Rehabilitation Is More Than Just Exercise

Exercise is NOT a magical pill – it is great for many things though.

There is a current trend to treat painful problems with exercise, conflating it as rehabilitation.

Before I elaborate, let me make a few things clear:

  • Done correctly, exercise is a good thing, for most people
  • Exercise can be part of the recovery process from pain and injury
  • Exercise has many health benefits
  • I promote exercise actively – if you follow my social media accounts you’d see that

However, exercise is not therapy, nor is exercise rehabilitation.

Yes, exercise can be part of rehabilitation, but it isn’t the same as rehabilitation.

We must keep in mind, however, that motor skill learning and exercise are not synonymous. – Stevans and Hall, 1998

I teach a workshop that talks about using kettlebells for rehab.

In it, I present this argument that performance training and rehab are on the same continuum, with health somewhere to the right of middle.

A slide from my Kettlebells for Rehab Workshop

My point is this:

Performance training is aiming to maximise performance of a particular task.

Rehab is aiming to improve physical performance in one or more aspects.

The principles of stimulus and adaptation still hold.

What doesn’t hold is that you can use performance training to achieve a rehab goal, if the deficit is not performance related.

There is a saying that you can’t put fitness on top of dysfunction.

That’s not completely true, but nor is it true that simply adding load makes things better.

Solely focusing on resolving dysfunction (whatever that means) and solely focusing on building capacity (performance) are both inadequate.

So what happens when rehabilitation is inadequate?

  1. Presenting issue (often pain or injury) is not adequately resolved
  2. Increased risk of future injury
  3. Impaired performance (be it at sport, work or activities of daily living)

Strength Training Is Not Rehabilitation

I have a weak back.

I need to train my core.

My knees aren’t as strong as they were.

Almost every day I hear stories from patients correlating their pain with weakness.

There is a meme floating around about the relationship between strength and pain that is growing in power and becoming really hard to undo.

If there was a direct link between strength and pain, we would not see strong high level athletes suffering from chronic pain.

But we do.

The main reason I suspect we see this link is two fold:

  1. Visually, strong people fill our idea of health and fitness.
  2. Simplicity: it is easier to blame on weakness, teach somebody how to strengthen the so called weaknesses and then use strength as an outcome measure.

Strength training can definitely be part of a rehabilitation program.

But getting strong alone is not the reason we see improvements in pain.

Strength training, done properly, improves movement quality, load tolerance and builds confidence. All these contribute to improving pain in certain conditions.

Stretching Is Not Rehabilitation

The second common issue is “tightness”.

People often feel tight and cite this as a reason they need to stretch.

Therapists then perform an assessment.

They say this feels tight, this is weak. Stretch this. Strengthen that.

If only it were that simple!

Stretching is a valuable technique. I use it as part of my own personal exercise programs, and often prescribe stretching to patients.

Stretching has value beyond lengthening muscles (which it actually doesn’t do*), like improving body awareness (interoception) and relaxing both body and mind. All of this can help people in pain improve.

But alone, stretching is not rehabilitation. In fact, changes to flexibility are not associated with improvements in pain.

Oh and by the way, feeling tight doesn’t actually correlate with being “stiffer”. This has been shown in research. One is a perception of the body, the other is a physical property.

“Cardio” Is Not Rehabilitation

Whether it is going for a run, stationary cycling or walking – all these forms of exercise can have positive effects on health, pain and function.

However, again, is it rehabilitation?

Time again we see improvements with these (and other) cardio activities, which do not correlate to improvements in fitness or endurance.

Again, this isn’t to say cardio exercise has no value in a rehabilitation program, it is simply saying, that cardio in and of itself is not rehabilitation.

What Is Rehabilitation?

Comprehensive rehabilitation should involve restoring optimal function to both the sensory and motor systems, in a manner that builds resilience and enhances adaptability.

Huh? Does that sound complicated? It kind of is. We are talking about the body, which still remains a mystery to us.

We don’t know it all.

But what we do know, is that rehabilitation should be tailored to the individual, and process based.

It should include education and a graded exposure that takes context into account.

