Picking The Right Exercises For Your Patient
Posted By: Andy Barker
What exercises do they need?
How many reps or sets should they do?
Is bodyweight ok or should they lift weights?
Is rehab with weights appropriate for your patient?
All these questions may confuse you and maybe you feel unsure about whether or not you have prescribed the right exercises for your patient.
This is common amongst new grads and a regular sign this is happening is when you find yourself prescribing the same exercises over and over…
Setting every patients the same sets and reps, like 3 x 10, with any of the exercises that you choose.
These are all questions relating directly to rehab.
So you might think they are rehab problems.
But often they are not.
They are actually assessment problems.
Let me explain…
To be confident you have picked the right rehab exercise for your patient…
You need to do a good job with your patient assessments.
Your subjective and objective assessment can tell you exactly what exercises to pick for your patients.
Doing a good job with your assessments will also help you better explain your rehab exercise decisions to your patient, so they can clearly understand how the exercises you have given them, will actually help them get back to full fitness.
If you can do this, you will get better patient buy in, meaning patients actually do their rehab exercises…
And this results in patients that actually get better, which equals happy patients and happy therapists!
So how do you ensure you have picked the right exercise?
Firstly, it is important to know that there is no such thing as a bad exercise.
An exercise could be used at the wrong time in the treatment plan or it could be wrong because it is too easy or indeed too hard for your patient…
Or wrong in the sense that it is not fixing a problem that needs fixing or wrong because it is not helping your patient progress to the next stage of their rehab.
But no exercise is better than another.
The skill in rehab is picking the right exercise at the right time for the right patient problem.
To do this, the exercise you select must directly relate to the problem or problems you have identified during your patient assessments.
#2 Identify your patients problems e.g. loss of ROM, strength, balance…
#3 Establish your patients end goal e.g. run a sub 20 min 5 k or bench press 100kg.
That is it.
Whatever exercise you select for your patient, must have these 3 things in mind.
You might diagnose a patient with a patella tendinopathy.
The diagnosis helps guide your rehab as you may choose to use isometrics, eccentrics or heavy slow resistance training, three different methods that have all been evidenced to help tendon based problems.
During your patient assessment you might identify that your patella tendinopathy patient has reduced glute activity on their affected side.
Selecting a glute exercise would seem beneficial as this could be used to restore the reduced glute activity on that side.
Identifying the patients end goal is also important and helps you pick the right exercise.
Say your patient wants to get back to running and has his eyes set on a sub 20 min 5 k.
Running is the end goal, so could you prescribe a running based exercise?
Even in the first session this might not be as hard as you might think.
If we think back to the problems our patient had…
Patella tendon pain…
Reduced glute activity…
And his end goal was to get back to running.
The above exercise ticks all those boxes.
Patella tendon pain is addressed by using an isometric position of the knee (isometrics have been shown to help reduce pain with tendon based pain).
Reduced glute activity…
The glute-hamstring exercise will make the glute work (if you don’t believe me, try it yourself!).
And he wants to get back to running.
The above exercise position mimics the running position, with one foot in contact with the floor (wall) and the contralateral limb positioned in the air.
3 problems – 1 Exercise.
It is also important with any rehab programme that you explain to your patient why you want them to do a certain exercise.
Using the example above you might tell your patient this…
‘This exercise is going to help with your knee pain; keeping you knee still causes the muscles to work hard even though they are not moving and this sort of exercise has been proven to reduce ten-don pain….
It will also get your glute and hamstring muscles working harder and these muscles will not only take the pressure off the knee and the muscles in the front of the knee that at the moment are doing too much…
But are also really important running muscles and if we can get them to work better we can get you to clock that sub 20 min 5 k.’
Until you have assessed your patient you do not know what exercises you should prescribe.
Do a good job with your assessment and choosing the right exercise is much easier.
Do not make the mistake of trying to fit an exercise to a patients diagnosis.
It should be the other way round.
Identify a patient’s diagnosis, identify what problems they have and give them an exercise that ad-dresses these problems.
If you can link it to their end goal, whatever that may be, then that’s the cherry on top.
Then ensure you clearly explain to your patient why you have chosen that exercise and why it is go-ing to help them get back to their desired activity, job, sport or hobby.
If a patient can not see a clear connection between their injury, your rehab and their end goal, then there is a much higher likelihood that they will not do their rehab.
And you know that patients that do not do their rehab, do not get better.
So maybe your rehab prescription of rehab and knowing what exercises to pick, is not really your problem.
Maybe it is your assessments.
Hope this helps
PS. If you want some more help and guidance with your own rehab planning and exercise selection then get in touch…
Just hit this link to book a free CPD call and we can go through it together.
On the call we can identify what exactly is stopping you being able to confidently pick the right exercises for you patients…
And devise a plan of attack to make sure you put this right, improve your assessment and rehab skills and get better patient results.