In this, part I of this series of posts, I will identify one of five items the physician must address within his/her practice in order to successfully include a fitness program within the treatment plan, and later, five obstacles the patients must remove from their thinking if healing is to be attained through exercise. First, the physician:
Education
Most physicians, including those who practice complimentary or integrative medicine, have received some instruction in exercise physiology. Sadly, the number of hours in this subject is very limited and the level of depth is shallow at best. This is also true for the subject of nutrition which according to the experts is as important as exercise physiology; the two are inseparable.
To further aggravate the issue, physician have very limited knowledge of exercise principles such as Gradual Progressive Overload, Periodization and Selective Adaptation to Imposed Demand (SAID), to name a few. Without this knowledge, a physician is incapable of writing an exercise prescription for his/her patient. The common solution is to outsource/refer the patient to the physical therapist.
While physical therapy plays a pivotal role in the rehabilitation of many muscle skeletal complaints related to pain, it is a profession that is sadly handicapped by a bureaucratic system within the insurance companies which dictates the number of visits and treatment modalities in the “rehab” process.
A growing trend in orthopedic practices is to have an in-house physical therapy department. While this is a step in the right direction in that the quality of treatment can be monitored and offers convenience to the patient, its shortcomings become evident when the treatment protocol is based on insurance coverage. As a side note, the inclusion of in-house rehab, has also caused many independent and free thinking physical therapists to close their practice due to a decrease in referrals.
A Possible Solution
The suggestion that a physician should return to school and become a fitness professional may seem laughable. But upon farther consideration, it is the best option available if he/she intends to provide patients who suffer with pain the service and education they need and deserve.
This does not mean that the physician must act the role of a personal trainer and meet the patient at the local gym at 5 am three times per week. What it means is that the physician will be able to demonstrate the exercise, explain to the patient in a layman’s term the anatomy and body mechanics needed for proper form and gradually guide the patient through various levels of sophistication or difficulty for that particular exercise.
The benefits of such interaction between doctor and patient cannot be overemphasized. Several things happen when the doctor takes the time to instruct the patient:
- The doctor benefits physically from the demonstration. After all if the practitioner is unable to perform an exercise with good form and breathing pattern, how can the patient be expected to comply?
- The physical demonstration of the exercise nourishes the rapport between the patient and the doctor. It is a stronger sign of commitment from the doctor than the simple act of giving the patient a cookie cutter sheet of exercises.
- It makes the patient accountable.
In my next post, I will address the equipment and amount of space the doctor needs to teach the patient proper exercise technique..
p.s. Interestingly, today, after I finished writing this post, I found on the news the following report on pain management and exercise.
