Complimenting Physiotherapy

It is a common experience for people who have attended physiotherapy sessions to be given some exercises and sent away to do them without much follow up.

A good physiotherapist will explain the “why” of an exercise, and show you in detail how you should do them. They should also help you with the motivation to keep up the exercises through the inevitable boring, tedious or uncomfortable phase to get the result : to be as functional and comfortable as you can be. Unfortunately, in the NHS setting, there is often not enough time to give the necessary detail and support.

Have you given up on your physiotherapy exercises because they don’t seem to be helping, or they are too pain provoking?

Or maybe they are just tedious to do, and you just don’t quite see the point in doing them.

I often ask people to show me the exercises they have been given for a particular condition.  In many cases I find they are subtly avoiding using the painful or concerning part of their body and therefore not targeting the exercise properly. This means that even if they are doing their exercises diligently, they are not getting full benefit from them.

For instance, when doing shoulder exercises, people often slightly rotate their trunk to “achieve” the exercise rather than using the shoulder joint itself. They are not aware they are doing it, and need some help to learn to undo this habit.  Pain is a very powerful driver of behaviour, even subconsciously, so it is very understandable that when we are trying to do exercises that inevitably hurt a little (because they are targeting the recovering area of the body) we tend to avoid them by moving ourselves differently. It can be very difficult to pick up this avoidance for ourselves. A mirror can help, but even then, the movement changes can be subtle. Having an accurate picture of how the body works useful. This is an aspect of Alexander Technique called Body Mapping: it is basic anatomy, but learnt in a particular way: to apply it to yourself and your movements rather than just knowing theoretically where bones and muscles are.

Where an Alexander Technique approach also compliments physiotherapy is in improving the quality of the movement, as well as the accuracy of movement. If exercises are done in a rushed or tense way many of the benefits are lost. Often the main reason to do an exercise is to “teach” the nervous system that a movement is “safe” and doesn’t need to be avoided. Therefore, you don’t want to do so many repetitions that a lot of pain is provoked, and you don’t want to be ploughing through your exercises, holding your breath and tightening your neck and shoulders. This teaches your nervous system that this movement is not “safe”: it is something to worry about!

(If this idea seems a bit strange see here about how pain is only partly about what is going on in the tissues of your body).

The problem is we often don’t feel or notice our own tensions or reactions, so we can’t change the way we do an exercise for ourselves. A little hands-on help can go a long way.

Where your pain or condition is more general e.g. lower back pain, it may be that I might encourage you away from doing specific physiotherapy exercises to just being more active doing things that you enjoy. Numerous studies have shown that for back pain no form of exercise is really better than another, and doing things you enjoy is important.

If you feel you can’t do that activity you love anymore because of pain, then we can look at how I can help you to get back to it. It may be that the ease with which you move can be improved so that it is comfortable to do again.  You may be worried that it may cause a flare up of pain, and we can give you tools to avoid and manage flare ups. Or, you may need help building up your fitness and tolerance so you can do more, reliably.

If you would like help and support with your rehabilitation or prescribed exercises I would love to help .   I’m always happy to have a no pressure chat about your needs. Contact me 

Want to learn Body Mapping? Workshops in February and March 2019