It should have objective outcomes that measure improvements in function, but should also focus on resolving the presenting pain or injury as best as possible as well.

Exercise can definitely (and usually should) be part of this process, but I have seen many fit and “dysfunctional” people over the years, along with many people who have “rehabbed” themselves to become stronger and fitter but still suffering from their initial complaints.

There of course, is a balancing act – it’s not always about the pain – and often improving function in spite of pain is the best outcome, but that doesn’t make exercise alone magically turn into rehab.

How Do You Do It?

Educate, Educate, Educate

Without properly educating someone about what they are doing and why they are doing it, rehabilitation lacks meaning. When things lack meaning we don’t give them appropriate focus, which leads to lack of results.

This is why the who treatment encounter should be centred around education from the beginning.

Create the appropriate context, and then each intervention fits into that context.

Sensory Rehabilitation Should Precede Motor Rehabilitation

When somebody has referred pain down their arm or leg, I will test their reflexes.

A reflex tests both the sensory and motor function of the related nerves.

The body has to sense the stimulus (the tap of the reflex hammer on the tendon) and then respond to it.

If you have impaired sensory function, but your motor function is fine, then you won’t demonstrate normal reflexes.

Rehabilitation is similar.

If you have impaired sensory function, your motor function (movement, strength etc) will not be at the level it should be.

Initially, rehabilitation should aim to restore sensory function – this can be achieved in many ways with manual therapy/taping (sensory nerve stimulation), body awareness exercises (enhancing interoception), mobility/flexibility exercises (enhances sensory input), motor control exercises (enhances proprioception).

If someone displays poor sensory awareness, improving this will often develop their motor qualities concurrently, as outputs are a product of inputs and processing.

This is why simply exercising doesn’t always improve things. It’s not just what you do, but how you do it.

Rehabilitation Should Be Contextual

Soldiers in the army face numerous challenges when deployed. An uncertain and continually changing environment, unpredictable tactics from enemies, and the threat of death create extremely high stress situations.

In these high stress situations, our brains go into survival mode – thinking decreases and insinctive behaviour increases – unfortunately, what is instinctive is often dangerous, so these behaviours must be stopped.

As a result, training for soldiers involves as real as possible simulations, to cause an adaptation to the brain.

As the soldiers are exposed to realistic threatening scenarios, they become less and less sensitive – their brains do not enter survival mode as easily – allowing them to think and act intelligently, even under extreme stress.

With pain, our brains are protecting us from a threat, real or perceived. If you experience pain while you are working, and you work in a fast paced financial office, rehabilitation in a calm clinic room only goes so far.

Rehab should progess in context, from safe and secure to challenging and confronting, to allow the brain to adapt its response.

This is one of the most overlooked aspects of rehabilitation, in my opinion. It is why education is so important, and also one of the hardest things to do.

Rehabilitation Shouldn’t Be Based Solely On Sets and Reps

Fixed set/rep schemes work great in theory.

However, given the dynamic nature of the human body, some days we can do more, some days it’s less.

Creating an environment or set of parameters that allows you to “fail forward” is usually more optimal than grinding out movement to achieve a number.

One of the ways this can be achieved is with self-limiting exercises.

Another is with auto-regulation using a “rating of perceived exertion” (RPE) scale. This requires good sensory awareness. See earlier point.

While exercise is often focused on achieving a number, to ensure progression, rehab is slightly different. Numbers can play a role, but shouldn’t be the main focus. Quality and feelings should, at least in the beginning.

Conclusions

Exercise is definitely an important part of the rehabilitation process, but what we have learnt in recent years is that it doesn’t matter as much what you do, but rather that you do something and how you do that something.

When we frame exercise in terms of capacity (load, volume, range of motion etc) without paying attention to the contextual factors involved in someone’s presentation, we are missing a large part of the problem at hand.

And while it is easy to measure strength and endurance gains, it is much harder to measure gains in body awareness, confidence and resilience.

I myself have been guilty of defaulting to the former many times, purely because patients often demand something tangible, and this is what I am familiar with.

The challenge for everyone involved in rehabilitation from pain and injury is to bring the bigger picture into focus, and to really shift the emphasis towards rehabilitating people, not problems.

