As an Osteopath in Guernsey, I am often questioned by patients about my tendency to prescribe exercises and stretches as part of my treatment plan. In my clinical experience, exercise often carries a negative stigma among patients who have misled beliefs about Osteopaths being some kind of body mechanic who instantly fixes or ‘realigns a joint that has suddenly gone wonky! Unfortunately these unfounded concepts about realigning hips and spines are still perpetuated by some practitioners. What we tell patients about the body is essential to the advancement of our profession and can make it more challenging for practitioners who try to involve patients in active therapeutic treatment such as structured exercise therapy.
Unfortunately in my clinical practice the majority of patients I see don’t participate in regular structured exercise and often associate it with hard work, low self-efficacy and discomfort. So much so that I have often tried to stealthily incorporate it into their activities of daily life without putting them to too much extra effort. At a time when exercise as a therapeutic modality for pain is being hotly debated in the world of musculoskeletal medicine, the line between exercise and activities of daily life seems to be far more obscure. Therefore I think it is important for people who seek help from musculoskeletal therapists to have an appreciation of the highly therapeutic benefits that structured exercise provides, over and above day today activities of daily life.
One of the main questions I ask patients in order to get a general idea of their musculoskeletal health, is – do you do any regular exercise? Surprisingly most people answer yes, however, only a few answer with a certainty that reflects a real recognition of structured exercise. Most yes’s are far less convincing and are usually followed by a description of, what I would describe as, domestic and occupational activities of daily life. I want to be clear when I say that activities of daily life can contribute significantly to better health, however when musculoskeletal pain arises it is often a warning to move differently or pay attention to certain areas of the body with more deliberate, structured and progressive movement.
In many of the patients I see, it is repetitive daily activities (that are often described as exercise), performed without an awareness of the body’s postures, which contribute to pain. In the name of specificity and function, many practitioners would argue that a patient’s therapeutic exercise should just be an amplification of movement patterns performed during their daily tasks. However, people who don’t really move much at all, often have poor body awareness, so asking them to perform exaggerated and controlled movement patterns that reflect their daily activities may be initially too complex. These people may gain more benefit by firstly participating in very simple structured movement patterns that focus on specific areas of the body in a controlled range, rather than doing more of the stuff that has already caused physical stress and pain. Simple, structured and repetitive exercises provide an opportunity to be completely present with the body and develop a relationship with movements that both hurt and heal. Additional benefits of intentional and structured exercise include improved breathing, tissue perfusion, muscular relaxation, proprioception, coordination, self efficacy and exercise induced analgesia.
When performing activities of daily life, are we really thinking about the quality of our movement, posture, breathing etc, or are we just focused on completing the task in hand? Generally, we perform activities of daily life with little regard for therapeutic effect and with the aim of conserving energy. This can result in poor postures being adopted, and repetitive stress through certain structures as the body looks for the easiest and most effortless way of completing the activities at hand. This style of movement (often regarded as exercise) can compound stress on more vulnerable areas of the body and contribute to pain.
Exercise and physical activity have a lot in common, however therapeutic exercise is a subcategory of physical activity that has been characterized as structured, repetitive and purposive with the objective of maintaining or improving components of physical wellness  . Therapeutic exercise doesn’t require lots of time or effort and can be easily adapted to an individuals level of tolerance, so from a patient perspective, tailored exercise should be expected as part of a comprehensive treatment plan. In addition, I believe every Osteopath should be enthusiastically promoting active participation in treatment by both endorsing and prescribing therapeutic exercise within most, if not all, treatment plans.