I’ve been experimenting, lately, with a new concept in therapeutic exercise: not counting repetitions during physical therapy treatments.
Counting repetitions (reps) has been a mainstay of physical therapy exercise treatments for decades. Patients like reps because they set a solid goal, and completing a set number of reps gives them a feeling of accomplishment and closure. Physical therapists like reps because recording them can show a progression in strength and exercise tolerance.
However, some patients push their bodies too hard, just to complete a set number of reps, while others don’t benefit from the normal number of reps and may require more; both types of patients do better without a defined number of reps. Some conditions benefit from a particular quality of exercise, rather than simply a quantitative strengthening approach of three-sets-of-ten of the maximum-tolerated weight. For example, tendinopathy may respond to low-weight, high-rep approach of up to 40 reps, while conditions such as autoimmune disorders require limited reps to avoid aggravating muscle soreness and pain.
When I identify conditions or situations in which rep counting is contraindicated, I instruct the patient to “do controlled reps until you feel a slight (or moderate, or significant) fatigue or burning in the muscle.” This forces the patient to “listen” to his or her body, to learn to monitor his or her symptoms and tolerance. This approach takes more time to teach the patient, but truly individualizes the program to each person’s daily tolerance and needs.