 

Nick Efthimiou Osteopath

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 

 

Your Body Is Not A Machine

Back of man with arms elevated exposing machine internals.

What a machine!

Food is fuel!

The heart is a pump.

The brain is a computer. Inputs. Outputs. Processing.

Analogies likening the body to a machine have been around for centuries, if not longer.

They exist in almost every culture.

They shape the way people think about their bodies.

They are wrong.

Your body is not a machine, and that is an extremely good thing.

Your body is a biological entity, which adapts over time to the stimuli it is exposed to.

Moreover, your body is part of you and you are part of your body – the separation is an illusion of the mind.

Let’s look at this a little more deeply.

Why Do We Use Machine Analogies?

In a word: simplicity (even I succumbed to computer based analogies in this post – my understanding is better now).

Even the most complex machines are computers are created by, and hence can be understood by humans.

When it comes to our body, our brain, our mind – we really don’t know that much.

We are learning at an astounding rate, but almost all research in human biology and psychology ends with the dreaded statement more research is needed.

So, to simplify things, we use analogies of machines. To the non-technical minded person, machines are complex, but we have an idea about them because of our interaction with them in daily life.

But, in the process of simplifying, we have made things too simplistic, and as a result, our explanations lead to incorrect ideas.

Incorrect Ideas Lead To Poor Health Behaviours

Many people are afraid of activity due to a fear that they will “wear out” their body.

You hear doctors described arthritis as “wear and tear” all the time.

This leads people to stop doing the very things that would improve their condition – exercise.

We see similar problems with the “hardware/software” analogies used (I have been guilty of this in the past).

When people are told their brain is like a computer, it is very limiting.

Computers cannot create.

Computers cannot feel.

Computers cannot express themselves.

At this point in time, computers can only do what they are programmed to do.

If we think our brain is like a computer, then it is becomes a tool for processing information, rather than the core of our experience.

Additionally, a computer can be reset. While we all love the idea of a clean slate (new diet on Monday, new year’s resolutions etc), in reality, everything we have experienced in our lives shapes us in ways seen and unseen, which affects what we do, think and feel going forward, which shapes us further, in a big, ever expanding circular fashion.

What Kind Of Analogies Should We Use Instead?

When it comes to adaptation, which is the hallmark of living organisms, I like to use examples from nature, like this tree from a Facebook post I made a couple of years ago.

I love how, despite the challenges of an unfamiliar, urban environment presented to this tree, it manages to adapt and thrive. This is true across all of biology. Species, both plant and animal, will do whatever they can to adapt to their environment in order to survive and reproduce.

From an evolutionary biology perspective, this is what our primary purpose of life is.

Now, as humans, we have higher aims – creation, expression, fulfilment, enlightment etc – but deep down, these biological imperatives are still there.

Instead of saying “the body is a car that needs servicing and alignment”, why not say the body is like a tree, it grows until maturity, then it endures good seasons and bad throughout its lifespan, but it adapts and survives?

Instead of saying “the heart is like a pump”, why not describe it as a river that keeps flowing to maintain it’s own health – sometimes it flows faster, sometimes it flows slower, but it still flows?

Instead of saying “what a machine”, why not say what an amazing person?

Why It’s So Important To Get This Right

Imagine if, instead of being told that her sore knee is because of wear and tear, a doctor tells her patient that her knee pain is because her nervous system is being protective of it. 

Imagine this doctor then tells her patient that to deal with the pain she needs to become more adaptable and resilient, and that she can do this by improving her flexibility, strength and endurance with exercise and activity.

Imagine if this doctor also told her patient that stress and fear makes her pain worse, and that she not only needs to become more physically adaptable and resilient, but more mentally as well, and that this is possible because even into older age, the brain and nervous system can learn and change for the better!

Conclusions

Medical and allied health practitioners need to lead the charge towards healthier attitudes towards bodies, pain, injury and ageing.

More needs to be done to build confidence in people’s health, especially in the face of pain and ageing – two big drivers of fear.

