Friday 8 June 2007
Home Exercises
As I’m sure most of you who have completed or are completing their musculo prac may find it quite difficult to get your patients to complete their home exercises on a regular basis. On a number of occasions already I have had to explain to my patients the importance of home exercises. One example springs to mind, a young female with bilateral trochanteric bursitis. Her pain is 0/10 at rest and only comes on after approx 3km of running. I have seen her for 3 sessions now with me and had been coming for 3 sessions prior yet has seen now improvement in the distance she can run before the onset of pain or the severity of pain (6/10). Treatment in the clinic has consisted of ITB and priformis release and ultrasound. Both seem to improve muscle length but this improvement does not seem to be maintained by the next time I see her. She has poor pelvic control (increased lateral pelvic tilt) during running, so I have given her a number of glut med ex’s to improve her glut med control and endurance and hopefully pelvic control. I found it difficult to find an effective way to stretch the ITB however she has now found a useful technique which she adapted from her body balance class. I have advised her to rest from long distance running as much as possible and have warned her about the importance of daily prolonged ITB stretching and ongoing glut med and TA exercises. I have suggested to her to record a dairy of her exercises over the week so that I can monitor whether she is really doing as much as I have recommended. I trust that she will not lie, but I am still concerned that she may still not be seeing the importance of her exercises. Does anyone have any suggestions to increase the compliance of patients with home exercises?
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2 comments:
i guess in the long run rowan, if people dont want to do their home exercise program, what can we do!!! You've done the right thing in explaining the importance of everything and getting her to do an exercise log is a great way to find out what she is really doing.
The only other thing i could suggest is to give her a fixed regime. If she knows she has to do 2x3-5 min prologed ITB stretch and a piriformis stretch before and after exercising, she may be likely to follow. I know from when i injured my knee, the physio started off by just telling me to do the exercises assuming that as i was a physio, i would do the right amount. he then gave me set reps and i found that i was more compliant!! and im a physio so i really should have known better!!!!
Just tell her straight that you are not happy about she is not doing streching enough and you dont want to waste her time. If you are confident that you wont make a difference without her compliance, then just say go to see some phsyio who can make her work (but of course in a nice way).
Simon
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