• Dr. Judy Spilka, PT

Home Exercise Programs

Sometimes less is more.

I have been observing a trend with a portion of my clients. Sometimes, they have been getting a little too excited when doing their physical therapy regimen at home. I provide them with a set of home exercises to perform, instructing them to perform a few sets of each exercise once a day. These clients then come back feeling at times more sore because they got too eager, doubling or tripling the amount that they were instructed to do; quoting “well, I was feeling better after performing them one round and felt that if I doubled the amount, I could speed up the healing process”. Another client recently asked me, “do you think I’m more sore because I stretched my hamstring muscle out for the whole duration of my TV show?” I then reinstructed her with the proper exercise and duration.

I am excited for my patients who are ready to work on themselves, but at times, less can be more in allowing our body to recover following an injury. My job is to assess when a treatment or exercise can be too much. When first working with a client, I provide feedback that it may take a couple visits to observe how each patient’s body responds to the therapy provided. I also need to assess what stage of the healing process they are in acute, sub-acute or chronic. These stages of healing need to be assessed because it changes how I load a patient with exercise. Is the patient a candidate for stretching or will stretching pull on tissue that is already too inflamed? Are the muscles ready for heavier weights and more loading?

Educating the patient is critical in how they respond to physical therapy. Stretching, strengthening, and massage have a different set of criteria of when we should perform it. If the following exercises are appropriate for that stage of healing, I instruct most with the following protocol noting that not everyone fits inside these criteria.

  • Stretching: To improve your flexibility and mobility, stretching normally is less strenuous on the tissue. This can be performed 1-2 times a day depending on the case. I usually instruct the client to stretch no more than two minutes for each muscle group. I cue the patient to stretch not into painful motion but a stretch that feels “gentle and achy” is an appropriate response. I have had some clients who push into severe pain and can cause tissues to become too inflamed when they are not ready for that type of load.

  • Strengthening: When we are loading a muscle with resistance, the goal is to temporarily cause micro trauma to the tissues to allow for proper rebuilding into the stresses that we provide. Two to three times a week maximum is appropriate to give muscle proper time to restructure and rebuild following each strength session. If we perform loading with weight every day, the “micro trauma” can turn into “macro trauma” which is known to cause a larger delay in healing and to not allow for effective recovery. If a patient reports that they have been doing a certain exercise everyday and they start feeling more sore and then even more as the days go on (at times they say it is harder to perform the same weight too), I instruct them to take a 1 to 2 days off to allow the muscle to heal.

  • Massage: If a client is instructed to loosen up muscle by massaging the tissue, whether it’s with a foam roller, massage stick, percussion gun, etc., performing every day and only once for a few minutes is optimal. I have had clients state they started feeling relief performing massage once per day but decided it was appropriate to perform multiple times a day but then the muscle starts feeling worse. Performing multiple times a day can cause more inflammation to occur which may delay tissue healing.

It is important as a physical therapist to check in with each client to make sure they are following the instructions appropriately and with proper form. It is also imperative that the client self analyze how their body is responding to treatment.

In closing, it is important to help the client realize their limits within their exercise program to allow for effective healing based on clinical instruction. At times, less can be more to allow for the most effective healing response. Regardless of how the patient feels when performing the exercise, being overzealous and performing more can be detrimental versus less with more effect.

Featured Posts
Recent Posts
Search By Tags
No tags yet.
Follow Us
  • Facebook Basic Square
  • LinkedIn
  • Instagram