This can be achieved by stopping the use of machine based analogies and encouraging people to build strength and resilience in the face of pain, rather than retreat and avoid aggravation.

The evidence is clear: while short term rest in the case of tissue injury and post surgery is sometimes warranted, the sooner people resume activity, the better their outcomes.

We also know that expectations drive outcomes. This means more positive messages about recovery and less fear based mechanical analogies.

It’s time practice started reflecting the evidence, it’s been around for a while now.

Nick Efthimiou Osteopath

 

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 

 



 

 

Factors Influencing Treatment Outcomes

Treatment outcomes are influenced by more than most people think.

To the average person who rings up a clinic, books and appointment and then shows up to get help with their painful problem, the expectation is that the treatment will do something, and hopefully make them feel better.

Often, people do get better, but not because of what they had done treatment wise.

If someone feels better, does this even matter? Is the outcome all that is relevant?

To me it does.

And it should to you as well.

Why?

Well, firstly, if you are paying for treatment and getting better despite what was done, not because of it, then you are wasting your money. I don’t know about you, but I work too hard to be wasting my money.

Secondly, if there is risk associated with a particular treatment, and an equally effective alternative is available that has less risk, well it’s obvious you would want the safer option.

Thirdly, if we know what influences treatment outcomes, we can strive to optimise all the variables.

So what are the factors influencing treatment outcomes?

Your Condition

If a practitioner wanted to look really good, they could focus on treating acute low back pain.

Simply seeing people for 12 weeks would give them approximately a 70-80% success rate (condition resolving), no matter what they did! (1) This is because for most people, acute low back pain is a self limiting condition that gets better with time. Experienced practitioners can probably predict your recovery more accurately (and there is research to support this). Essentially, they could just play the numbers and end up looking good. (2)

There are many similar conditions that do get better with time, and what research is showing us, is that often minimal management is just as good as lengthy treatment plans. (3, 4)

On the flip side, there are some conditions which we simply cannot treat, but rather have to settle for managing as well as we can. Many (but not all) chronic pain conditions fall into this category.

Time

Recall how I mentioned many conditions improve with time?

Well if you suffer from one of those, then you need to be patient. This is often lacking. I don’t know if impatience is more prevalent these days compared to decades past, but it definitely makes people do silly things.

Things like taking too much medication, seeking out controversial treatments and “doctor shopping” for stronger analgesics are all too common.

If a practitioner says the best course of action is to do nothing and wait, then they aren’t being lazy, and they are definitely not idiots (as is commonly mentioned to me in practice). What it means, is they are likely trying to save you from unnecessary interventions, which all have potential costs and risks.

Your Expectations

There is growing body of research showing that your expectations have a big influence on whether you get better.

This isn’t a case of new-age “believe in it and it will come true” stuff either.

Rather, if you expect a certain outcome, both consciously and unconsciously your behaviours and thoughts end up shaping that outcome.

This has to do with all sorts of things, but I like to credit the concept of priming for some of it. (5)

Priming is when you are shown words, pictures or similar with a certain theme, and then you are unconsciously influenced by them. Studies have used elderly words with students for example, and the students have changed posture and walked more slowly. When young words were used, they moved quicker and stood taller.

Because of this, managing expectations is one of the most important aspects of treating pain. If you are expecting to get better in 2 weeks, but you have a 2 month condition, you will need to adjust your expectations accordingly.

Likewise, if you expect you won’t get better because you are “old” and have lots of “wear and tear”, well chances are, you won’t.

Your Current Health Status

People who are healthier recover from injuries faster.

People who recover well from injuries are less likely to go on to develop chronic pain.

If you have co-morbid conditions you are likely to recover slower than someone your age with the same condition who is healthier.

Some things are in your control: what you eat, how much you move, whether you drink and smoke or take drugs.

Some things aren’t in your control: genetic predisposition, accidents, environmental factors.

All you can do is to try and maximise the positive things you can control, minimise the negative and worry as little as possible about the rest.

Your Socioeconomic Status

This isn’t talked about much, because in Australia (and many other cultures) it is generally taboo to talk about money.

If you are in a low income household, or unemployed (not by choice), then your both your current health status and your recovery from painful problems are negatively affected.

