You just spent twelve weeks doing physical therapy (PT) for your injury and your doctor finally gave you permission to return to your regular training schedule. Yes! While it may feel great to get back to your fitness routine, it’s essential to stick with your physical-therapy exercises.
“Patients who ignore their discharge orders to keep up with PT exercises risk losing everything they have gained from physical therapy,” says Helen Dallaris, the director of Burke Rehabilitation. “You’ve put in all that time, effort and perhaps some discomfort to regain your mobility, strength, range of motion and to reduce physical pain. You risk losing it all.”
We asked the experts and found three major setbacks that can happen if you stop your PT exercises prematurely.
1. Experience re-injury, a new and more severe injury and long-term effects.
According to American Physical Therapy Association (APTA) spokeswoman Alice Bell, PT, DPT, GCS, there are two roles to physical therapy; one addresses the immediate injury and the second promotes recovery and long-term injury protection. “If an individual only commits to the first phase of therapy but fails to commit to the life changes necessary for sustainable performance, it is more likely they will re-injure or experience long term-effects associated with the original injury,” she states.
“The body undergoes natural and progressive stages of healing and the timeline for full, injury recovery differs for different tissues in the body,” states Karen Friel, PT DHS. “During the various stages of healing, if either insufficient stress or too much stress is placed on these vulnerable tissues, the body will not adapt appropriately to heal properly. This makes the possibility of re-injury greater. By ending therapy prematurely, the tissues may not be able to accommodate the forces placed on the body when returning to a full level of activity.”
And Stephen Chao, PT, DPT, CSCS, reminds us that physical therapy is not only about working on short-term, injury recovery. “Essentially, remember that rehab and PT is a process with stages, and ending early can risk missing an essential stage which can add to your risk in the future,” he states. “Certain conditions which are long-term and degenerative, i.e. Parkinson’s disease or arthritis, are always going to be trying to chip away at our function. This means that you need to combat this constant degeneration with diligent and frequent adherence to your PT home exercise program.”
2. Lose strength, balance and all gains made.
When you start feeling relief from your symptoms, this is when you need to concentrate on your PT exercises the most, according to Brian Schulz, M.D., orthopedic surgeon and sports medicine specialist at Kerlan-Jobe Orthopaedic Clinic. “Improvements can be lost if a maintenance program is not followed because the patient can fall into the old habits or redevelop muscular imbalances that may have led to, or is a risk factor for, the initial injury,” he states. “This can lead to reoccurrence of the same injury, or even worse, a new injury that is more severe than the initial event.”
In fact, you can start to lose your muscle strength within two weeks of discontinuing your exercise program, per Michelle M Gant PT, MPT, OCS of Akron General Edwin Shaw Rehabilitation. “Re-injury is likely to occur; perhaps worse than the first time, and it can become a chronic issue,” she states. “Tendons and muscles adapt through specific training, preparing you for return to your favorite sports and workouts. Continuing the individualized program designed for you can prevent joint degeneration and chronic issues.”
Other experts agree. “If continued activation and recruitment of these muscle is not consistently reinforced and advanced, the body will naturally revert to previous movement patterns,” states Albert Bednar, Total Body Physical Therapy Director of Physical Therapy. “Ultimately, the same compensations and imbalances that were created in response to the body’s initial injury may return along with the symptoms.”
And Jacon C. Chun, MPT, SCS, ATC, CSCS Clinical Specialist at AlterG, reminds us that “returning to recreation and activities of daily living without full range of motion, strength, or balance, sets the person up for re-injury in the future.” “Adding load or repetition when the body’s movement capacity is not optimal opens up the potential for overuse injuries like sprains and strains,” he states.
3. Scar and be unable to heal.
In addition to avoiding muscle imbalances, PT can also help your body prevent scarring and heal tissues. But these particular exercises usually happen later in the healing process. “Depending on what is injured (bone, muscle, ligament) and if it has been surgically repaired or not, some exercises are not allowed early in PT because they would place too much stress on the healing tissue,” states Matt Holland, a physical therapist at Houston Methodist who also works with the Houston Astros.
“There are also specific exercises to help promote collagen healing and reduce scarring, many of which are not initiated until long after ‘formal’ physical therapy has been stopped,” he states. “Proper timing of exercises following this healing continuum are critical to the overall outcome.”
Stop Sabotaging Recovery!
Unfortunately, many people stop their PT sessions due to limited health-insurance and lack the motivation to continue home exercises. But this is when it’s essential to continue. “Being discharged from a physical therapy program doesn’t often mean a person is completely done, it often means they’re just done with that phase of the rehab program and need to continue at home on a long-term basis to help ensure favorable results,” states Dr. Samuel A. Mielcarski, DPT, a licensed physical therapist and wellness consultant.
You may feel better, but your body is still healing. “Generally speaking it can take one to two years to maximally heal and recover from a significant extremity injury,” states Glenn D. Cohen, M.D., a hand surgeon certified by the American Board of Orthopedic Surgeons. “Curtailing a home exercise program prematurely can negate the gains made while supervised. Continuing physical therapy exercises will guarantee the best, possible outcome.”
The process may seem slow and arduous, but the good news is that your PT exercises will lessen over time. “Ideally, if the patient has been taught how to use their body better in conjunction with these exercises and has embraced those changes, they become less important and may need only be done occasionally to remind the brain of a better way of moving,” states. Rick Olderman MSPT, a sports and orthopedic physical therapist, author, speaker, and personal trainer.
Instead of stopping your physical therapy exercises upon medical discharge, keep going. After all, “the exercises are not only designed to heal injury but to maintain and increase a person’s ability to live a full life,” states Stacy Jaffee Gropack, PT., Ph.D., FASAHP, acting dean of the School of Health Professions and Nursing at LIU Post.
Now, what PT exercises do you need to do today?