As a physio giving out exercises is not just what people expect of us, but we do give them out a lot. Strength is one of many reasons we might give out exercises, but there is strength and strength. Traditionally physiotherapists give out exercises that offer resistance to the concentric action of the muscle, it was certainly what I was taught at Uni. When John Hardy and I developed functional therapy we built it on the principles of function, which to a large degree make the traditional concentric exercises redundant.

A common example of this can be found when treating Total Hip Replacement (THR) patients. They commonly come to me a few months after their immediate aftercare, with a referral of ‘further strengthening’! Of course I am more than happy to treat these patients because within a very short time they are responding extremely well and think you are a magician. However, I’m not a magician…it’s just not strength training, it’s function. These patients will invariably come in with a trendelenburg gait and will have been told to strengthen the hip abductors on that side (always the side of the operation). Post-op exercises are all concentric, traditional exercises either in lying or standing. The patient will show you these and say ‘I’ve built up to X number of reps with X seconds holds, but my walking isn’t improving’. If they’ve seen physios before they will have the ‘clam’ exercise and will have built up the resistance to the toughest band, but still no change in gait pattern. It sounds obvious to say, but I see it so often, maybe it isn’t obvious. They have the strength, but they can’t use it.

So as soon as I see them they start on a simple modified 3D pivot matrix, which, depending on their age/ability, will challenge not only their strength, but also their balance.
A patient I saw a few years ago fitted this example exactly (like so many), however, I only took over his care for his last two sessions. He showed me all his exercises (all in lying positions) and his piece of the strongest theraband (I hate resisted clams!). He had the worst Trendelenburg ever and was forced to use two sticks. He was frustrated, because he had clearly stuck to the exercises religiously, but no change.

We spent 10 minutes learning the modified pivot matrix and 5 minutes going through a serious of squats in a variety of foot positions. I asked him to walk without his sticks up and down his kitchen: he had a marked reduction in Trendelenburg and couldn’t believe the difference in just 15 minutes. He continued with his new exercises for a few weeks and 1 more visit and when I last saw him he was using 1 stick for confidence when he left the house, but was much improved and very happy.

It’s simple, but devastatingly effective: there’s strength and there is strength. You can make a muscle as strong as you want, but if your body doesn’t know how to use it progress will be limited.

Please feel free to ask any questions and post any comments.