The eminent British epidemiologist Prof Sir Michael Marmot, the president of the World Medical Association and presenter of 2016’s ABC Boyer lectures, has shown that a person’s lifestyle and health choices (what medical types like to call your “risk factors”) simply cannot account for the differences seen in death and disease among people of different incomes. In his landmark Whitehall study, which examined British men working in different levels of the public service, those on the lowest grade of employment still had double the risk of dying from heart disease – even when accounting for all the factors we traditionally think of as causes. There was a clear gradient of risk between levels, with deaths decreasing as the public servants climbed the employment ladder. (6)

Being an osteopath, I’m not trying to solve all our political and social issues, but they must be considered when considering outcomes.

Practitioner Skill

This is a topic that interests me to no end. Two great questions linger in my mind:

  1. How much of somebody’s outcome is down to practitioner skill?
  2. What components of practitioner skill are the influential ones?

If you look at all the other factors, you can see pretty quickly that practitioners often take more credit than they deserve for achieving positive outcomes, then turn around and blame every other factor but themselves when they don’t.

I feel that the skill of a practitioner is not only having good diagnostic and treatment skills, but being able to have all these listed factors circulating in their minds simultaneously, while also giving people the voice, space and time they need to explain their story.

They then need to put all this information together into a plan of action that people can understand and apply, so that they actually achieve the desired outcomes.

I think that selecting a good practitioner can actually be the difference between developing chronic pain or not. There is evidence to suggest appropriate identification of risk factors, coupled with education and reassurance all reduce the likelihood pain progresses from acute to chronic.

So what makes a skilled practitioner?

I would say they all have highly developed the following attributes:

  • Clinical knowledge
  • Clinical reasoning
  • Clinical skills
    • Assessment and diagnostic skills
    • Treatment skills
    • Rehabilitation skills
  • Communication skills
  • Experience

Each of these areas is a massive topic, which means it takes time to develop them.

This doesn’t mean that more experienced = more skilled. Rather, it means you need to be continually learning and applying, so that your experience is congruent with the current scientific understanding.

All this complexity is why they call it practice. 

Conclusions

The purpose of this post was to illuminate the complex nature of treating pain and injury, and why things don’t always go to plan.

This is why it is important to have the right support. Family and friends are a good starting point, as they can provide social support and reassurance, but for anything more than a simple strain, often it is good to have medical management, to (hopefully) prevent the slide from acute to chronic.

Good education from the beginning, appropriate management (not over management, not under management) and a view to long term outcomes, not just symptom relief are all signs you are in the right hands.

It’s always funny to me that someone will happily drive half way across the city to go shopping, but when it comes to health professionals, many people choose convenience.

Nick Efthimiou Osteopath

 

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 

 


 

 

References

(1) Prognosis in patients with acute low back pain

(2) Predicting recovery in patients with acute low back pain

(3) Effect of early supervised physiotherapy on recovery from acute ankle sprain

(4) Comprehensive physiotherapy program or advice for whiplash

(5) Blink: Reading Guide – Chapter Two

(6) Our so-called ‘universal healthcare’: the well waste money and the poor get sicker

 

7 Effective Ways To Avoid Injury Exercising

Group Exercise @ Healthy Fit, Fitzroy North

Supervised group training at Healthy Fit – professional supervision is a great way to reduce injury risk whilst exercising.

There are numerous benefits to exercise, but what’s often not mentioned in all the pro-exercise publicity, is that there are also risks involved, chiefly the risk of injury.

Many people, despite their best intentions to get healthier and feel better, actually end up unhealthier and feeling worse after injuring themselves pursuing their fitness goals.

Recently, I polled my personal Facebook account for stories of injury whilst exercising.

It didn’t take too long for my notifications to start pinging like crazy. Here are some of the responses I got:

went for a 7-8km run then stupidly tried to do a back session whilst fatigued. deadlifting with no energy then gave me a slipped disc and a very shitty year ahead.

it still niggles. its probably at about 85%. back in the gym but i never lift at more than about 60%. also trying footy again this year but am a little worried about getting a big bump. long car trips are also a horrible experience if i dont have a rolled uo towel to place on my lower back.

