Crazy Things In PT: Stupid Exercises

Welcome to our series on “Crazy Things In PT.” You can find other posts in the series via these links – Outdated InterventionsPostural Restoration, Crazy Manual Therapy. Before we begin, here’s a little note from the management:

These articles are intended to show some of the things currently done by physical therapists around the US and around the globe. There are many very well meaning PTs out there and we are not in this to shame or accuse specific people of evil motives, only to expose specific theories and/or interventions in physical therapy. We acknowledge that patients do get improvement with some of these techniques, but strong claims call for strong evidence to back it up. Remember, some people do get better after taking a sugar pill.
Individuals will be used as examples from their own videos or published articles, but in every case we will use as much of their own material as possible so they can speak for themselves. Oh, and this is not an educational/research site, so if you have a problem with satire you should just move on.

Oh boy. The sacred cow of physical therapy…exercise. Truth is, some exercises are just stupid. And for this post we’ll be focusing on stupid exercises, corrective exercises, and things that loosely fall under the term “exercise.”

The Shoulder

Let’s get something out of the way right now, is there anything more stupid than the “empty can” exercise? First off, it’s unnatural. Second, for many people it’s painful. Third, it’s stupid.
Empty can ex
If someone has pain with a combination of shoulder internal rotation and elevation, maybe you shouldn’t have them do it as a strengthening exercise! Think, just a little.

While we’re talking about the shoulder, let’s talk about a really popular stretch given to many people having trouble with internal rotation. I’m talking about the “sleeper stretch.” The crazy thing is, if you do this “stretch” to a person while they’re sitting up, it’s called a Hawkins-Kennedy impingement test. How many tests for shoulder pain do you make into exercises? Think about that for minute. Plus, look at how dumb this is, even this cartoon guy is pissed off about it.
hawk ken test

My last shoulder exercise is the shrug. I know soooo many PTs that give their post-op shoulder patients shrugs as an exercise for their home exercise program. WHY?!?! Seriously, have you ever seen a post-op shoulder patient try to lift their arm? All they do is fire that trapezius muscle. In many people, it’s so excessive that you have to really work to get rid of this “shrug sign” so they can lift their arm over their head! Is it really a good idea for them to work this muscle MORE?!

So what should you do? Give them this exercise, so they can tell you what kind of therapist you really are, you loser.
loser

The Core

Can we talk about stupid “core” exercises? If you patient requires maximum verbal and manual cues to perform the exercise correctly, do you think they’re EVER doing it correctly at home? If they can’t perform an abdominal brace in hooklying, with your constant cues, with the soothing sounds of Kenny G in the background, do you think it’s something they’ll be able to do while doing anything remotely functional? Here’s an inside tip: the only time Winfred is doing them is when he is on the crapper…and he’s holding his breath…let’s say a prayer right now that he doesn’t have a stroke. Don’t die on the toilet Winfred.

Are you having your patient do extension exercises? Do they know that the only way to have a strong back is to also have a really dumb looking spray tan? Seriously, take a second and do a Google search. This is what you get.
spray tan optional

The Legs

Are you one of those PTs that tells your patient that their knees should never go ahead of their toes? If so, I’d love for you to show me how to get up out of a chair or go down stairs. There’s a different between trying to use your glutes more and being realistic and functional.

Plus, you don’t have to do exercises to have a great ass. All you have to do is go to a gym, anteriorly tilt your pelvis, and take a selfie.
selfie glutes

Stool scoots. For making your patient be the best damn office chair racer in the company. Really, this exercise may engage the hamstrings, but it’s in a limited range of motion and there’s no chance of your patient doing this at home. This might sound crazy, but squats and lunges work the hamstrings pretty damn good.

Quad sets. If your patient isn’t immediately post-op and you have them doing quad sets every visit, you need to retire. Just stop being so stupid.

Any. Damn. VMO. Exercise. Seriously, stop having people try to isolate their VMO. It’s not how the muscle works. Ever. Consider these two very contradictory exercises that “isolate” the VMO.
vmoband

vmoball

Does rotating your hip when you squat/lunge/perform a quad set really change which part of your quads are engaged? Is that what you think happens?

