Training is Rehab and Rehab is Training

By: Nick Sienkiewicz, DPT, CSCS

Reshaping the Traditional PT Model

 Physical Therapy has been growing as a profession for the past couple decades, and for good reason! We have been intuitively treating sick or injured humans with forms of physical activity for a long time, but the contemporary occupation of physical therapy did not come around until the last century. During this time, our society developed various forms of formal exercise to maintain physically active lifestyles in our current modern world that breeds a more comfortable, sedentary condition. As exercise, sports, and the diverse options for physical activity have evolved rapidly, physical therapy has had to do the same.

Here’s the issue… It really hasn’t as a whole!

In our modern world, many people have become passionate about sports and recreational activities in their free time. This is great because it is easier than ever to be sedentary and sit on your couch all day, so enjoying a form of physical activity can help to offset the lures of present day civilization. In the presence of pain and/or injury, physical therapy serves a wonderful purpose of getting people back to the exercise that they enjoy doing. As we know an inactive lifestyle can be detrimental to your health, it is more important than ever that the field of physical therapy be performing at the highest level!

The word “training" in the world of health and fitness refers to one practicing and improving their craft, whether it be weight lifting, a team sport or other recreational activity. For the purposes of this blog, we are going to simplify by making the term, “training,” refer to resistance or strength training. The word “rehab” often means one is recovering from an injury or currently receiving physical therapy treatment. Training and rehab are mostly thought of as separate entities. An individual is either training or rehabbing. You cannot do both at the same time. That would be madness. You would surely implode into another dimension (I’m being facetious clearly!!)

The concept of training and rehab must be thought of as a spectrum. You simply fall on one spot on the spectrum at any given point in time. The position on the spectrum could change by the week, day, hour or even minute depending on the individual and a variety of factors that are unique to him or her. What this really means is that training and rehab are intimately intertwined. Someone could be more toward the rehab end of the spectrum because of an injury. Or maybe work has been busy so he or or she has gotten less sleep and nutrition has been suboptimal recently, shifting the individual more along the rehab side. It does not mean he or she is injured. It just means this individual’s body may not be able to tolerate the normal strain it is accustomed to through physical activity because of other life stresses. There is more at play here than just simply injured or not, painful or pain-free.

It truly boils down to capacity vs. demand. We must assess what capacity an individual’s body has currently and compare that to the demand of their lifestyle and recreational activities of choice. If one’s demand is surpassing his or her capacity, then that individual currently falls more on the rehab end of the spectrum at this point in time. On the contrary, if your capacity is greater than your demand, you are currently more on the training end. That means you can take on more demand, and if you want to progress more (aka play more of your sport, lift heavier), you must make sure you gradually increase your body’s capacity before abruptly upping the demand.

Through this model, you can see how interwoven rehab and training are, and begin to get an idea for where you fall on the spectrum at this point in time. There is where traditional physical therapy often fails when it comes to getting people back to doing what they love to do. For example, if someone enjoys golfing, but we never address and build capacity back for their trunk rotation, we have not adequately prepared their body for the demand it will be undergoing tomorrow. This is not okay! With this individual, the rehab process may start slow and steady, but should gradually progress to more of what would often be considered training through the modern lens. That way this person’s body will be challenged in a fashion that will match the demand he or she will experience on the golf course, or in any other athletic endeavor the individual pursues.