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        • Speed's Test
        • Posterior Apprehension
        • Sulcus Sign
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          • Costoclavicular Brace
          • Hyperabduction Test
          • Roos (EAST)
        • Yergason's Test
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        • Cozen's Test
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Why We Give Our Patients HEP's

6/7/2016

0 Comments

 
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.
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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.

-Chris

If you are looking to improve upon your clinical skills and orthopaedic knowledge, consider joining OPTIM's COMT program. With OPTIM, you can expect a residency-like learning experience without breaking the bank, all while learning from highly skilled physical therapists. Check out optimfellowship.com for more information!
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  • Home
  • About Us
  • Insider Access
    • About Insider Access
  • Online Courses
    • Hooper's Knee
    • Physical Therapist Entrepreneur Course
    • Physical Therapist Consultant Course
    • Orthopedic Management of the Cervical Spine
    • Return to Sport Essentials Course
  • Resources
    • Newsletter
    • Business Minded Sports Physio Podcast
    • Day in the Life of a Sports PT
    • Residency Corner
    • Special Tests >
      • Cervical Spine >
        • Alar Ligament Test
        • Bakody's Sign
        • Cervical Distraction Test
        • Cervical Rotation Lateral Flexion Test
        • Craniocervical Flexion Test (CCFT)
        • Deep Neck Flexor Endurance Test
        • Posterior-Anterior Segmental Mobility
        • Segmental Mobility
        • Sharp-Purser Test
        • Spurling's Maneuver
        • Transverse Ligament Test
        • ULNT - Median
        • ULNT - Radial
        • ULNT - Ulnar
        • Vertebral Artery Test
      • Thoracic Spine >
        • Adam's Forward Bend Test
        • Passive Neck Flexion Test
        • Thoracic Compression Test
        • Thoracic Distraction Test
        • Thoracic Foraminal Closure Test
      • Lumbar Spine/Sacroiliac Joint >
        • Active Sit-Up Test
        • Alternate Gillet Test
        • Crossed Straight Leg Raise Test
        • Extensor Endurance Test
        • FABER Test
        • Fortin's Sign
        • Gaenslen Test
        • Gillet Test
        • Gower's Sign
        • Lumbar Quadrant Test
        • POSH Test
        • Posteroanterior Mobility
        • Prone Knee Bend Test
        • Prone Instability Test
        • Resisted Abduction Test
        • Sacral Clearing Test
        • Seated Forward Flexion Test
        • SIJ Compression/Distraction Test
        • Slump Test
        • Sphinx Test
        • Spine Rotators & Multifidus Test
        • Squish Test
        • Standing Forward Flexion Test
        • Straight Leg Raise Test
        • Supine to Long Sit Test
      • Shoulder >
        • Active Compression Test
        • Anterior Apprehension
        • Biceps Load Test II
        • Drop Arm Sign
        • External Rotation Lag Sign
        • Hawkins-Kennedy Impingement Sign
        • Horizontal Adduction Test
        • Internal Rotation Lag Sign
        • Jobe Test
        • Ludington's Test
        • Neer Test
        • Painful Arc Sign
        • Pronated Load Test
        • Resisted Supination External Rotation Test
        • Speed's Test
        • Posterior Apprehension
        • Sulcus Sign
        • Thoracic Outlet Tests >
          • Adson's Test
          • Costoclavicular Brace
          • Hyperabduction Test
          • Roos (EAST)
        • Yergason's Test
      • Elbow >
        • Biceps Squeeze Test
        • Chair Sign
        • Cozen's Test
        • Elbow Extension Test
        • Medial Epicondylalgia Test
        • Mill's Test
        • Moving Valgus Stress Test
        • Push-up Sign
        • Ulnar Nerve Compression Test
        • Valgus Stress Test
        • Varus Stress Test
      • Wrist/Hand >
        • Allen's Test
        • Carpal Compression Test
        • Finkelstein Test
        • Phalen's Test
        • Reverse Phalen's Test
      • Hip >
        • Craig's Test
        • Dial Test
        • FABER Test
        • FAIR Test
        • Fitzgerald's Test
        • Hip Quadrant Test
        • Hop Test
        • Labral Anterior Impingement Test
        • Labral Posterior Impingement Test
        • Long-Axis Femoral Distraction Test
        • Noble Compression Test
        • Percussion Test
        • Sign of the Buttock
        • Trendelenburg Test
      • Knee >
        • Anterior Drawer Test
        • Dial Test (Tibial Rotation Test)
        • Joint Line Tenderness
        • Lachman Test
        • McMurray Test
        • Noble Compression Test
        • Pivot-Shift Test
        • Posterior Drawer Test
        • Posterior Sag Sign
        • Quad Active Test
        • Thessaly Test
        • Valgus Stress Test
        • Varus Stress Test
      • Foot/Ankle >
        • Anterior Drawer
        • Calf Squeeze Test
        • External Rotation Test
        • Fracture Screening Tests
        • Impingement Sign
        • Navicular Drop Test
        • Squeeze Test
        • Talar Tilt
        • Tarsal Tunnel Syndrome Test
        • Test for Interdigital Neuroma
        • Windlass Test