The single most important question a rehab physio can ask before they prescribe an exercise: Does the movement directly contribute to the client's functional goals? 🤔 ❌ SLS will NOT help someone hang out washing ❌ Standing heel-toe will NOT help negotiating a kerb

🚨 Partial squats do NOT help an older adult with getting up off a low chair or toilet 🚨 👉 To improve depth of sit-to-stand, progressively lower the height of the sit-to-stand while training in the strength training repetition range

Partial squats are a great exercise if clients have trouble moving from sit-to-stand from a barstool... ... but if their problems relate to a standard chair, park benches or public toilets then training needs to be at that depth Principle of specificity applies to joint angle

If an older adult can only just stand up from a chair 5 times in a row? Then every time they stand up they're working at an intensity equivalent of you doing a heavy squat at 85-90% of your 1RM several times every single day 👉 Strength training is the key to independence

The pain of effort is temporary... The cost of inactivity is permanent

If a client doesn't have the capacity do 8+ reps of a given task, they're operating in the strength training intensity range just to complete their ADLs This guides my conversations and clinical practice with the older adult for joint goal setting and treatment planning

The quote "exercise is medicine" is often thrown around... but imagine if a pharmacist didn't have even a basic understanding of frequency, dose & types of medication? Luckily there's A LOT of readily available data on the relationship between rep ranges, 1RM%, & training load

It can take months to improve balance sufficiently enough to prevent falls… ... yet it can take only a session or two to help someone regain the ability to get up off the floor Physios, think about this next time you are prioritising goals and planning treatments

EVERY older needs a progressive ankle-hip-step response: ✅ Forwards ✅ Backwards ✅ Sideways, & ✅ Ability to cross-&-step Assessment & development of these essential movement skills should be prioritised (they're needed everyday AND are foundations for functional tasks)

Effective balance & mobility rehab: 🟢 Systematically developing a few priority movement skills over several sessions THEN moving onto other skills 🟠 Addressing multiple skills simultaneously 🔴 Prescribing exercises with no clear relationship to the clients movement goals

Physios: If for some reason you still persist with exercises like tandem-stand "for balance"... ...at the very least get your clients to step into & out of position without upper limb support (this is the part of the exercise that actually has some value for falls prevention)

The world would be a better place once rehab physios recognise that partial depth squats do not improve an older adult's ability to get out of a low chair

There is no science behind prescribing 3x10 for balance skills... ...and there's even less science behind daily 3x10 for strength training It's lazy programming. Come on physios,we know better than this.

Perhaps the single most important concept when it comes to improving balance: 👉 Select variations of the movement skill you're trying to improve BUT the level of difficulty is such such that you DO NOT need use of your hands Exercises like this 👇👇👇 do not improve balance.

Exercises that are useless when it comes to improving balance & preventing falls: 🚩Standing on foam mat 🚩Hip abduction 🚩Hip extension 🚩Single leg stand 🚩Heel-toe between chairs 🚩Marching on spot 🚩Standing feet together 🚩Calf raises 🚩Partial squats 🚩Anything seated

To improve balance & prevent falls the focus must be developing an integrated ankle-hip-step response And, practice scaled versions of each movement skill that needs to be improved, progressively increasing the challenge until the client reaches their movement goals

The optimal repetition range for a balance exercise might be 5, 15, or 50 reps Dosage of balance exercises must depend on both the client's current capacity AND the specific movement skill that's being practised

The problem with generic "balance" training is that you get diluted generic "balance" results When "balance" is the priority there are no priorities Balance is task specific. Good PTs provide movement skill training to address deficits & improve performance in specific tasks

There’s no perfect balance exercise. Rehab needs to be individualised. But not over-complicated. It’s simple: Practice scaled versions of each movement skill that needs to be improved & then progressively increase the challenge until the client reaches their movement goal