I was doing weight training and now my knees are stuffed!

Sore left glute early on in hockey season. Hockey is a right handed game (seriously) and a lot of players tend to develop niggles on the left side.

Buggered knee from years of over exertion bad form and bad knees

Yes many times mainly due to my strength being far superior than my mobility and flexibility at the particular time.

High volume squats. Poor form with my wrist. – sprain which eventually led to avascular necrosis of the lunate.
Heavy tb deadlift pb. Not enough food tat day and lifted too heavy given a lack of conditioning (hadn’t lifted heavy in 3 months) back injury – 6 months.

Back is fully recovered, wrist is permanently injured.

 

Not all injuries are created equally, however, and there were many stories involving accidents and trauma which I haven’t shared. Whilst little can be done to eliminate accidents, setting yourself up to exercise as safely as possible can greatly reduce your risk of injuries like the ones described above.

In my years of practice, and especially now being an osteopath based in a gym, along with almost a decade of personal training experience , I’ve learnt a few things about why people get injured exercising. A lot of the time, there is the perfect storm of preventable factors that combine to result in injury.

With that in mind, I’ve listed 7 ways to prevent injuries whilst exercising:

 

1. Make sure you want to exercise in the first place

Most people don’t think things through properly before they start.

When it comes to exercise, before you start, you have to know why.

Without a good reason to exercise, you won’t put in the effort to do things properly, which is a sure-fire route to getting injured, or you will, but the effort will be such a stress that it negatively impacts other aspects of your life.

Deciding to exercise will either have a positive or negative motivation behind it.

Positive: I want to be healthy and feel strong so that I can live a full life.

Negative: I don’t want to end up weak and frail and isolated in a nursing home.

Neither is right or wrong, but from experience, negative motivation only lasts so long. If it gets you going, great, but be aware that those that stick to exercise for life tend to have positive motivations for doing so. Don’t worry though, chances are you’re reasons for starting will be different to your reasons for sicking to it.

Exercise is fantastic, most people should be engaging in some form, but it is not essential to exercise to be healthy.

So if you chose to do so, know your reasons.

 

2. Learn to move well

This was almost going to be number 1, because, even if you don’t “exercise”, chances are you move.

Learning to move well is both simple and complex at the same time.

The knowledge behind the process is actually quite complex, but what you have to do is relatively simple. The key is to seek out an expert who has the complex knowledge but can provide you with simple, actionable steps to get you to move well.

Whether it’s an osteopath, a personal trainer or both, the initial investment in learning to move well will pay you dividends for life.

 

3. Know your weaknesses (and address them)

We all have strengths and weaknesses. Naturally, we gravitate towards our strengths.

Big strong people tend to like to lift heavy things. Tall and lean people tend to like to run, row or ride.

Of course, these are just generalisations, but the point is, if we only ever focus on our strengths, chances are we will limit our potential achievements and increase our risk of injury, as our bodies become ever more efficient at compensating until they can no longer.

Identifying your weaknesses is a tough thing to do. Most of us a terrible at looking at ourselves objectively. This is where it pays to hire a professional to tell you what you need to work on.

Not only will address your weaknesses make you more resilient, but your biggest fitness gains will come from improving your limiting factors.

 

4. Progress intelligently

One of the biggest predictors of injury is the ratio of acute to chronic training volume.

What the heck does that mean?

It means when you see a big increase in the amount of work done in the short term, relative to the amount of work done in the long term, then injury is more likely.

Put another way, you have to build up your tolerance to large training loads.

That means starting well within your capabilities and progressing gradually.

The 10% rule – not increasing total training volume by more than 10% per week – is a good general guideline to go by.

Start with an assessment to work out your current abilities, and then progress gradually, using different means of progression. Intensity, volume, frequency, rest, density and even activity/exercise selection are all variables that can be manipulated to provide progressions.

You should have certain indicators that help you identify when you are ready to progress – whether they are qualitative (rating of perceived exertion (RPE) scales) or quantitative (biofeedback like heart rate or power output). (1)

This will prevent your ego getting in the way and causing you to make to big of a jump too soon, which is a massive cause of injury.

