Common Physical Therapy Mistakes #2: Incorrect Intensity
Why Intensity/Dosage Matters in Physical Therapy
Common physical therapy mistakes are perilous to your path to recovery. One of these is incorrect intensity (what we also term as ‘dosage’) of exercises. We discussed this with Dr. Gary Wang, PT here at Reload. Here’s what he had to say.
Don’t Misjudge Your Recovery
When you’re returning from injury, it can be easy to think you are ready to return to your normal level of activity too quickly. In fact, it’s one of the most common mistakes we see when people come to us for advice and guidance on a recovery that has fallen off the cliff. The scenario is almost always the same:
You start to do more
You feel better
You push yourself to normal activity
Your recovery falters
You return to square one
What’s happened is that you haven’t realized that everything is a stress on your body. It all accumulates. Instead of properly measuring what physical activity you’re doing, you add the old with the new, and you push yourself over the edge. You hit the bottom, and find yourself back at the start line.
“Let’s say it’s someone with a goal of running five miles,” says Gary. “This might be what they used to do before injury, or a new goal. As part of their program toward their goal, they’ve been doing a lot of cardio, or cross training on a bike, or swimming.
“Now they start to say, ‘Oh, I’m doing well in physical therapy, so I can run again’. They go from one mile to two miles in a few weeks. Everything feels good. So, they go for the five-mile run. But they don’t realize that they haven’t decreased the amount of strength training they’re doing. They haven’t decreased the amount of cross training they’re doing. All they’re doing is increasing on all cylinders. Unsurprisingly, their body hits a wall.”
Exercise? It’s Like Tylenol
Especially when you’re in recovery, you should treat exercise like a prescription medicine. That’s why we also refer to the intensity of exercise as ‘dosage’.
“Let’s say you’ve got a fever. You’ve also got a wedding you want to attend in a few days,” says Gary. “If you don’t get the fever under control, the wedding is out of the question.
“What do you do? You turn to Tylenol – but because time is tight, you ignore the recommended dose of two tablets a day. Thinking that more will work faster, you self-administer double or treble this. You don’t think of the negative effect of too intense a dosage.
“On the other hand, if you only take a quarter or half a tablet, the dosage won’t be enough to have the intended positive effect.”
When you hear Gary explain exercise intensity like this, you begin to understand why it is crucial to get the dosage right. Too much exercise, and you’ll break yourself. Too little, and you won’t repair yourself.
Five Key Practices of a Good Physical Therapist
Dr. Gary is adamant that there are five key things that a good physical therapist will cover when treating a patient:
Test Quality of Movement
“We want to know if the movement looks good. Can you get into the position we’re asking you to without pain or discomfort?”
Identify That the Desired Muscle Group is Working
“If we are putting you in a split squat and we want you to feel your quads, we ask targeted questions to see what you are feeling and adjust until you can feel the desired tension.”
Identify the Right Level of Intensity
“We need a specific movement to be hard enough to create a training stimulus but not too easy where it will be a waste of time. We also don’t want it to be too hard where a client needs to compensate and do weird things with the body that may cause the client to feel pain.”
Communicate
“Physical therapists should ask you how you feel after the session, so they can understand your body and understand what tweaks might need to be made to the program… Again, the goal of the physical therapist is to understand the right exercise for the person in front of them, not necessarily what is the right exercise for knee pain.”
Help Clients to Communicate How They are Feeling
Pain is unique, and always challenging to describe. At Reload we use a traffic light analogy with the clients so they can communicate to us how they are feeling. “There’s green light; there’s yellow light; and there’s red light,” says Gary. “We want to train in that green to yellow light where your body’s like, okay, I feel it. I know it doesn’t feel the same as maybe my stronger side or my non-injured side, but it doesn’t stop me from doing the exercise.”
The Reload Approach
Pain is a conundrum with no single answer. Because of this uniqueness and complexity, you’ll find that we ask many questions to establish initial and evolving baselines for performance.
“We look at the bigger picture, and the program around it, to make sure we rule everything out but also make the body system stronger and healthier,” explains Gary. “It’s crucial that we help you focus on what you can control one step at a time – you can’t address all the pieces at once.
“We might start with walking. We may make some lifestyle modifications. This gets you a little bit more active and builds a little bit of fitness. Then, when we do add strength training stressors to your life, you can recover from it and you can tolerate it better, as we build to a full and sustainable recovery.”
The first time you’ll recognize how different our approach is – the personal approach instead of the business approach – is when you first meet with us. No 15-minute swift assessments here. Your first assessment is a deep dive in which we get to know you, your fitness goals, your current physical state, and your capacity to move and exercise.
To take this crucial first step on your physical therapy journey, book your comprehensive 90-minute body evaluation with Reload.
