As an orthopedic physical therapist, the most common request from my patients is a one exercise fix for pain. For example, “Can you give me one stretch to really get this back pain under control,” or “What is the best exercise for a meniscus tear?” While all physical therapists keep a list of go-to exercises, there is no one exercise that can fix a problem.
As a physical therapist, I prioritize strong education for my patients. Making sure they understand the cause behind their pain is the first step in recovery. Additionally, everybody moves differently, and there is no one exercise or stretch that can magically fix an issue. Two people can have pain in the same spot in the knee, but the cause behind that pain is different. Similarly, two different clients can have the same MRI results showing a rotator cuff tear, but the causes behind the tears are different, and one may not even be symptomatic.
Physical therapists look at both pathoanatomical and pathomechanical diagnoses. A pathoanatomical diagnosis identifies specific tissue injury as the primary cause of symptoms; i.e., ligament tears. A pathomechanical diagnosis focuses more on how biomechanics and abnormal movement patterns can cause injury. A rotator cuff tear would be the anatomical diagnosis, while the nontraumatic cause of the rotator cuff tear would be the mechanical diagnosis. For example, if a shoulder blade is not moving properly with repetitive overhead movement, it can lead to shoulder instability, weakness in rotator cuff muscles, and impingement. Eventually, if proper shoulder blade movement is not restored, it can lead to a rotator cuff tear down the line.
While physical therapists must consider the anatomical diagnosis, the tissue injury itself may not be the source of the client’s pain. The anatomical diagnosis often results from “wear and tear” or “overuse” from repeated tissue stress over time. Finding the movement pattern (i.e., the mechanical diagnosis) that is causing the wear and tear can be more helpful in preventing injury. The mechanics is what truly guides a treatment program. Similarly, while imaging can be helpful in problem-solving an anatomical cause of pain, a physical therapist relies on a full body assessment to find the mechanical cause of pain. Often, the results of the imaging won’t change the PT plan at all.
Many clients choose to have surgery to fix the anatomical cause of injury. Sometimes this cannot be avoided. However, even if a client has surgery, if the initial abnormal movement pattern still exists the surgery may not ultimately be successful. Making sure you get a proper PT exam to find any mechanical causes of injury is important to not only potentially avoid surgery, but to optimize outcomes if someone does choose the surgical route.
A PT exam can include a subjective patient history, symptoms, and a thorough movement exam that can help identify a pattern contributing to pain. We look for contributing factors like tissue flexibility, muscle strength, coordination, balance, and specific injury tests. All these things combined help guide treatment programs and exercise prescriptions that are meant to be individualized to each person.
So when someone asks for the best exercise to prevent or fix an injury, there is not always one answer. If you find someone on social media who promises you “this” is the best exercise for “this injury,” I would be cautious and hesitant. On the other side of the spectrum, it’s not wise to try every exercise and see what happens. Specific trialing of an exercise that was thought out is one thing, guesswork is another.
Exercise selection is important, but the reason to seek out a PT is so the PT can monitor load management and progress with tolerance. A PTs job is to educate, teach proper load management based on symptoms, and prescribe exercises to help reach goals. We want to progressively improve load tolerance until the patient is at their highest level (which varies greatly from person to person). A patient with a rotator cuff tear with one cause may require separate exercises than another patient with the same tear with a separate cause. Both will have different responses to load changes, which drives our decision making and helps us know when to progress or regress activities.
Many people focus too much on their anatomic diagnosis and get caught up in imaging results. While it’s comforting to know if you have a tear or injury somewhere, sometimes getting stuck on labeling the injury can delay recovery. Strong education regarding mechanics and the purpose behind specific exercise instruction can be more helpful. Just like you should know which medications you are taking and why, it is important to understand why you are performing each exercise. Getting stuck on “this is torn and PT won’t fix it” is counterproductive. Thinking in terms of “this is torn, but the way I move can decrease pain and improve function” is more helpful, especially when the reasoning behind each exercise is given.
Both understanding anatomical and mechanical diagnoses are important, not only to help patient recovery, but also between healthcare providers. Finding the balance between anatomy, mechanics, patient symptoms and the impacts of pain on daily activities can help guide the ultimate treatment program.
Not sure where to start or have any questions? Book a consult with your friendly neighborhood physical therapist.
Jenny Buchbinder is a local private physical therapist and owner of Next Step PT. She specializes in general orthopedics for adults and teens, is pelvic floor specialist, works with pregnancy and postpartum women, is a running gait analyst, and more. For a free PT consultation or more information, contact [email protected].
