Why Do Patients Not Know How To Do Their Exercises

We frequently hear stories from physical therapists and physical therapist assistants that their patients can’t seem to remember how to do their home exercises. The typical story goes like this:

Patient comes into the clinic.
PT/PTA,  “Did you do your home exercises this past week?”
Patient, “Yes I did.”
PT/PTA, “Great. Let’s get you started with this exercise.”
Patient stands around looking a little lost.
PT/PTA, “Is there something wrong?”
Patient: “How do I do this exercise again?”

If you’ve experienced this exchange with your patients, you’re not alone. What were your thoughts after this exchange?

Perhaps you would think, 
“Clearly he/she hasn’t been doing their exercises!”

One other thing therapists might think is,
“If I can do a better job of teaching him/her how to do this exercise, then they’ll remember how to do this exercise.”

However, as an ex-patient, I can honestly say that I was able to remember how to do all of my exercises as I left the clinic. I believe that the challenge is when the patient never or doesn't regularly do any of their exercises and then shows up at the clinic the following week. After days without doing their exercises, it is unlikely that the patient is going to remember how to do an exercise even if they had it memorized the previous week.

Since learning how to do an exercise is not the issue, then getting your patients to do their exercises is! 

One of my good friends recently had back surgery 3 months ago. Even though she’s a nurse and fully understands the benefits of doing her home exercises, she confessed to me that she often doesn’t do it as she gets busy and can’t allocate the time to do all of her exercises. She said something always gets in the way. 

I wonder if she’s ever had this discussion with her therapist. I know that she’s made significant progress since the surgery but after standing at a corner of a bike race for a few hours directing riders and traffic, she started to exhibit significant limping and was clearly in pain. 

How can a therapist overcome the excuse of “no time”. Would breaking up her exercise program into multiple shorter sessions allow her the opportunity to complete at least some of her exercises instead of doing none? Maybe reducing the number of exercises in her program would be enough to overcome her no time excuse.

Each patient is different and may also have different behaviors depending upon how far away their injury or surgery occurred. Keep an open communication channel with your patient to stay on top of how well they are completing their home exercises.

… and if they tell you they’ve been doing their home exercises, they just might not be telling you the truth…

Start your Free 30-day Trial of the PT-Helper CONNECT tool for physical therapists and other therapy providers, so you may create and prescribe a Home Exercise Programs. Share the HEP program with your patients using the PT-Helper mobile app.

Photo by Jon Flobrant on Unsplash

Physical Therapy Exercises for Plantar Fasciitis

Plantar Fasciitis is a common cause of heel pain and can cause pain at the bottom of the foot while walking. Approximately 2 million Americans are treated for plantar fasciitis every year. It is particularly common injury for runners and people who stand for long periods of time.

Fortunately, plantar fasciitis can be treated by physical therapy treatment, including icing, manual manipulation, and stretching.

The Cleveland Clinic also suggests other treatments such as:

• Heel gel pads
• Orthotic arch support
• Night splints
• Walking cast

According to the American Academy of Orthopaedic Surgeons, “more than 90% of patients with plantar fasciitis will improve within 10 months of starting simple treatment methods.” Recovery from plantar fasciitis is not a quick process and often includes activity modification or rest to reduce the activities that make the pain worse.

The AAOS recommends doing calf stretches and the plantar facia stretch:

• Soleus Stretching - Stand in front of a wall with feet staggered, one in front of the other. Lean towards the wall, bend back knee but keep back leg’s heel to the floor. Feel gentle stretch in back calf and Achilles area. Make sure back foot is facing straight ahead, not turned out.

• Standing Gastroc Stretch - Stand in front of a wall with one foot in front of the other, keep the back leg straight. Lean towards wall while keeping back heel down, feel gentle stretch in calf of back leg. Make sure back foot is facing straight ahead, not turned out.

• Plantar Fascia Stretch - While seated, cross your foot over the knee of your other leg. Grasp the toes of your foot and slowly pull them toward your shin in a controlled fashion. Place your other hand along the plantar fascia. The fascia should feel like a tight band along the bottom of your foot when stretched. Hold. Slowly return your toes to their starting position. Repeat. 

Athletico Physical Therapy recommends additional exercises for plantar fasciitis.

• Towel Calf Stretch - Sit with knee straight and towel looped around the ball of one foot. Gently pull on the towel until a stretch is felt in the calf. You can also sit in a chair with leg straight, heel on the ground

• Tennis Ball Exercise 1 & 2 - While sitting, place a tennis ball under your foot. GENTLY press into tennis ball then move your foot forwards and backwards so that the ball moves down the middle of your foot from heel to toe. Then roll the ball side to side under the ball of your foot. May be tender but should not cause pain

You can find the above exercises in the Ankle and Foot category in the PT-Helper mobile app to add to your Favorites which allows you to customize each exercise’s repetitions, sets, and hold time.

Reminder: Please consult your physician before engaging in any physical activity and stop if you experience pain or discomfort.

Start your Free 30-day Trial of the PT-Helper CONNECT tool for physical therapists and other therapy providers, so you too may create and prescribe Home Exercise Programs like the one shown above.

How to Save Time by Creating Exercise Protocols

A physical therapist or health professional can save time prescribing exercises to patients or clients after creating a home exercise protocol or template. The template function in PT-Helper CONNECT allows the therapist to group exercises together to be able to quickly add these exercises into a home exercise program.

To create a template, follow the steps below to easily add exercises to a template:

Select Settings in the pull-down menu found at the top right of the browser window.

This will take you to the organization’s or clinic’s configuration menu. Press the Manage Templates button at the bottom left of window.

Select Add Template to create a new template.

The Edit Template page will appear where you can provide a name for your template/protocol, add exercises to the template and assign the template to everyone within your organization or to specific individuals.

Once you’ve provided a name for your template, press Advanced Search to visually select exercises to be added into the template.

You can use the Search field or the By Category pull-down menu on the left of the screen to filter exercises to match your search. 

Once you’ve finished selecting all the exercises that you would like to add to the template, press the Add Selected Exercises button at the top or bottom of the exercise list page.

This will take you back to the Edit Template page where you can select the “Is Available To Everyone” button or select specific therapists within your organization or clinic that will have access to this template.

If you select specific therapists, this template will only appear in the Add Exercise page when the specified therapist is also selected as the treating therapist for the patient’s specific injury. 

One reason why templates may be only available for a specific therapist is the therapist may have a unique specialty such as Hand & Finger. Then Hand & Finger templates created for that therapist would not need to be seen by other therapists within the organization.  

Once a template has been created, it can be selected in the Add Exercise page of a patient’s treatment plan. 

Exercises within a template or protocol are meant to be a guide to the treating therapist to ease the process of selecting exercises for the patient. The therapist can select individual exercises within the template and change the exercise parameters to match the patient’s condition and progression. 

Start your Free 30-day Trial of the PT-Helper CONNECT tool for physical therapists and other therapy providers to create and prescribe Home Exercise Programs.