Give a man a fish, and you feed him for a day. Teach a man to fish, and you feed him for a lifetime.
– Anne Isabella Thackeray Ritchie
The mind of a new graduate or third year PT student is a chaotic, yet optimistic expanse, overflowing with idealistic dreams of curing all injuries for all people, virtually eliminating the need for opioids, surgeries, or physician visits entirely. Ok, although laced with sarcasm, focusing all you’ve learned into a coherent, rationale treatment approach is easier said than done. You may ask yourself, where do I start: an effective treatment plan, appropriate exercise selection / dosage, optimal and timely progressions, innovative manual techniques, comprehensive knowledge of anatomy and biomechanics, and eloquent and evidence-based documentation? My advice would be to focus on the basics. Mastery of the basics ensures a solid foundation from which to grow. One basic tenant that is often overlooked is patient education. Several articles point to the fact that “education, not income, is the best predictor of a long life.” We, as physical therapists, are primly suited to occupy the patient education corner in the healthcare system. One way to greatly influence the long-term recovery and prevention of injury is through a good home exercise program (HEP); however, programming an effective HEP that is both effective and convenient is no simple task.
There are several factors that influence compliance: patient motivation, convenience, efficiency, and meaningfulness. One study found that less exercises resulted in greater compliance, finding that 2-3 exercises were the “sweet spot” for adherence. Another study cited that “time constraints and convenience” were common barriers that mitigated compliance. With these factors in mind, prioritizing an efficient and convenient HEP is a skill all physical therapists should possess. As a new graduate, promoting patient-centered care revolving around education and patient empowerment truly separates average treatment from excellent treatment. A simple way to design a good HEP is to incorporate ordinary, household items. The following three items are great to use for a variety of home exercises.
Few items provide the crossover to multiple joints / impairments and across exercise modalities than the towel. Whether strengthening weak muscles, increasing mobility in stiff joints, promoting flexibility in tight muscles, correcting improper postural position, or enhancing decreased joint range of motion, the towel is unmatched. Specific examples include supporting the elbow with external/internal rotation at 0 degrees abduction to increase infraspinatus firing; self-SNAG procedure for restricted facet joints in the neck; towel stretching for internal rotation deficits, gastroc/soleus stretching to increase dorsiflexion; lumbar roll in the low back when sitting / traveling to reduce disc-related pain; and friction reduction under foot/hand to assist with passive or active-assisted ROM post-operatively.
- Dowel / Broomstick
Soft tissue work and range of motion activities predominate the dowel’s popularity. Self-myofascial release, which has shown effectiveness in muscle recovery and joint mobility, is a great way to utilize this tool. Whether over the anterior tibialis / gastroc-soleus complex with ankle restrictions or over the quadriceps/hamstrings to promote knee mobility, the dowel is perfectly suited to assist. ROM exercises are great post-operatively to prevent capsular restriction and modulate pain thresholds with proprioceptive stimulation. With regards to LBP / SIJ dysfunction, the dowel is great for grooving a proper movement pattern giving real time feedback for the patient, whether with the hip hinge pattern in standing or neutral pelvis in quadruped.
- Tennis Ball
The usefulness and versatility of the tennis ball may not be as evident, but numerous uses exist. When prescribing self-myofascial release to your patients, the tennis ball may be the way to go, as its focal surface area is ideal for hard to reach muscle groups including the pec minor, foot intrinsics, quadratus lumborum, and psoas. Another use involves joint mobilizations for the cervical spine: taping two tennis balls side-by-side to facilitate cervical retractions with overpressure for cervical derangements; also thoracic mobilizations can be incorporated. Stability and balance drills can also be prescribed: dynamic stabilization of the rotator cuff with external rotation drops in standing / prone and wall ball windmills / ER toss; and balance activities that encompass hand to hand ball tossing or ball bouncing incorporate dual tasks and subsequently more difficulty into the HEP.
Patient education and empowerment is essential to ensure your patient has a successful rehabilitation experience and optimal recovery. Being efficient and effective with your HEP requires a delicate balance of exercise selection and convenience. Using ordinary, household items gives your patient the best route for success. Ultimately, all of your patients will have access to one superior, consistent item for recovery: You!
Author Credit: W. Evan Stringfellow, PT, DPT, CSCS, Cert. DN
Photography Credit: CMDR Shane