What is the difference between physical therapy and personalized program design services at EVOLVE Flagstaff?
Consistent and long term resistance training is one of the most important actions we can take to improve our health and resilience to injury.
However, there have been times we have inadvertently provoked symptoms or worsened pain by starting patients and clients on a gym program too soon. At times we at fault, and were over-eager to provide fun and challenging workout programs. We love seeing people exercise and work hard, after all! On other occasions, patients came to us after several unsuccessful attempts at physical therapy, and specifically requested personalized strength training rather than physical therapy. In these cases, we were not able to fully understand the nature of the individual’s problem, including the diagnosis, triggers, and contributing factors. No matter the cause, we take these shortcomings seriously, because the first priority across all of our services is to ensure that you have the best experience and achieve the best results possible.
Pain can be weird, and it can cause you to move differently, recruit different muscles when completing an exercise, or respond in unexpected ways to exercises that previously were just fine, or exercises that have worked well for other individuals. All of these factors can take time to parse out, and they require an attentional focus that is different than what is used when designing a strength and conditioning program.
But, because I oversee both our physical therapy and training services, it can been understandably confusing to know when physical therapy ends and strength training begins. In fact, we want to in some ways intentionally blur this line at EVOLVE Flagstaff, because traditional physical therapy is not often concerned with your long term health, wellness, and resilience.
Regardless, we found by creating bolder lines between physical therapy and strength training that we have been able to improve what we value most: results for you. By doing this, we’ve found that we are able to support you with the plan, tools, resources, and education that are best for you right now. We still maintain a comprehensive, long term focus, but we are able to take that journey one step at a time, in the right order, with fewer wrong turns.
With all of that preamble out of the way, here is how we differentiate our physical therapy and personalized training services:
Goals AND INTENT of Physical Therapy:
Physical therapy is intended to fast track the healing and recovery of individuals who currently cannot exercise or strength train due to pain or injuries, or individuals who are already training but have an issue come up. Specific aims of physical therapy sessions include:
Diagnose pain or an injury
Identify key contributing factors or causes of pain/injury
Explore and modify triggers that exacerbate pain
Determine a prognosis for injury healing and recovery
Provide in-depth education on all of these factors
Create efficient and effective home plans to reduce symptoms and promote healing
Provide appropriate hands-on manual therapy to reduce pain, promote healing, or change movement
Guidance on modifying exercise and training (not full/specific program design)
Progress you to the point that you can either 1) Return to your previous exercise/training; and/or 2) Start a new exercise/training routine
There is a free program available on our website that you can modify with your physical therapist
Long term exercise and training is ALWAYS a goal of physical therapy, as that is what keeps us healthy long term, but physical therapy sessions are not where the long term training is provided. This is because physical therapy should not be an ongoing, forever thing for most people (whereas aerobic and resistance exercise MUST be a forever thing).
Goals of Personalized Strength and Conditioning:
Personalized strength and conditioning is overseen by a physical therapist at EVOLVE Flagstaff, but it is distinct from one-on-one physical therapy. We have a different process to ensure that you get the best possible long term results.
The initial program design session is different than a physical therapy evaluation. It is focused on determining which elements we intend to address in the program, not on what is causing pain.
Sessions are focused on teaching exercise technique and other long term training principles, not on addressing acute pain.
You are paired with an EVOLVE strength coach, who is an expert in strength training and movement, but not in pain and injury.
The systems that we use to deliver and monitor training programs are different than physical therapy.
While it is unrealistic to require individuals to be pain-free prior to starting a strength and conditioning program, we do have specific gym readiness criteria that must be met (see below). We have found that when these criteria are not met, there is a high likelihood that pain/injury will worsen with a strength and conditioning program, and you will be better served in the short term by focused physical therapy.
