I recently had a former patient return to me, unfortunately for the same thing I treated him for last time. I don't mind treating the same patient for multiple things, but hate treating them for previously addressed issues. It's a sign that I did not fully do my job. When I discharge my patients, they are given Home Exercise Programs (HEP's) to maintain or even improve upon where they are at in the management of their injury.
So why are HEP's necessary? Unless it is a traumatic injury, people don't just randomly develop pains. There is a reason for this dysfunction. Typically, each individual is doing something repetitively or for prolonged periods that predisposes them to injury. The painter with his repetitive overhead painting, the warehouse worker with lifting, and, of course, the desk jockey with the prolonged sitting. I try to educate my patients that our bodies have a balance of motions each direction, and, when an excessive end of the spectrum is utilized, each individual has an elevated chance of pain or disability. When a patient comes to us with some sort of pain, our job is to not only address the pain, but also the dysfunction that led to the pain. After the patient has been "fixed" and discharged, management of their condition is not discontinued. They are given HEP's. Why is that? Even after the condition has been addressed and the pain is gone, the patient likely will return to whatever it is that contributed to developing pain. It is inevitable, even if we advise against it. By incorporating the Home Exercise Program, the opposite end of the health spectrum can be addressed to bring the patient back into balance. To speak more anatomically, if a patient is sitting in lumbar flexion all day, repeated lumbar extension and lumbar roll usage can dampen any concerns about prolonged sitting.
Giving patients HEP's is the easy part, convincing them to perform them is the hard part. Typically, a patient will ask, at discharge, how long they will have to do their HEP. The answer: for life. Because our patients likely will continue with certain activities that predispose them to injury, they will continually have to exercise their defense against them. Now, I am not saying they will need to do hourly repeated motions forever, but they may need to do it before and after their normal exercise routine or occasionally throughout their work day. The goal is to help maintain each patient's balance to avoid dysfunction and pain.
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