Clinically reviewed by Dr. Zahra Fatima, DPT TREATMENT TECHNIQUES
Exercise Therapy
Exercise therapy is the part of physiotherapy with the strongest evidence and the part people skip. How a programme is chosen, dosed and progressed.
Al-Shama Physiotherapy Clinic · Khanpur · English & Urdu
What is exercise therapy?
Exercise therapy is a programme of specific movements chosen for your problem, with set repetitions, a set load and a plan for making it harder. It is not general exercise, and not a sheet of pictures handed over on the way out.
The misunderstanding worth clearing up first: most people treat exercise as the optional part and the machines and hands-on work as the real treatment. It is the other way round. For most musculoskeletal pain, including knee and hip osteoarthritis, low back pain, neck and shoulder pain and tendon problems, exercise has the strongest evidence of anything a physiotherapist does. Everything else exists to make the exercise possible.
It is also the part people skip, because it is slow and dull and nobody can do it for you.
What it can help with
- Knee and hip osteoarthritis, where strengthening the muscles around the joint reduces pain and improves walking
- Long-standing low back pain, where trunk and hip control matter more than any single stretch
- Neck and shoulder pain from desk or machine work, where the shoulder blade muscles are not coping with the hours
- Tendon problems, including tennis elbow, shoulder and Achilles pain, where graded load is the actual treatment
- Recovery after surgery or a fracture, rebuilding range, then strength, then your day
- Rotator cuff shoulder pain, where most people improve with a loading programme and no operation
- Balance and falls risk in older adults, where strength and balance training has measurable benefit
What happens in a session
The first session is mostly assessment. Dr. Zahra measures what you can do: how far the joint moves, how much the muscle holds, how many times you can stand from a chair, where it starts to hurt. Those numbers are your starting point and the way progress gets checked.
Then you are taught three or four exercises, no more. You do each one in front of her so the position gets corrected, and you are given exact numbers: how many, how often, how heavy, and how much discomfort is acceptable. Record a short video on your phone, because almost nobody remembers it correctly by the next day.
At follow-up the same measurements are repeated. Exercises that have become easy are made harder, ones that flared you are changed, and ones you have not been doing are discussed honestly rather than swapped for new ones.
Clinic sessions are for teaching and progressing. The treatment itself happens at home, three to five days a week.
Does it hurt?
It can be uncomfortable, and some discomfort is acceptable. Use this rule: pain that rises while you exercise but settles within about half an hour, and leaves you no worse the next morning, is within range. If you wake stiffer and sorer than the day before, the dose was too high, and the answer is less load rather than stopping.
Muscle soreness two days after starting something new is normal and does not mean damage. It settles within a week or two as the body adapts.
Not acceptable: sharp pain inside a joint, a knee or shoulder that swells after exercise, pain spreading further down an arm or leg, or new numbness or weakness. Stop those exercises and have them reviewed.
Who should avoid it
Very little rules exercise out completely. Usually the programme is changed rather than cancelled. A few situations need a doctor first.
- Chest pain, unusual breathlessness, palpitations or fainting with activity. See a doctor before any programme starts
- Uncontrolled high blood pressure or uncontrolled blood sugar, reviewed first, particularly before heavier loading
- Fever or an active infection. Wait until it has passed
- A fracture or surgical repair not yet cleared for loading. Your surgeon’s restrictions come first
- A hot, swollen, very painful joint, which needs a diagnosis before it is loaded
- Weakness getting worse, loss of bladder or bowel control, unexplained weight loss, or night pain that wakes you
- Pregnancy does not stop exercise therapy, but the positions, the load and the abdominal work are adjusted
How many sessions?
Count this in weeks, not visits. Four to eight clinic sessions over six to twelve weeks is usual, with the work done at home in between.
The timescales are worth knowing so you do not give up too early. Movement and confidence often improve in two to three weeks. Real strength change takes six to twelve weeks of consistent work. Tendon problems are slower, often eight to twelve weeks, and they need load rather than rest.
If you have done the programme properly for six weeks and nothing has changed, do not keep going. Either the dose, the exercises or the diagnosis needs revisiting. That is a reason to be reassessed, not to repeat the same thing for another month.
Urdu
Exercise therapy aam warzish nahi hai. Ye aap ke masle ke mutabiq chuni gayi khaas warzish hai, jis mein ginti, wazan aur usay barhane ka tareeqa tay hota hai.
Purane dard mein, jaise ghutne ki arthritis, kamar dard, gardan aur kandhe ka dard, warzish ka faida sab se zyada sabit hua hai. Machine aur haath ka ilaj madad karte hain, asal kaam warzish karti hai.
Warzish ke doran thora dard theek hai, agar wo aadhe ghante mein baith jaye aur agli subah zyada na ho. Agle din dard barh jaye to wazan ya ginti kam karen, warzish band na karen.
Taqat barhne mein chhe se baarah hafte lagte hain. Jor mein sujan aaye ya sun hona shuru ho to rok kar dikhayen.
Questions people ask
Why can I not just use the exercises I found online?
Because the choice and the dose are what make it work. Two people with knee pain can need opposite programmes, and a back problem that improves with bending backwards can get worse with the stretches most videos show. Generic exercises usually do nothing, and sometimes they flare the problem.
Is it normal for exercise to hurt?
Some discomfort is normal. Use this rule: pain that rises during exercise but settles within about half an hour and leaves you no worse the next morning is acceptable. Pain still higher the next day means the load was too much. Sharp joint pain or swelling afterwards is not acceptable at all.
How long before exercise therapy works?
You will often feel easier movement within two to three weeks. Genuine strength takes six to twelve weeks of consistent work, and tendon problems often need eight to twelve weeks. This is the main reason people stop too early and decide that physiotherapy did not work for them.
Should I rest instead if it hurts?
Rest helps in the first day or two after a fresh injury. Beyond that, rest makes most musculoskeletal problems worse, because muscle weakens quickly and the tissue becomes less tolerant of load. The usual answer is not rest or push through, but a smaller dose done regularly.
Do I need gym equipment?
No. Most programmes start with body weight, a chair, a wall, a towel and a resistance band. Load is added later, and a bag of rice or a filled water bottle does that job well enough. If you do have access to a gym the programme can use it, but it is not required.
Understand your care
What is physiotherapy? → How many sessions might I need? → Building a home exercise routine →Appointments with Dr. Zahra
INFORMATION → INDIVIDUAL CARE
A plan built around you.
Talk with Dr. Zahra Fatima, DPT. Understand your next steps, with guidance for your own symptoms and daily routine.
Talk it through
Discuss your symptoms, what you find difficult and what you want to get back to.
Understand your next steps
Use the consultation to discuss which care and exercises fit your situation.
Take your plan with you
Your online consultation includes a written plan you can refer to afterwards.
Explore other treatment techniques
Al-Shama Physiotherapy Clinic
Ask about an appointment
اپائنٹمنٹ کے بارے میں پوچھیںAppointment ke liye poochein
Fill this in and WhatsApp will open with your details ready to send.
یہ فارم پُر کریں؛ واٹس ایپ پر آپ کی تفصیلات کے ساتھ پیغام تیار ہو جائے گا۔Yeh form bharein, WhatsApp aap ki tafseel ke saath khul jaye ga.