One of my friends asked me how they could maintain the work their massage therapist did between appointments. Self care is how! Not the wine and reading in a bubblebath kind, though that can be lovely. I’m talking about exercises, stretching, and targeted hydrotherapy. Many body workers will give you remedial exercises (remex) without needing to be asked, but if yours doesn’t, you can ask them for recommendations. I am guilty of forgetting to give self care homework (if I do that to you, remind me). Body work is more effective when you work towards your goals with your health care provider, as a team.
Before I get into ANY of this, please remember to check with your doctor to see if the suggested homecare modalities will work for you. Exercise, self massage, and hydrotherapy rules are different for people with uncontrolled diabetes, high blood pressure, varicose veins, vertigo, and some other conditions.
Self-directed homecare (when your body worker does not give you any homework and you want to do it yourself) can be tricky. If your healthcare provider lets you know which muscles they think are affected, you can find exercises or stretches yourself, but do some research. Videos on the internet are a) not always correct and b) not always well-explained. If you’re looking online, make sure you take the recommendations of trained bodyworkers over popular influencers who don’t have remex background. SensoriMotor Education is my favourite reputable source of home care and body education. If books are your jam, I would suggest Therapeutic Exercise by Kisner and Colby. Read the instructions and make sure the exercises you choose will help you achieve your goals and are appropriate for you.
Stretching
Stretching is the most often-suggested self care homework. Usually the stretch that is given to a client doesn’t require more equipment than a wall, floor, or doorframe; these are called passive angular stretches. The body part you’re targeting remains passive as it is stretched along its angle of movement until you feel a stretch in the target muscle or muscle group, then held for 30-60 seconds. They’re the most suggested because they are easy to do and easy to show, and it is unlikely (but not impossible) that you will be injured if the stretch is done incorrectly.
Strengthening
Strengthening remex is a step up from stretching, because as you strengthen a muscle that is weak, you are automatically stretching the antagonist muscle (the one that does the opposite job). Antagonist muscle pairs cannot both be ‘on’ at the same time; when one is contracting, the brain’s ‘move it’ signal to the other one is turned off and it relaxes. Strengthening is basically a two-for-one, because a weak muscle is usually the cause of its antagonist muscle being ‘tight’.
There are different levels of strengthening exercises for different kinds of problems. For example, if you have not moved a body part for a long time because of a fracture or surgery, you will have atrophied muscles in the area. Jumping to challenging exercises right away won’t be helpful–in fact, it may be damaging. So start off small; work up from what you can easily do and gradually move to something that challenges you. When atrophy is your issue, muscle setting is your game. The verbal cue is ‘think into action’; you tense the muscle but don’t move yet. Later you can start to push it into static resistance (that’s called isometric exercise), meaning that you contract against something sturdy that won’t move.
If the target muscle is weak but not atrophied, start with isotonic concentric exercise; contracting the target muscle against movable resistance. Active free range of motion–the movement you can already do without strain or resistance such as walking or windmilling your arms–is great for maintaining your body in the condition it’s already in, so if you want to get stronger, you’ll need to add resistance. Resistance can be your own body weight, free weights, or resistance bands. Whatever will make the targeted muscle move a weight against gravity–or elastic resistance–is the exercise for you. I have a whole rant about planking not being helpful for your abs, but that might be something for another post…
Anyway, grab a weight or band and work your muscle until you get tired. Not when your determination tells you to stop, but when you start to hold your breath, clench your teeth, or get shaky in the movement and lose form. When those things happen, it’s best to rest for a while and come back to the exercise later, otherwise the home care will be less effective. That can be because your muscle is too tired to do the job and is recruiting its ‘synergists’ (other muscles that do sort of the same thing), or because you have done more than the muscle is able and are creeping into strain territory. As I mentioned in my last post, do as many reps of an exercise as you can do WELL.
When concentric exercise becomes easy, start thinking about isotonic eccentric exercise; contracting the target muscle against movable resistance and then slowly returning it to resting position with resistance still applied. Once you can move the muscle well against resistance AND smoothly return to your starting position and not get tired after several repetitions, it’s time to add more of a challenge. Try adding more weight or using a tougher resistance band.
Self Massage
Self massage is another way to get in some homecare. If you massage spots you can reach with your hands, remember to direct the pressure towards your heart and start gently, gradually working deeper. If you use foam rollers, find an appropriate sized roller for the muscle you’re working on; smaller muscles can be targeted with wee therapeutic massage balls rather than a huge cylindrical roller. Textured rollers or balls are especially fantastic for hands and feet! They provide helpful sensory input AND release. Just a quick aside: foam rolling your IT band isn’t useful. The IT band is a tendon, it can’t tighten or stretch. If it feels ‘tight’, it’s either because the muscles it’s attached to (TFL or gluteus maximus) are overworked, or the muscles underneath it are up-regulated; try targeting those instead.
Hydrotherapy
Try hydrotherapy! The general rule is cold hydrotherapy for short time periods when things are newly injured, hot, and swollen, and hot hydrotherapy for longer time periods on injuries that are old and feel stiff and cold. That’s EXTREMELY general. When you use hydrotherapy, always make sure it is on top of the body part you’re targeting, and never underneath you with weight on it. That means no laying on heating pads or hot water bottles, and no sitting on ice. For real. Don’t do it. The hydrotherapy gods are watching you. Also, avoid hydrotherapy on any areas where you have surgical pins or plates as they tend to get hot or cold faster than your body, and could do damage.
Ice may be effective for pain management in fresh injuries (some evidence exists that it is better to let your inflammatory response do its thing rather than using cold hydrotherapy in the acute stage of injury, so you could try MEAT over RICE), and should only be applied to an area until it feels numb. Leaving ice on longer will trigger the hunting response, and then the injury will start to get hotter and more swollen. Wrap the ice in a cloth so it isn’t in direct contact with your skin. Cool cloths are also short-term, but aren’t likely to make you numb, so remove them in one or two minutes. Same deal with dipping body parts in cold water (usually feet). Don’t worry, you can apply cold hydro again after a while, just don’t keep it on constantly.
Hot hydrotherapy such as heating pads, hot water bottles, hot compresses, and hydrocollator packs should be used for a maximum of 20 minutes, and not hotter than 74º C. Hydrocollator packs and hot water bottles should have a towel wrapped around them to protect your skin. Hot baths or epsom salt baths have the same time limit; longer than 20 minutes or an incorrect amount of epsom salt (the package should have instructions) will shift your body’s water content in ways you don’t want, making the bath less effective. If your skin turns red or your pulse gets faster, remove the heat source or get out of the tub immediately.
Patience
Home care only works if you do it, but of course it’s more complicated than that. If you shame yourself or ‘should’ yourself into doing your self care homework, it’s likely to be a chore you put off. If you find the home care you’ve been given includes more exercises than you ever have time to do, ask your healthcare provider which one (or two) are the most important, and do those. Or alternate days; do a different one each day as they fit into your schedule. And remember to be kind to yourself!