After prescribing a variety of exercises in my 33-year career as a physio, I’ve finally come to the realization that how I prescribe an exercise matters far more than what I prescribe. I went through a phase of prescribing mostly flexion exercises, then to extension exercises; general stabilization to isolated core exercises, then to proprioceptive exercises, etc.
In my younger days, I truly believed that I needed to be exact and perfect in my exercise prescription; after all, I was an almighty PT with the wisdom of anatomy, human kinetics, and pathology, so I must be able to prescribe the perfect exercise to make my patients better. If they didn’t do their exercise the “right” way, not only would they not get better—they would potentially damage their fragile body.
In this excellent paper by Ben Cormack, he covers how too often exercise becomes a nocebo, in fact worsening symptoms and delaying recovery.
“… providing exercise explanations based on biomechanical models could lead to avoidance instead of action.” – Cormack et al., 2025
“Make sure you don’t flex your spine when squatting.” / “You must maintain a perfect posture when carrying groceries.” / “Keep knees over the middle toes on stairs.” / “Walk this way, not that way.” Etc.
The message that is too often given to patients is that if they accidentally do the “wrong” move and do it “incorrectly,” they will irreversibly damage themselves. Therefore, they understandably assume that they are better off not doing it at all. We live by this false belief that unless the movement is done perfectly, we should not do it at all—and certainly not do more—or else we will… I don’t know, explode!
I agree that sometimes modifying techniques and biomechanics do matter, but we must also agree that sometimes we go overboard with the biomechanics and harm people with fear—hence the nocebo effect of exercise. So the next time you prescribe an exercise, if the patient is comfortable, allow them to do it however they desire!