What should I feel when doing my physio exercises?

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If you’ve had to visit a physio for an injury or pain presentation its very likely you’d have been given some exercises to do. Exercise is the most common tool we use to help move people out of pain and restore normal function.

Not all injuries are the same. That might seem obvious right? But a broken arm is different to a pinched nerve which is different to a tendon problem. So while injuries differ in nature, exercises and the effect they have differ too.

Horses for courses

Understanding the exercise and what you should feel as a result of doing it, is really important to a successful recovery.  Some exercises should directly make you feel better, some will reproduce your pain a bit and others you might feel nothing at all. The exercise should match the injury – horses for courses – and will therefore feel different to each other.

So how do you know what you should be feeling with any rehab exercise?

Here’s three different types of exercises you might get for different knee pain presentations to help illustrate the point.

1.Exercise to remodel a painful patella (knee cap) tendon

Any exercise that is aimed at remodelling (changing the internal structure) a tissue (eg a tendon, muscle etc) will be painful. It’s painful because load or stretch/strain is being put through the tissue that is either weak, or sensitised.

So the exercise should produce pain when it’s done and then the pain goes away straight after stopping, without worsening with repetition. The pain goes on and off like a light switch but when you stop nothing is worse overall.

This is a good response. The pain won’t feel better straight away but will improve over weeks/months as the tissue remodel (becomes stronger and less sensitive)

2. Exercise to restore a mechanically blocked knee joint

Some knee pain is due to a stiff or blocked joint. In this case nothing is damaged in the joint it’s just not moving as well as it needs to. And it’s this stiffness that’s causing pain.

Exercise aimed at restoring the knee motion might feel stiff and painful to start with but gets progressively better as you repeat the movement. The exercise in this case is like a pain reliever – the more you do the better you feel. In this situation you often notice recovery is much quicker – and it’s easy to do the exercise because it obviously improves your pain.

3. Exercise to strengthen a weak muscle around the knee

Sometimes pain in the knee is related to weakness in a muscle or a collection of muscles around the knee/hip/foot. The knee is sore because the movement in the leg isn’t well controlled.

Exercise in this case should feel hard to do as you’re trying to take the weak muscle to fatigue – you might even feel sore in those muscles the next day. But it typically doesn’t have any direct effect on your knee pain – it’s effect is neutral in the short term.

Strength takes time to build up – so you typically start to feel better in the knee after several weeks of strengthening exercises on the surrounding muscles. Nothing changes quickly here – its a slow process of progressively increasing load/weight to a weak muscle.

Understand the injury and the solution

Three different types of knee exercises aimed at three different injuries/sources of pain.

Knowing what your injury is and the point of the exercise is crucial. Always talk to your physio about why you’re doing a particular exercise and what the effect should be when doing it.

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