 

5. Prioritise recovery

Everyone loves to train hard, not many people like to put in the effort to recover well. However, your ability to exercise is determined by your ability to recover.

Recovering means more than time off training. It means actively taking steps to relax and regenerate both your body and mind.

That means your nutrition and sleep must be on point, but also, your workload and personal life must be taken into consideration of your exercise load.

There are a few ways you can monitor you recovery.

Old school: keep a journal, track your mood and a RPE for each session. If your RPE is going up and your mood is going down, it’s a good sign you’re not recovering enough.

New school: Heart rate variability (HRV) apps. HRV is a way to measure your autonomic nervous system activity, which is a good marker of how stressed you are. You can download various free apps which will sync up with a chest heart rate monitor, whilst at least one can use your smart phone’s camera to measure your heart rate via your finger tip.

Recommended HRV apps*: EliteHRV,  ithlete, HRV4training (iPhone only) (2)

The best approach, which is also the most effort, is to combine a journal, RPE scale and HRV data. Initially, it won’t tell you much, but over a longer period of time, you’ll gain valuable insight to your physical and mental state, which will allow you to know when to push hard and when to back off.

Even if you don’t monitor your recovery status, simply allocating time for active recovery techniques is doing better than 95% of people.

 

6. Balance your training over time

Depending on your individual goals and personal characteristics, you will train in a way which builds particular physical qualities.

However, it is important for health and longevity to build all physical qualities to some degree – flexibility, mobility, power, strength and endurance.

Even if you are a highly specialised athlete, outside of your sport, all training is general in nature, and thus you should aim to improve a range of general physical qualities to minimise injury and maximise performance. If your sport is “the game of life”, then this only adds to the need to exercise a broad range of attributes.

Balance is more than being well rounded; you want balance between periods of hard training and periods of consolidation, which goes back to prioritising recovery.

 

7. Don’t chase fatigue

Anyone can make you TIRED. It takes a skilled professional to make you BETTER.

One of the biggest mistakes people make when exercising, whatever their motivation for doing so, is “chasing fatigue”.

This is a problem, because whilst how we feel on any given day is important, it gives us no insight into whether we are actually improving.

Additionally, chasing fatigue often results in compromising your movement in order to complete a given task, which is risky business to say the least.

This occurs because people associate with certain feelings, and a common association, often perpetuated by the mainstream media is that a workout has to be hard to be effective.

Now, of course, some exercise sessions will be tiring, that’s completely okay, but fatigue should be a by product of exercise, not a goal in and of itself.

You don’t always have to improve from session to session, or even in a straight line (pro tip: neither happen in the real world anyway), but, over a long enough period of time, you should improve at what you are doing.

The best way to know this is to keep a training journal, but if that’s too tedious, having “milestones” throughout the year where you test yourself are a good way to keep track on a macro scale.

8. (BONUS) Fit the exercise to your body, not your body to the exercise

Not everyone is built to run long distances or squat heavy weights with a barbell.

This goes back to knowing your weaknesses (and strengths), but you should choose activities and techniques that suit your body type and abilities.

If you like to run, that’s fine, but maybe marathons on roads don’t agree with your body, so instead, you try shorter distances or trail running.

Likewise, if the gym is your thing, build your program around exercises that suit your body, not what some article online says is the best “butt builder”.

Final Thoughts

Injuries can still happen, despite your best intentions, but there are lots of things you can do to minimise your risk, the above list covers 7 very important elements to consider.

A lot of them have overlap – doing too much too soon and not getting enough rest – and are generally brought about by not knowing any better (forgiveable) or getting emotional/letting your ego guide your decisions (not-so forgiveable).

Exercising should be enjoyable, not a chore, and this list isn’t meant to take the fun out of exercise, but rather, help keep you injury free so that you can continue to exercise in a way that you enjoy.

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 



Notes

(1) To read about a simple, easy to use RPE scale, as used by the Australian Institute of Sport, read this.

(2) I’ve only used EliteHRV, but the other two come highly recommended from other professionals I trust.