at the core of the physical therapist’s skill set – the ability to assess and diagnose sources of musculoskeletal pain and injury, knowledge of underactive, overactive and substitute muscle activation patterns and the role they play in the patient’s problem, and the ability to prescribe the most appropriate type of exercise for a given stage of healing and recovery.
Rest and stretching have their place in the management of certain musculoskeletal conditions, as does the skilled application of hands-on manual therapy techniques. But the key to making a full and complete recovery, and the area in which physical therapists have no peer, is to restore optimal functioning of the neuromuscular system.