Exercises

Here you will not find a list of exercises. Or descriptions of the implementation and when and how to apply it. If you want that then you better consult a search engine. There you will find a huge and unclear amount of exercises where the experts try each other out. In this article we are going to talk about: different types of exercises, for which to apply, the advantages and disadvantages and what is known about the effectiveness.

Specific exercises

Giving an exercise without a goal is like a shot in the air and hoping that you hit something. The chance that you will succeed is very small and then the question is whether you are happy with what you have shot. An exercise must be specific: made to achieve the goal and tailor-made for the person who will perform it. For people with complaints, the goal is to get rid of the complaints. A number of people also want to prevent complaints from returning. So many different complaints and people requires so many different exercises. I try to sort out the chaos.

General exercises

A number of people do not recover from complaints because there is (also) a general problem. From a physical point of view, the most common are: something with the posture (for example, a protruding neck), being unable to relax (raised shoulders), insufficient general condition or strength (such as when climbing stairs or getting up). Exercises can be devised for each of these problems. The difficult thing about this is that they have to be sustained for some time to achieve an effect, often months, and that they also need to be maintained afterwards to prevent relapse. This is because it concerns the "adjustment" of automatisms that have existed for many years and that are deeply rooted in body and behavior. Try to get rid of that.

Function exercises

To properly perform an action, various structures will have to function as a unit to achieve the purpose of the action. Pain and movement limitation in particular disturb this. Pain reduction is important because pain gives adjustments to the action or exercise, which in itself can hold symptoms or give new ones. Sometimes there are exercises that dampen pain. Movement is one of them: relaxed repetitive movements in particular. Restriction of movement can have different causes and require different types of exercises. Stretching exercises can be given when structures are shortened. With a healing inflammatory process (for example muscle tear) modelling exercises can be given for an optimal scar strength. When limiting the mobility of a joint, mobilizing exercises can be given to optimize the interaction of the participating bone elements. If the structures are of good quality, but the interaction is not optimally coordinated from the nervous system, coordination or technical exercises are the choice.

Order of exercises

To successfully complete a change process through exercises, the order in which exercises are given over time is important. If someone cannot walk upright due to shortening of the front structures, then giving posture exercises immediately is doomed to fail. First the shortened structures will have to be practiced to allow an upright posture. Posture exercises can then be given. And finally, the new posture behaviour must be integrated into daily life. When it is necessary to gain more strength in the leg muscles (for example when getting up from a chair), the technique of getting up can first be looked at to make this process run as efficiently as possible. This also prevents complaints from developing elsewhere due to overload, for example in the lower back due to bending forward during the initial phase of standing up. If the technique is good, you can concentrate on strength, speed or endurance if necessary.

Benefits of exercises

Exercises, if indicated and well-chosen, return responsibility and self-reliance of patients to their own body. An activating policy with exercises increases the resilience. When complaints improve, confidence in their own functioning also increases. Therapist dependence is declining. Exercises are cheap and if necessary, such as with recurring complaints, can always be picked up again.

Disadvantages of exercises

These are unfortunately also there. The main disadvantage is that the patient has to do it himself. Almost everyone will have the reins celebrated over time. Exercises are monotonous, boring, it sometimes takes a while before noticeable success occurs, vacations ... When the symptoms have disappeared, the need to practice is no longer felt, so that the therapy process is not fully completed sometimes. Doing maintenance prevention exercises is also a difficult matter therefore. A number of exercises try to initiate behavioral change. But changing people's behavior (in general) is a tricky business. So a good dose of motivation is needed to go through an exercise process well.

Even though an exercise has been chosen correctly and is performed correctly, it is still possible that unwanted effects will occur. In general this affects 1 in 6 people. This concerns mild side effects such as pain, fatigue, low back pain, bursitis. When the exercises are stopped, this disappears again. Serious side effects do not occur more often than if they are not practiced. The type of exercise with the most chance of problems are the strength exercises. The groups of patients most at risk are: the elderly, people with low back pain or other musculoskeletal complaints, and possibly people with osteoporosis. Finally, little is known about the impact of exercises on the effectiveness of medication. The performance time of medication can be influenced by performing exercises. How to deal with this is not clear, with perhaps one exception: insulin. The blood sugar level can be measured directly to which the dosage can be adjusted.

Proven effectiveness

There is a lot of research available that shows that exercises are an effective and safe form of therapy for musculoskeletal complaints. However, strangely enough, it is not always clear which type of exercise is most relevant to which complaint. There is also limited research into the best execution: frequency, duration, intensity. In particular with non-specific complaints, where no clear causes are found, it does not seem to matter much. This suggests that just activating and stimulating the use of the complaints region leads to improvement. It is possible that the enormous variation in complaints and people cannot lead to unequivocal conclusions and causes confusion. In my opinion, this calls for an individual approach to patients. In the case of complaints with a clear cause, such as specific complaints, it is important to find a suitable exercise, such as in inflammatory processes, muscle or ligament cracks or hernia. Sometimes protocols have even been developed for this.

Conclusion

Exercises are an important form of therapy for musculoskeletal complaints. It is difficult to estimate which exercise is best suited to which complaint and patient. The adage "if it does not benefit then it does not harm" does not apply: there are also disadvantages. However, a well-chosen and performed exercise can help a patient in many ways, including reduction of the complaint.

References

Pedersen BK, Saltin B. Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports. 2015 Dec;25 Suppl 3:1-72.

Daenen L et al. Exercise, not to exercise, or how to exercise in patients with chronic pain? Applying science to practice. Clin J Pain. 2015 Feb;31(2):108-14.

McLaughlin M, Jacobs I. Exercise is medicine, but does it interfere with medicine? Exerc Sport Sci Rev, Vol. 45, No. 3, pp. 127–135, 2017.

Niemeijer A et al. Adverse events of exercise therapy in randomised controlled trials: a systematic review and meta-analysis. BJSM Published Online First: 28 September 2019.