Every now and then we get chronic pain clients who come to us for a visit and we never see them again. When we check in on them a few weeks or months later, they told us they’ve tried many exercises at home and they didn’t work.
Of course, they didn’t work!
When we think of exercise, we think of strength training, weight training, or aerobic activity. These workouts are focused on increase strength, endurance, VO2max, muscle mass, weight loss, etc. Exercising for pain relief is a completely different ball game.
Today we want to talk about how clinical exercise work and why your Instagram rehab is not going to help you find pain free living.
#1 Instagram rehab is generic
When we flick through Instagram, we see a lot of posts titled ‘five exercises for back pain’, ‘ten workouts to prevent knee pain’, etc. If you take a look at them, they are no different from regular back and knee workout routines.
In short, they don’t address the factors contributing to your pain experience.
#2 Nobody, including you and I, knows what exercises will work for you
I think this is the part most people struggle to understand.
You probably think there are finite, clearly defined problems for your pain. For example, if you have knee pain you are thinking it is due to tightness in your ITB (iliotibial band), poor hamstring or glut strength, poor knee tracking, etc.
We look at the above factors as independent causes where if we addressed the “right” factor, your pain will go away.
Well, it’s more complex than that.
First, you have to understand pain is a biopsychosocial process. Pain is not the direct result of what happens to you in a physical or bodily aspect.
For example, you can feel pain without injury (e.g. knocking your elbow really hard against the wall, stepping on a lego). Likewise, you can experience no pain with damage. The most common example is a papercut. You didn’t realise you cut your finger till you wash your hands.
In essence, just “fixing” your physical problem might not necessarily make your pain go away.
(Also, there are different types of pain but we won’t address this here.)
You have no idea what exercises will work for you because you don’t have the clinical training for that.
I, despite having chiropractic clinical training, do not know for certain what will help you.
Rehabilitation or exercise therapy is process driven. What this means is that we make very good guesses. On your first visit, we make educated guesses on what exercises you are most likely to respond to. Between the first and second visit, you will work on those exercises.
What we see on the second visit will confirm if my initial thought process is right or wrong.
#3 There is a dose component
Everyone responds differently to exercises. Even if a particular exercise will definitely help with your pain, how often and how much to do are questions that needs to be answered.
Does is your Instagram pain guru going to tell you that? Maybe.
His or her suggestions are more likely from personal experience. They are broad strokes approach to what may work and, from my experience, everyone responds differently.
There are rehabilitative exercises that are meant to be done 2-3 times a week, there are others that are meant to be done 2-3 times a day. Believe it or not, there are exercises that you are meant to do EVERY HOUR for the full therapeutic effect.
Yes, we do regularly prescribe that. It is a big ask, we know. But that’s what it takes for the optimal outcomes.
Let’s face it. What you see or read on Instagram is unlikely to address your specific situation.
#4 What to do if your pain worsens?
Most people will stop doing the exercises.
Do you know that rehabilitative exercises that are painful are superior to those that are pain-free? Shocking right.
What matters, from a bigger picture viewpoint, is not how you feel during rehab. It is your risk of injury while performing a specific movement and what are the odds of the exercise helping you in the long term.
Can you Instagram injury guru address that? No.
#5 Pain rehabilitation is not about strength!
Most people think their pain will go away if they are stronger. Therefore, exercises will help.
This is 100% false.
You can recover from pain using simple movements that do not translate to an increase in strength. In fact, some studies have shown aerobic exercise like walking improves low back pain intensity. (Not the same as symptom resolution.)
Furthermore, if strength is the variable that changes your pain experience … people who workout aplenty should have zero pain. No?
Let’s face it. Pain is a common complaint among weekend athletes. Being stronger doesn’t mean your pain will go away.
Pain is complex. There are other variables that go into changing your pain experience as well.
Graded exposure is a common psychology strategy to help people overcome fear. Do you know we also use that in clinical practice? If it hurts for you to run, gradually introducing running either at different loads, volume, frequency, or pattern might help you get back to running pain free.
Do you get stronger from doing that? No. It’s not just about doing less and it’s certainly not about rest. Just because we get an injured athlete to run less doesn’t mean they get to work less hard. Believe it or not, rest is probably the worst thing you could do.
There are many considerations in prescribing an exercise program for your symptoms. Most of the time, typical fitness goals from strength to flexibility to forms and techniques are just irrelevant.
#6 Instagram is a small, skewed sample size
So it might seem from the comments that people are getting better by following X or Y Instagram rehab recommendations. Does that mean it is good? No.
We know yoga doesn’t really help scoliosis in adults. If you were to go to a yoga studio, it is not uncommon to meet many people whose scoliosis have improved since yoga practice. Does that mean yoga helped? It is a lot of people who are better, right?
Yes, that is completely correct. But how many scoliosis patients who have tried yoga didn’t improve from it? Are you able to account for them?
Furthermore, is it reasonable to expect a scoliosis patient to keep doing yoga as a form of treatment if it doesn’t work? No.
In short, people who did not respond to the Instagram guru’s program would probably stop following him or her.
It’s not common to hear chiropractors saying surgery doesn’t work. Because they have seen a lot of patients who have had surgery but didn’t improve. This is also a flawed sample group!
Why would people who have improved from surgery be seeking chiropractic care?
#7 You don’t have a relationship with the IG guru
Believe it or not, therapeutic alliance – also known as the relationship between a therapist and a patient – is one of the most important factors are achieve successful treatment outcomes.
If you cannot have a relationship with the person you are seeking treatment from, how can you expect yourself to get better?
IG rehabilitation doesn’t work
I can’t emphasise this enough.
If your self-direct exercise program hasn’t been working, it is not because rehabilitation does not work. It is because you haven’t been doing the right thing. Rehabilitation works. Instagram rehab? Not so much
Of course that is not to say you will 100% get better with a health care professional service.
At Square One, over 80% of our clients achieve full recovery in four to seven visits. Without the chiropractic adjustments, spinal manipulation, shockwave therapy, pain killers, etc. Just rehab. About 10% take less than four visits and a small 5% that doesn’t respond well to what we offer.
Pain is complex. Doesn’t matter if you are current suffering from piriform is pain syndrome, acute pain from a sports injury or even cancer pain, always seek professional advice. Chiropractors, physiotherapists, medical doctors are all suitable to help.
Don’t forget, current evidence supports rehabilitation as first choice treatment to musculoskeletal pain. When seeking chiropractic care, make sure your preferred doctor of chiropractic offers more than just spinal adjustment.