May marks 10 years since I graduated from Mount St Joseph University’s Doctor of Physical Therapy program. I started doing a series of posts on Instagram last week about 10 things I’ve learned in 10 years as a PT. I figured this would also be a great topic to put into a blog post, so in this post I’m sharing the first 5 things I’ve learned.

1 - There is no one “best exercise”

I often have people ask me what the “best” exercise is for a certain injury or pain they are experiencing, or what type of exercise or activity is best for their age, injury prevention, etc.

The truth is, there is no one best exercise for everyone. It really depends! Here are 3 simple guidelines I recommend to find the best type of exercise for you:

1) Choose exercises or activities that you enjoy.
2) Choose exercises that feel good to your body.
3) Choose exercises that align with your goals.

If you are dealing with pain or injury, it is your physical therapist’s job to help choose exercises that will align with your goals. They should be able to explain to you why they are choosing those exercises. It’s up to you to let them know if you can be compliant with them - that they feel good to your body and they are feasible to do. You may not LOVE doing the rehab exercises you were assigned, but if you can see the path back to the activities you do love, that can be incredibly helpful.

2 - There are no exercises that are inherently bad

Trainers and PT’s alike love to make lists on Instagram of exercises they hate or would never have patients/clients do. These range from saying things like clamshells are useless to stating that burpees are bad and will cause injuries.

Like any other provider, I have my favorite exercises that I like to prescribe for certain things. I also think as a whole, PT’s can push our patients more than we do when it comes to exercise. However, any time I see these lists I can always think of patient scenarios I have come across in my career where these exercises were appropriate.

Are clamshells the best exercise for someone who is otherwise healthy and trying to get back to running? Probably not. But they can be great to introduce hip external rotation against gravity for someone who has had a stroke, or an amputation, or even someone who is in the hospital for medical complications that is non weight bearing.

And what about burpees? Do they have a place? Well, getting off the ground is pretty functional. But also, maybe the patient or client sees value in doing burpees or simply wants to be able to do them. Yes, this exercise often looks sloppy in the gym when someone is doing it for speed and without instruction. But if the person we are working with has a goal to do them, we as a PT or trainer better figure out how to help them scale a burpee and do them well.

The problem with labeling an exercises as “good” or “bad” is that the conversation simply needs to be more nuanced than that. An exercise that may not be the best choice for some populations may be fantastic for others.

3 - Not everyone needs manual therapy, but it can be a game changer some

Some patients come into my office and we focus completely on movement and exercise, and I simply leave my cups and needles and all the other tools on the shelf. Other patients may need some manual therapy to reduce pain or increase movement in a certain area, and sometimes this hands on work is key to our progress.

I always let patients know that I have plenty of tools in my tool belt so if dry needling sounds like their worst nightmare, there are plenty of other things we can try! Other patients are intrigued by dry needling or have had positive experiences with it in the past, and it can be a huge game changer for them. They may notice an immediate improvement in symptoms and finally be able to tolerate more movement.

This is where an individualized approach can make a big difference. Would you benefit from manual therapy? Do we need to do some manual to calm your symptoms? Or should we focus on movement and activity modifications? It depends! After a conversation about goals, response to previous treatment, your preferences, and of course completing a movement assessment, I’m able to make a confident recommendation about where we need to go with your treatment plan.

4 - Not everyone needs individualized, 1:1 physical therapy

On the flip side, maybe you don’t need manual therapy or multiple sessions of 1:1 PT. In an ideal world I would love for everyone to at least have a 1:1 assessment (for at least an hour), but that can’t always happen.

I work with a lot of moms, and sometimes making it to their own appointments can be a huge challenge. Luckily there are a lot of physical therapists who are now creating online programs to address many different areas of the body, from feet, to the pelvic floor, to general mobility programs. Sometimes these generalized programs are exactly what the person needs and they are able to meet their goals by working through the program alone. I also think there is a time and place for combining these programs with in person physical therapy.

I also spent many years before I opened AK working in higher volume clinics. I often had short treatment sessions or was asked to treat multiple patients at a time. Although this isn’t how I like treating, I did have a lot of patients who got better in these settings. I think most patients find more benefit and “bang for their buck” in 1:1 care, but some patients (for example, patients who are post hip or knee replacements) do just fine working with a pretty standard protocol in a busy PT clinic.

5 - Patients need to be assessed as a whole person, not just their musculoskeletal system

Our body doesn’t function as separate parts. Knee pain is never “just the knee joint”, and it’s rare that a single muscle being tight is causing a problem.

Your body is a complex system. It’s important that we consider the way fascial connections, visceral restrictions, and even neural restrictions may be affecting movement. Additionally, our stress management, nervous system, sleep, and nutrition all play a role in how our physical body feels and functions.

If as a physical therapist I am only looking at muscles, bones, and joints, I’m missing so many things that need to be assessed to get to the root of an issue. Treating some of these things may be outside of my scope of practice, and that is where collaborating with other providers can be incredibly helpful to make the right referrals.

Check back next week for part 2!

Blog post written by Dr. Alexis Hutchison, PT, DPT, OCS