Physical therapy vs. training and program design: An analogy
This analogy is helpful in understanding the difference between physical therapy and personalized strength training. Imagine that you are hiring a landscaping company. The same landscaping company can provide you a variety of services
LANDSCAPING
New Backyard: You hire a landscaping company to completely redesign your backyard. There is a clear goal (new backyard), and you don’t expect the company to be working on your backyard forever.
Ongoing Maintenance: You expect that your new backyard will need some TLC. Someone has to water the plants, trim the grass, and keep the weeds at bay. You could either learn to do this yourself (perhaps with some guidance from the landscaping company), OR you could hire the company to do it for you on an ongoing basis.
New Plants Need to Grow: The landscaping company might plant some trees or shrubs that will need months or years to come to full maturity. So, even though official “construction” on your backyard is complete, you know that things will continue to evolve and progress over time. Once you understand how to care for the immature plants, they can be tended to within your ongoing maintenance.
Occasional Bigger Projects: Finally, even with the best ongoing maintenance, every so often you might need the landscaping company to come back in to do a bigger project (plant new bushes, new mulch, etc).
PT AND TRAINING
Physical Therapy: You hurt your knee, or your back, or your shoulder, and you schedule a physical therapy evaluation to resolve it. There is a clear goal (understand and resolve your pain), and you don’t expect to be in physical therapy forever.
Strength Training: The best way to prevent injuries from returning is to have a consistent training routine. After you get a handle on your injury, you can either exercise on your own (perhaps with some guidance from your PT), or you could enroll in EVOLVE’s personalized training services so we can support you every step of the way.
Ongoing Stable Injuries: There are some injuries that may need ongoing training and management to fully resolve them long term. One example is a chronic tendon injury. The tendon will need long term exercises to help it to remodel in a more resilient way. This is appropriate to do in a strength program once symptoms are stable and predictable, and contributing factors and triggers to pain are understood.
New Injuries: Even with the best training program, things come up. Even if you are consistently following a great training program, you might have pain from time to time that requires a new physical therapy evaluation.
Gym Readiness Criteria
In order to start an EVOLVE strength and conditioning program, any pain or injury must meet the following criteria.
Pain Criteria:
For the past month, pain has not been >4/10, or defined as:
Not interrupting sleep, work, or activities of daily living
Not requiring NSAIDs/pain medication
Not causing limping or other significant movement change
Symptoms have a clear and understandable feedback loop, which means:
You can predict if an activity or movement is going to aggravate it or not
You have a good understanding of triggers and relieving activities
You understand how to modify a movement or exercise if symptoms begin to arise
If symptoms do flare up, we can reasonably predict that the increase will be minor and manageable, as defined as:
Pain not > 4/10 (see above)
Pain settles within 1-2 days
Functional Criteria: Because strength and conditioning programs require a wide variety of movements, we also require that individuals are able to perform with minimal pain:
Squat to a bench 10 times with at least 10 pounds
Perform an overhead press or landmine press ten times with at least 5 pounds
Step up to and down from a 12 inch box 5 times on each leg
Get up and down from the floor 5 times
If below the age of 45: Stand on 1 leg and touch the floor 5x without losing balance
Additional Criteria:
Able to self-monitor symptoms and adjust ad necessary to avoid significant flare ups
Comfortable in a gym setting and able to give feedback to your coach
Able to commit to at least two 45-60 minute workouts per week
Willing to engage in ongoing monitoring, feedback, and program updates.
Not looking for frequent changes in the your workout plan, as our programs generally involve 8-12 week plans with minimal week-to-week changes so that we can predict your response and track progress. Consider classes, or personal training membership if you want frequent changes or need more accountability.
Why do we have these criteria?
We don’t want the gym program to flare up symptoms or cause injury.
We want to make sure our programs are the right fit for you.
We want you to be consistent and successful.
If you do not meet these criteria, you will have more success starting with physical therapy.
Want to get started? Schedule a free call with our Doctor of Physical Therapy. We’ll talk about your goals and challenges, and then create the ideal plan for you.