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The Physio-Fitness Continuum

This article looks at the difference between physio and fitness, before moving on to explore how exercise exists on a spectrum, commonly asked physiotherapy questions, and how Pilates fits into the picture.

June 10, 2021  6 min reading

Pretty much everyone will experience a form of injury at some point in their lives.  The reality is that if you want to go anywhere or do anything, there’s always some form of risk involved.  Luckily, physiotherapy and fitness knowledge are better than they’ve ever been, so with the right information you can recover quicker than ever before.

This article looks at the difference between physio and fitness, before moving on to explore how exercise exists on a spectrum, commonly asked physiotherapy questions, and how Pilates fits into the picture.

Physio Vs Fitness: What’s the Difference?

Physiotherapy is aimed at restoring function after an injury, or ideally in offering advice to help reduce injury risk as a preventative measure.
Fitness is aimed at improving cardio, strength or physique whilst already healthy and non-injured.

So if you’ve just had an injury or significant health issue, chances are you’ll be working with a physiotherapist.  Whereas if you’re looking to run a marathon, lose a few pounds or step on a bodybuilding stage, you’ll likely be working with a fitness trainer of some sort.

Exercise Exists on a Spectrum

A commonly held misconception is that fitness and physio are two completely distinct, separate activities.  The reality, however, is that all exercise exists on a spectrum all the way from early-stage rehabilitation through to high performance.

  • Stage 1: Early Acute. In which an injury is desensitized, and we aim to get back to full range of motion.
  • Stage 2: In which we rebuild some muscular endurance and capacity
  • Stage 3: In which we rebuild muscle size in the affected area(s)
  • Stage 4: Mid-Late. In which we start to introduce strength and power
  • Stage 5: Late / Performance. In which we ramp up training environments to improve performance metrics as much as possible.

We’re not going to go into loads of nitty gritty detail here, but if you’re interested there’s a great article by the Physio Network that explores the five stages in-depth.

Instead, we’re going to provide a couple of quick, practical examples of exercises across this spectrum.

Example One: The squat for a Powerlifter who is recovering from a knee injury.

  • Stage 1: Bodyweight squats to a box, lowering the box height over time.
  • Stage 2: Bodyweight or Banded Squats for multiple sets of 15+ reps.
  • Stage 3: Loaded dumbbell or barbell squats for multiple sets of 8-15 reps.
  • Stage 4: Heavier barbell squats for 3 to 5 sets of 3 to 6 reps.
  • Stage 5: Very heavy barbell squats for sets of 1-3 reps.

Example Two: The Calf Raise for an 800m Runner recovering from an ankle injury.

  • Stage 1: Seated, unweighted ankle flexion and extension
  • Stage 2: Bodyweight calf raises on a step for multiple sets of 15+ reps, along with slow paced walking
  • Stage 3: Loaded calf raises for multiple sets of 8-15 reps, along with moderate pace walking.
  • Stage 4: Heavier Loaded calf raises for 3 to 5 sets of 6 to 8 reps, along with some slower paced running
  • Stage 5: Continued calf strength work, alongside faster paced running and ankle plyometric exercises like bunny hops.

As you can see, it’s possible to progress an exercise, or group of exercises, all the way from early-stage rehab through to high-performance.  A good physiotherapist, often in combination with a good trainer or strength & conditioning coach, will be able to best advise you.

If you don’t have access to those services, then your best bet is to create your own ‘ladder’ of exercises progressions from least challenging to most challenging in line with the stages we described above, and work through it one stage at a time.

Is Physiotherapy a Workout?

When done properly, yes, physiotherapy is absolutely a workout.  Good physiotherapy isn’t just about getting a nice massage and hoping that your body gets better by itself.
Good physiotherapy is just like good fitness training, you’re applying a stress, which forces your body to adapt.  If you’re applying the right amount of stress, it should feel challenging but manageable, just like a workout.

How Long Does Physiotherapy Take to Work?

It really depends on the severity of your injury (more severe = longer recovery) as well as what you mean by ‘work’.  Let’s say that you have an elbow injury…

  • If your goal is simply to get back to being pain free and having good range of motion, then it might only take a few weeks.
  • On the other hand, if your goal is to get back to bench pressing 225lb for reps, or to regularly playing tennis or golf, then it might take a few months.
What is Clinical Pilates? And Where Does it Fit On the Physio-Fitness Continuum?

Clinical Pilates or ‘physio pilates’ is a variation of pilates offered by certain providers that combines elements of traditional pilates practice with some of the more modern and up to date ideas of physiotherapy.

The Pros
  • Could be useful for stage 1 and stage 2 rehab as it helps to build range of motion and low load muscular endurance.
  • Class based environment keeps it affordable and easy to access.
The Cons
  • Doesn’t load or challenge muscular-skeletal systems enough to take you through stage 3, 4 or 5 of the rehab process.
  • Exercise isn’t as individually tailored as working with a physio or coach, and so may not be appropriate for everyone.
Physio to Fitness: The Number One Rule

Progressing from physio to fitness is all about gradually increasing the difficulty of what you do over time.  The difficulty needs to increase to make progress, but it shouldn’t increase too fast, or you’ll risk setbacks.   You should be able to perform everything in your current stage without pain before moving onto the next stage.

Wrapping Everything Up

Fitness and Physio might have different goals, but they share the same exercises and approach, operating on a continuum of difficulty all the way from early-stage rehab through to high-performance.  Keep this in mind the next time you need to recover from an injury.

References / Further Reading

Allen DD. (2007) Proposing 6 dimensions within the construct of movement in the Movement Continuum Theory. Phys Therapy; 87:888–898

Physio Network (2021) https://www.physio-network.com/blog/rehab-continuum/