This Is The Most Important Part Of The Post!

Gotta end this somewhere, so this is the best place. If you have your patient do the same amount of reps, with the same weight, for different exercises targeting different muscles, you are a stupid therapist. 10 reps of shoulder external rotation is very different than 10 reps of shoulder abduction, so why would they do the exact same amount of reps at the same resistance?! What are you trying to accomplish? Do you know how strengthening happens? Are you doing anything of significance? Or are you just trying to fill up the time slot so you can bill that extra therapeutic exercise code? Use your damn brain. Take a refresher class on exercise science if you need to. The profession needs you to not be a shitty PT, otherwise you drag the rest of us down with you.

shitty PTs

Advertisements

15 Comments

Filed under Crazy Shit, Physical Therapy

15 responses to “Crazy Things In PT: Stupid Exercises

  1. Jeancarlo Alencastro

    Hilarious post and very true regarding shoulder shrugs for shoulder post-op. I don’t know many therapist recommending sleeper stretch for shoulder pain if it’s impingement.

    Like

    • steve joseph

      About time it was said. Sad to say that I encounter clients that have been from other PTs in my area wanting to know why they were given incorrect exercises. I’m not saying that I haven’t been guilty, on occasion, of adopting an exercise or two that was popular back in the day, only to realize later that I was not helping but hurting the rehab process. That being said, I hope everyone that reads this takes a minute to reassess and get off their lazy butts, get off the cookie cutter program and do some real good. Once they stop laughing that is. Nicely done.

      Like

  2. Doc P

    I like a lot of what you posted. However, the knees over toes thing is wrong. You should avoid excessive knee bend over toes. It is more a preventative cue. You might need to revisit physics and joint mechanics before making a profound statement like that. Although you are right about step downs, you are wrong about squats and sit to stands. If you can’t get out of a chair without your knees going over your toes, you might want to start strengthening your legs.

    Like

    • You should encourage increased hip flexion. But I think you’re the one who is mistaken on physics. Watch someone perform a deep squat.

      It’s something we’ve been taught, but why? Just an observation on my part.

      Like

      • not a doc, really don't care

        It reduces the compressive force vector of the patella on the knee joint. A better verbal cue may be “push down your heels”. The idea to avoid excessive knee flexion and unstable weightbearing on the forefoot.

        Like

      • Again though, there’s research to show deep squatting isn’t bad for your knees. I’m open to learning new stuff, but this is one thing that might sound good in theory but be a non issue in reality.

        Like

      • Bill

        Knee break only squats are stupid. Hip break only squats are stupid. You need to do both. I think too many people fear the knees traversing the toes to the point where they can’t load their quads anymore. This is bad for people with weak quads. My other problem is people who won’t use knee extensions for people with weak quads. Open chain 2 months after surgery is not dangerous if you program in a smart way.

        Like

      • Agreed. Time and place for just about everything…Except empty can exercises.

        Like

  3. Pingback: Crazy Things In PT: Crazy Manual Therapy Techniques | The Awesome Physical Therapist

  4. Pingback: Crazy Things In PT: Postural Restoration | The Awesome Physical Therapist

  5. Pingback: Crazy Things In PT: Outdated Interventions | The Awesome Physical Therapist

  6. Pingback: Reasons Why Physical Therapy Doesn’t Work Sometimes | Dynamics Physical Therapy and Performance

  7. coach

    Problem with open chain knee extensions is inaccurate proprioceptive input. Quadriceps never extend the knees in upright human function without the feet also being on the ground, along with the hamstring and hip muscles for patellofemoral control.

    Like

  8. Hahaha. I still remember being taught to teach exercises exactly like you mentioned in the post in PT school. I find myself refresh my clinical beliefs every few months in practice. This field is advancing so fast to new theories and research results. Catching up is indeed a lot of work and requires passion for what we do.

    Like

  9. Matt

    Wow, how refreshing and rare. A PT who thinks critically and who asks why. Why are we doing this? Does it make sense? Very rare, a PT who actually justifies with reasoning their treatments..

    Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

w

Connecting to %s