Physical Therapy Timing

Why The Timing, Sequencing, And Supervision Physical Therapy Exercises Is Important 

By the DPTs of Premier

Introduction: 

The timing, sequencing, and supervision of exercises are the most important factors in your rehabilitation program. Your rehabilitation program is a finely tuned sequence of physical therapy treatments designed to promote healing of the damaged tissues. Rehabilitation IS NOT just a few of the “best” exercises in a random order spread out throughout the day, using a massage gun, stretching, etc.

Common Mistakes:  

• Poor timing and sequencing: Spreading out exercises throughout the day rather than at the same time (unless specifically told to do so by a DPT) or picking only a couple of exercises to do (our DPTs design a program for you the same way you would have a program in the gym or with your trainer; volume, intensity, tempo, and rest breaks are a part of both).
• Lacking supervision: Finding exercises on the internet/social media and winging the technique. This is risky as poor performance can promote continued pain and poor movement. We do go to school for a long time to understand the anatomy, physiology, and biomechanics of the human body. Please…let us help you!
• Warming up without follow-up: Warming up, performing self-massage, mobility work, stretching, etc., or doing a couple of exercises for 10 minutes at home an hour before coming into the clinic. This is like waking up at 6 am on a cold day, warming your car up for 10 minutes, then turning it off for an hour and expecting the car to still be warm and ready to go. Your body works the same as you have a short window after warming up to optimize your movement. Like we said, timing is everything!

How A Doctor of Physical Therapy Creates Your Plan of Care  

In general, a DPT will perform a physical, orthopedic examination that teases out the source of how you developed your pain, weakness, stiffness, etc, and then builds a specific rehabilitation program that progresses into a performance program.

The first step in a physical therapy visit is determining if your pain is primarily due to a restriction in mobility. Restrictions can develop from a tight muscle, stiff joint, nerve tension, or some other musculoskeletal structure that just doesn’t move well. We will use hands-on techniques to address this restriction, and if it helps, will eventually teach you a way you can do this on your own. Improving restrictions in soft tissue gives us a short window of opportunity as it prepares your body to recalibrate high-quality movement patterns.

Next, this is where supervision becomes extremely important as we will teach you how to achieve your optimal movement pattern with your new mobility via neuromuscular reeducation, or NMR. We will use various cuing techniques to correct movement errors slowly developing your understanding of better, more efficient control of your body.

NMR is where a DPT will give you a specific movement, typically the one you describe as painful or uncoordinated, and will guide you through it with hands-on cuing to desensitize you to this movement.

Ultimately, this is where the timing, sequencing, and supervision merge in perfect harmony as you will be mobile, stable, coordinated, and less fearful of movement. It will then be time to put some weight in your hands and load up that movement and build strength and resilience.

Conclusion: 

In conclusion, it should be clear that physical therapy is a dynamic process and can change daily based on a myriad of things such as how you feel at the specific timing of the start of your visit or home exercise, how quickly you can learn new motor skills, programming your homework, and retaining concepts in rehabilitation that you need to continue applying long after you are discharged. The timing of generating optimal movement patterns should be performed in a specific mobility window to solidify that new movement in your brain and resilience is built by adding load in that same window.