There are many things to consider to make one's work-outs do well for one's body. I have patients who get so consumed by exercise and diet regimen when starting sessions with me that they call in sick the following week. A case in point is Mr X, a giant of a man that stands at 6'4" and weighs maybe close to 400 lbs. He came to me in the outpatient clinic to address his poor walk, poor endurance and general weakness. He comes with the attitude of 'lets do this' followed by 'now!' Somehow I had to taper his enthusiasm because that's when people get injured mostly. Over-enthusiasm is dangerous at times. He came on a wheelchair, his legs stretched out (due to some joint problems in the past) and he is also being managed by Wound Care for his wounds. He is insulin dependent for his diabetes.

Of course my role here is purely therapeutic - using exercise as a treatment. The question is, treatment for what? Having been used to hospital settings all my life, I am more into "let me get you out of bed and prepare you to go home or go to some facility somewhere".


With the outpatient, I am thinking more along the lines of "let me get you fit and healthy to live a functional happy life." Mr X case requires more than simply walking and getting up the stairs, do shower, clean house, do work, etc. This is not a case of back pain where a management of manual therapy and exercise will suffice. This is a case of lose weight, exercise and then things will do well. I talked about diabetes management, weight management, exercise protocols etc. The man comes thirty minutes earlier than scheduled so he could do his 'exercise' early. I let him do simple weights and ROM exercises but I emphasize to him (and to most patients in general) that Physical Therapy is not a profession that builds you up, you need a personal trainer for that. I can help you design a program you can follow on your own but I can not bill you for something like a gym work-out. Going to the gym is much cheaper than coming to an outpatient clinic. What I offer are exercises and other modalities meant to treat your problem and for that, you must have a problem first. Mr X problems does not require a long term PT treatment because it requires a self-managed exercise program, medically managed diabetes, a nutritionist-managed diet, and I am here to facilitate all that. The poor guy decided to exercise a lot, diet a lot, and walk a lot on his own. The result is - he called in sick the following week. This is a case when I need to address the importance of gradual re-building, gradual return to active lifestyle and concomitant to that, the value of rest. It is all good to be enthusiastic but overdoing not only prevents us from going further, it also destroys the gains accomplished. This is a classic example of yo-yo fitness. Someone goes to the gym, promises himself to look good when? Tomorrow! or Next week! What happens is in that particular day or particular week, this person will do all the possible exercises he can muster in the gym, will skip eating (in a form of mistaken dieting)and probably lose sleep due to soreness or excitement. The result? Depleted immune system and via exposure to bad elements surrounding gym machines, a cold. Then this person will say, ah, this is not meant for me. Sometimes I need to tell my patients to chill out. Over-enthusiasm can cause not only cold due to suppressed immune system, it can also cause heart attack, diabetic coma, injury, and stroke.


So chill out. The keyword here is gradual, gradual, gradual. Rest is just as important as the exercise itself.