I’m sure you can think of many therapeutic exercises that are not appropriate for certain patients with axial pain. Most of the ones that come to my mind initially are higher level exercises; such as planks, prone-on-elbow manuevers or physio ball exercises.
These are for the more advanced and mostly for “out-of-pain” patients. We know not do prescribe these to certain individuals based on clinical experience, but I am going to dial it down a notch and write about simple exerices that are prescribed on consistent basis.
I have found two muscle groups that physical therapists usually concentrate on that are considered typical therapeutic exercise treatment approaches for either cervical or lumbar pain. If a layman or laywoman Googles an exercise, these will probably arise. They are also shown throughout the literature to be weaker, have altered neuro-muscular firing and needed to strengthen for proper posture & kinematics.
Don’t get me wrong, I think they are needed; but if implemented inappropriately, it can set them back.
Deep Cervical Flexors:
Refer back to a past post here on detecting strength and endurance of the DCFs, as well as if it is really needed anyway.
We typically strengthen this muscle group by using pressure biofeedback systems as ‘tucking the chin’, or even just actively as ‘taking the chin to the breastbone or Adams Apple’, but ‘dont protract the chin or lift occiput or whatever else can make this about the hardest exercise possible’ cueing.
If you have ever done this, even without pain, it usually isn’t comfortable at all and really, is it needed? There are a lot of studies saying the deep cervical flexors will work “right” when pain is abolished. I see that prescribing this exercise doesn’t make symptoms any better, but sets the patient back.
I am a big advocate for strengthening the glutes, especially gluteus medius; but ‘for every good, there is an equal bad’. As with DCFs, I feel strengthening this muscle group can have an adverse impact on low back pain if not implemented correctly.
Adverse effects can be due to incorrect form, body habitus or just because it is an extremely weak area and very strenuous for most to exercise it. Does an individual really need to perform SLR abduction 30 repetitions to fix their back? I really don’t have an answer, do you? No research to back it up, just what I see.
What are your thoughts? Any other exercises do you feel set the patient back? Do you see any correlation with the above statements? If so, how have you adjusted your treatment and if not, will you look for the cause-effect relationship now?