Finding the Right “Dosage” of Exercise for Your Pain
As a physical therapist, one of the most common questions people ask me is “what exercises are best for my pain?” We are quick to assume that there must be a magic stretch or strengthening exercise that will make us feel better. While this can sometimes be true, the problem is that it is not the same stretch or exercise for everyone. What exercise is best for you is dependent on you individually, and we cannot put each pain in the same category.
For instance, let’s say you see you primary care physician and complain or heart palpitations. Does your doctor immediately give you a pill to address your symptoms? No. Your doctor runs the appropriate tests to determine what course of action is best, and then, if medication is appropriate, selects the best one for you based on many factors. Sometimes that medication may have an adverse effect and a new medication needs to be utilized. Exercise is no different. The appropriate exercise needs to be selected for your individual needs based on how your body moves which is different and unique to you only.
When a person reports a pain, that area is typically that individuals compensation and not the true cause of the pain. For example, an individual with low back pain typically has that pain because they are compensating for a restriction above or below the painful joint/muscle. This is also known as “regional interdependence.” Regional interdependence states that unrelated impairments in one anatomical region may influence, contribute to, or affect the persons primary pain. (Wainner, 2007) Therefore, if your low back is painful, it is very likely that your thoracic spine (mid back) or hips are restricted and are likely leading to excessive compensation from the low back. The same holds true for most musculoskeletal pains that I see daily.
This makes answering the magic pill or magic exercise questions quite difficult because although we may be giving you an exercise to stretch your back or strengthen your rotator cuff, it is only a temporary relief; the root of the problem lies somewhere else in the body. Simply put, without a proper assessment we are focusing on the incorrect area and having to attempt far too many exercises in hopes that one is successful to alleviate your pain. In reality, by identifying the true cause of the pain and not just throwing random exercises at the wrong area we can be more exact and identify 2 or 3 key exercises that will be specific to your pain in your body.
Similar to medication, exercise dosage and compliance is of the utmost importance. Taking too much or too little of a heart medication will not help your symptoms and in some cases can create new problems. The same is true for exercise. For your exercise to have the desired effect it must be “taken” daily and with the specified “dosage.”
In the end, a simple article suggesting to do “these 5 exercises” to stretch your back pain or ‘complete these 3 exercises” for knee pain relief is unrealistic because we all move and compensate differently. They may help and you may have friends that experienced great relief with them, however the only way to truly know what exercises are best for your pain is to identify the root cause of your pain and treat your exercises like you treat your medication.
Wainner RS, Whitman JM, Cleland JA, Flynn TW. Regional interdependence: a musculoskeletal examination model whose time has come. J Orthop Sports Phys Ther. 2007;37(11):658-660