Prohibitions in physiotherapy and training – why this is not good

In the field of physiotherapy and training, there are numerous recommendations that can often be equated with prohibitions. Such statements about what you should do to achieve goals such as building strength, increasing endurance or reducing body fat create a lot of uncertainty, fear and even failure. Whether it’s avoiding certain exercises or training methods, bans can do more harm than good.

Patients often come to us and mention:
“He said I’ll never be able to ski again and I should accept that!” or “I was told I’m not allowed to lift weights during pregnancy?” or “Jogging is bad for your knees, isn’t it?”

Let’s take a look at a concrete example. Lisa* comes to us. She has been suffering from knee pain for two years and has not yet had a satisfactory treatment result, in fact there is not even a proper diagnosis. She was told “Don’t do squats because they hurt and crunch in the joint. Don’t do these exercises for a while and then you’ll feel better”. No sooner said than done. Lisa is actually feeling better. The swelling has gone down and the pain has virtually disappeared. She starts strength training again. One day later, the swelling is back and the pain is even more intense than before. What did the ban achieve? Nothing. On the contrary, Lisa is now very frustrated and, above all, confused. What would be the better course of action?

Let’s come back to what happens when prohibitions are imposed on patients and customers. And then what could be done instead.

1. individual needs are ignored

Every person is unique, and this also applies to the body’s needs and response to different treatment and training methods. A ban on not performing an exercise, for example, could be unnecessary and even counterproductive . Prohibitions neglect the individuality of the exerciser and often lead to important aspects of the training not being used. Besides, how can we forbid someone who is passionate about jogging and needs it as a mental balance just because someone once claimed it leads to osteoarthritis? (The fact that this is not the case is another matter). Or how realistic is it to forbid an 80-year-old from using extra weights for exercise when she lives alone at home and has to carry the laundry to the cellar? Instead: Take a closer look at the patient, inquire about the surroundings, look at the overall picture. Offer modifications to make a certain exercise easier for the time being, if necessary, until mobility is better or the pain is less.

2. psychological effects

Prohibitions can significantly reduce motivation and the enjoyment of training. If someone is told that he or she is not allowed to do a certain exercise, this can have a mental impact. And that leads to a negative attitude towards exercise and poorer health. When exercise goals are linked to prohibitions, a sense of fear and frustration can take hold, leading to long-term avoidance of exercise. Anxiety increases further, which often leads to a deterioration in general health. A vicious circle. Instead: Define goals, find compromises that don’t harm the body or the mind.

3. lack of flexibility and adaptability

A “forbidden” training regime can lead to important aspects of training not being tried out. This limits the versatility that is often necessary to overcome plateaus or make new progress. If you only ever do the same things, you won’t see any progress in the long term. Prohibitions prevent people from functioning in everyday life. Instead: Treatments and training should be a dynamic process that adapts to the development and needs of the individual.

4. promotion of extreme positions

Another problem with bans is the tendency to take extreme views. Instead of taking a balanced approach, some tend to think in black and white categorizations: “This exercise is bad and should never be done”, “Fat should be completely eliminated from the diet” or “Only very high weight training is effective”. Instead: Be open to new ideas. Always ask questions, listen and discuss, look for a solution together. Keeping up to date with the latest research findings.

5. risk of injury and chronic complaints due to incorrect alternatives

If certain exercises are prohibited, often no good and well thought-out alternative is offered. Instead of providing a safe and effective alternative to a prohibited exercise, this could lead to false compromises that even increase the risk of injury. If only a limited number of exercises are allowed, the body could be subjected to one-sided stress. Instead: Modify treatments and exercises. Do not leave out. Try to do fewer repetitions, incorporate more breaks, find other starting positions until you get better.

6. avoidance behavior and leaving the comfort zone

Physiotherapy and training should encourage you to challenge your body and push it to its limits (with caution). If you avoid certain techniques or exercises as a matter of principle, you prevent yourself from developing and learning new skills. Of course, some exercises are challenging and not everyone has the necessary strength or technique to begin with. However, the exercises that cause problems may be the ones that are the cause of the condition. Instead: Pushing the limits, stepping out of your comfort zone, always taking your health into account.

Conclusion: Treatments and training should be based on knowledge, not on prohibitions

Instead of establishing a rigid set of rules with prohibitions, the focus should be on understanding and individually adapting treatment and training techniques and making recommendations. A flexible approach based on goals, abilities and health condition is the key to sustainable success.

Ultimately, training is about learning and development – and this is best achieved without restrictions that hinder the natural development process.

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Physio Restart attended the 38th annual congress of the Society for Orthopaedic Traumatologic Sports Medicine (GOTS) to find out about the latest findings in sports medicine .

The congress is a meeting of all members and interested persons in sports medicine, including doctors, physiotherapists, trainers, sports scientists, nutritional therapists, etc. Over three days, various topics will be addressed, with experts giving an insight into their work and the state of scientific research. There will be discussion rounds and the opportunity to expand your network. There will also be an opportunity to get to know the latest products that may be relevant to us in practice at the industry exhibition. We also find it exciting to look into the work of the doctors so that we know which surgical techniques they may use on our patients.

Below you will find a brief overview of the program items.

Top topics

• Sports injuries from head to toe – from prevention to diagnosis and treatment
• Focus: cycling, triathlon, Olympic martial arts
• “My most difficult case in sports orthopaedics/traumatology”
• Sports physiotherapy and sports science
• Competition medicine
• Ethics and safeguarding in sport

Further highlights

• Updates from the GOTS Committees Spine, Prevention, Pediatric Sports Orthopaedics, Register, Functional Diagnostics, Muscle/Tendon, Concussion, Disabled Sports
• GOTS meets Scientific Partners
• Top international athletes
• Hands on workshops and instruction courses
• Nutrition strategies in sport
• Re-Live-Surgery

Another highlight for us was the visit to the Coque: Coque Luxembourg – piscine, sauna, fitness et hôtel au luxembourg with the Young Academy (picture below).

The Coque is the national sports and cultural center in Luxembourg. At the moment, they are still building the recovery center, where there will be a cold chamber, saunas and other facilities to promote regeneration. At the Coque, we were given an insight into performance diagnostics: into the strength area with instructions on how to perform the squat with a barbell, into bike training in an altitude chamber, how to measure lactate on the ergobike and how to set up change of direction training as a return to sport on the speed court.

Right: Speed Court. Practical tool for training control when it comes to returning to sport (braking, accelerating, changing direction)

Left: Strength area where we learned / repeated the techniques of the squat with the barbell.

On Thursday, Anneke took part in the first aid course, which gave her theoretical and practical instructions on resuscitation and defibrillator training on the sports field (we still hope never to have to use this, of course). It is important to know what we can do in an emergency and we therefore see it as our duty to regularly educate ourselves, especially about the practice.

Finally, we visited the IRONMAN 70.3 Luxembourg – Région Moselle – Anything is Possible. Oliver took part as a relay team, together with Nicole and Elena. Oliver completed the 3rd discipline, running, after he had already ridden his racing bike from Basel to Luxembourg on Thursday and gone on a racing bike tour with the former Tour de France and Tour de Suisse winners on Saturday. The result of the Ironman was great, 5:14:47, 428th place. of the 2,078 participants.

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