Physiotherapists should have a sound knowledge of strength and conditioning(S&C) training, especially those practising musculoskeletal or sports. However, when we mention Strength & Conditioning and rehabilitation, many attribute it as only for Sports Physiotherapy and that it should be a part of post-graduate study. I beg to differ on this. This is the crucial element missing from the profession’s basic training. In a conference, I once questioned why it’s not in our basic training. I was put off by a senior professor that it is not needed in the basic training and that it will overburden the students and said it wouldn’t do anything for physios in their practice and that S&C principles don’t apply to people in general rehab. As a Physio with 20-plus years of experience in rehabilitation, I find it unacceptable.
For some reason, we, as Physiotherapists, seem to get into the mentality that rehab and strength and conditioning are mutually exclusive. Thinking that strength and conditioning principles do not apply to the rehabilitation setting is incorrect. Physiotherapy and strength and conditioning go hand in hand. After all, it is integral to the Physiotherapist’s role to plan long-term rehabilitation and maintenance programs for acute and chronic injuries. We forget that muscles are muscles, and they respond to stress. We forget that certain principles work more effectively for specific outcomes like strength, endurance, and skill refinement.
Physiotherapists should start studying the foundations of strength and how to properly implement these strategies to see marked and sustainable results for their patients.
I learned what I know about strength and conditioning, mainly through independent study of this area and my experience working as part of a CrossFit gym. I am in no way claiming to be above any other of my fellow physios in having such knowledge; the important point is that those of us who have acquired it have done so through mechanisms other than our physiotherapy training. And I would like to caution that many physios practice without such knowledge.
So, what is strength and conditioning?
Strength and conditioning training covers a broad range of skills – strength, power, speed and agility, endurance and flexibility training and recovery methods – the significance of each varies according to the athlete being trained and their sport. All the above also applies to ADLs and the functions of the general population.
As a Physio, we need to understand the purpose of different exercises, exercise techniques, correct programming for different sports, for different populations, phases of training and individual circumstances, and the detail of how, when, and why to vary instructions on the performance of sets, repetitions, frequency, volume, and length of rest periods.
Three key elements
The key three elements of strength training – exercise technique/Specificity, progressive overload, and progression – are also critical to the competent practice of physiotherapy.
For example, if I teach how to do a squat (a Functional movement pattern) to an athlete who underwent ACL recon or a non-athlete patient with Knee OA, I will need to teach them proper technique and program the exercise. It will differ for both populations. Many Physiotherapists still do not know the type of squat or teach how to squat based on whatever clinical reasoning of the patient in front of them. So, if they can’t teach a double-leg squat, they surely can’t teach a single-leg squat, and we can wonder how Physios are rehabilitating someone with knee, hip, or lumbar condition. We will need to apply SAID (specific adaptations to imposed demands). The body adapts in a highly specific way to increased demands: the precise input will determine the precise adaptation. We need to progress and regress based on the response from the exercises.
Hence, the sequencing of exercise and treatment interventions can greatly impact Physiotherapy. Purposeful selection of exercise type, volume, and intensity can also be extremely valuable components of a well-designed rehab program
How many of us know the breakdown of the principles of Strength training, such as Sets, frequency, rest time, and volume, which are important variables in strength and conditioning programs for rehabilitation? Let us briefly examine it to understand what we have not been programming in our rehab process.
- Sets: Sets refer to the number of times an exercise is performed in a training session. In rehabilitation, sets may vary depending on the individual’s goals and physical capabilities. For example, someone with a lower back injury may start with 1 or 2 sets of 8 to 10 reps of exercises to strengthen the lower back muscles.
- Frequency: Frequency refers to how often the individual performs the exercise or training session. In rehabilitation, the frequency may vary depending on the individual’s goals and physical capabilities. Generally, individuals in rehabilitation may perform strength and conditioning exercises 2 to 3 times per week to allow for adequate recovery time.
- Rest time: Rest time refers to the time between sets or exercises. In rehabilitation, rest time may vary depending on the individual’s goals and physical capabilities. For example, someone with a shoulder injury may require longer rest periods between exercises or sets to prevent further injury and allow for adequate recovery.
- Volume: Volume refers to the total work performed in a training session. In rehabilitation, the volume may vary depending on the individual’s goals and physical capabilities. For example, someone with a knee injury may start with a lower volume of exercises, such as 1 or 2 exercises per training session, and gradually increase the volume as they progress in their rehabilitation.
Overall, sets, frequency, rest time, and volume are important variables to consider when designing a strength and conditioning program for rehabilitation. These variables can be adjusted based on the individual’s goals, physical capabilities, and progress in their rehabilitation. We need to move on from just programming a three sets X 10 reps exercise if we need to do justice to our patient.
So, knowledge of the fundamentals of strength and conditioning is essential in programming the exercises and incorporating them into the rehabilitation process.
Additionally, strength and conditioning can help increase your cardiovascular, skeletal, muscular, and mental health so that it can do wonders for your general health and well-being. For example, strength training will increase the strength of your muscles and bones and is known to help improve bone density. It can also improve your posture and mood while increasing your muscle mass and metabolism, so strength and conditioning are very important.
It’s time to acknowledge Strength & Conditioning in Rehabilitation
It’s time for my fellow Physios to recognize and acknowledge the importance of strength and conditioning in our practice. Remember that exercise is medicine, and the dose and timing make the medicine effective. We have powerful prescriptive authority in this area, and it’s our job to determine the effective dose.
Where can you learn Clinical Strength and Conditioning?
IF YOU WANT TO KNOW MORE ABOUT HOW YOU CAN APPLY THE PRINCIPLES OF STRENGTH AND CONDITIONING IN YOUR PRACTICE, YOU CAN JOIN OUR APTER Institute WORKSHOP TITLED
“CLINICAL STRENGTH AND CONDITIONING FOR REHABILITATION PROFESSIONALS”
Dr. Mohamed Kassim, PT
Co-Founder, APTER Institute