The Path to Exercise Adherence

I had the wonderful opportunity to attend Dr. Mike Israetel’s presentation “From Inspiration to Passion” at the National Strength and Conditioning Association’s 2018 Personal Trainer conference. I believe that the points he made are also valid from the perspective of getting physical therapy patients to adhere to their home exercise program.

Dr. Israeltel’s presentation addressed adherence in diet and fitness clients. He highlights that the client’s desire to adhere to the plan will fluctuate over time and psychological states. He identifies six constructs that clients/patients go through that coaches/therapists can utilize to maintain exercise compliance.

1. Inspiration
2. Motivation
3. Intention
4. Discipline
5. Habit
6. Passion

Inspiration: Inspiration represents the patient’s first step towards recovery. For PT patients, an illness, injury, significant pain, or functional mobility issues are the typical sources of inspiration to visit you, the physical therapist. Unfortunately, inspiration doesn’t last long and can quickly disappear when the patient realizes that you actually want them to exercise to get better and can’t wave your magic wand or give them special pills to suddenly make them better.

To help inspire your patients, you can educate them about the benefits of home exercise and provide them with relatable success stories.

Motivation: Motivation is the desire to do something about a goal and begins after inspiration. It is a less intense emotion compared to inspiration but longer lasting. Motivation will rise and fall but is not dependable in the long term.

From a physical therapist’s perspective, recognizing that your patient’s inspiration may end before the completion of their initial evaluation, you need to start helping them activate their motivational emotions by helping them set specific and realistic goals in their first visit.

As motivation will fluctuate, it is important to add another layer of structure to overcome the periods when motivation is low.

Intention: Intention is a commitment to actually do something and can give your patient the impetus to fill in the adherence gap when motivation is low. Intention develops within days of beginning the program and is especially important in the first month of the program.

To help develop intention in your patients, you can help them create a plan to execute their exercises to achieve their goals. Plan details don’t matter nearly as much as having a plan.

Discipline: When your patient’s motivations are low, they need discipline to fulfil their intentions. Your patients can use willpower to execute the plan.

You can help your patient by cultivating their discipline. You can remind your patients that motivation will wane and sometimes it will be tough to get through their home exercises. Remind them that it will get better but they have to continue with their plan.

Unfortunately, willpower is exhaustible and can be consumed by other aspects in your patient’s life. If your patient is experiencing high level of stress or other demands on their life, they may not have any willpower left to apply to do their home exercises.

Habit: After more than a month, activities soon start to become habits. The longer your patients regularly do their home exercises, the stronger the habit becomes. Maintaining a habit requires less discipline resulting in better compliance.

An exercise plan that suits your patient’s preferences are more likely to become habits. Understanding your patients and creating a home exercise plan that is sustainable and convenient for them is more likely to become a habit. Asking non-active patients to suddenly allocate an hour a day towards home exercise is likely not going to become a habit.

Passion: Passion is a deep love for the process of exercising.

Most physical therapy patients will not be under treatment long enough to develop a passion for exercising. However, physical therapy can lead a patient towards a passion for wellness and fitness that they pursue with a health and fitness coach.

Recognizing what your patients are passionate about may help you motivate them to exercise to get back to doing what they love to do.

Making Exercise A Habit In Your Kiddo

Guest blog by Richa Kohli

Like many other moms, it was also my concern that my kid is not involved in any outdoor sports or do any kind of exercises. Kids nowadays are very much involved in video games and mobile games that they refuse to go out of the house to play. During a recent visit to the doctor for a routine checkup, I came to know that my 8-year-old is overweight. That was the time when I decided to search for smart ideas to keep my kid engaged in fitness activities.

1. Set a goal – Setting up a goal can be really motivating. Set small goals, not unachievable ones. Once your kid is capable to reach for small goals, raise the bars.
2. Let’s dance together – Enroll in a dance class together as dancing is a very good exercise and fun too,
3. Park trips – Take them to the park and play with them. This will increase your fitness and is good for your kid as well.
4. Bike buddies – Be a bike buddy with your kid. It is a good cardio exercise.
5. How about a work out video – Do the exercises together while watching a fitness video. Choose the one who does not have complicated exercises. Go for the simple one so that your kid can also do it. You can take a consultation with board-certified physical therapists at TheraNow.
6. Get competitive – Get competitive in a healthy way. This can act as encouragement in kids and the kid tries to give their best.

Encouragement plays a very important role while you are trying something new with your kids. Do not get angry or scold them. Be patient, talk and tell them to know the importance to stay fit, what you are trying to do is good for them. Analyze your kid and see what are all their area of interest and how you can use them to incorporate fitness into them. You also share a special bond when you spend quality time with your kid while exercising. You should also monitor that your kid does not overdo anything as this can lead to injury. You can give rewards on the achievement of conquering a short-term goal. This will keep them encouraged and they will try to give their best every time.

Richa Kohli, CEO of TheraNow, is a young female entrepreneur and innovator with a vast knowledge of Physical Therapy field. Richa has a vision of making physical therapy services digitally available for everyone in the USA, provided by board certified and experienced therapists, ensuring convenience, effectiveness and lower cost of treatment. She is an avid healthcare blogger and also loves traveling the world.

PT-Helper's September Blog Posts for Physical Therapists

Concussions and Neck Exercises
Published On September 18, 2018
Neck strength is being recognized as a prevention and rehabilitation strategy for concussions. Strong neck muscles can help control the motion of the head and control the brain motion inside the skull during an impact. PT-Helper has collaborated with Iron Neck to put their neck strength and mobility training exercises in our neck exercise catalog providing therapists with additional resources to avoid and rehab concussions.

Create a New Exercise within the PT-Helper Mobile App

Published On September 13, 2018
Therapists may customize an exercise based upon their own experiences or the restrictions and capabilities of their patients. Creating a new exercise within the PT-Helper mobile app is a simple way to add customized exercises to your Favorites program ensuring that you have all of your exercises with you. Using the built-in camera feature adds pictures and videos to help you remember how to do the exercises correctly.


5 Reasons Why Your Back Pain Keeps Coming Back

Published On September 4, 2018

By guest writer Dennis Treubig PT, DPT, SCS, CSCS.
80% of the population will experience back pain at some point in their lives. Dr. Treubig identifies the 5 most common reasons from his 10+ years of treating athletes and active individuals that cause recurring back pain.

Subscribe to the PT-Helper Blog here so you don’t miss these helpful compilations and BONUS, you’ll receive Our Secret Guide, unveiling the secrets your patients are keeping from you.

Concussions and Neck Exercises

Awareness of long-term health risks of multiple concussions and recent changes to the guidelines on diagnosing and managing head injuries by the Centers of Disease Control and Prevention raises new approaches to dealing and preventing concussions.

Iron Neck Exercises Now on PT-Helper App

Concussion research over the past five years has brought more attention to neck strength as a prevention and rehabilitation strategy. Strong neck muscles can help control the motion of the head and control the brain motion inside the skull.

The Iron Neck is a strength and mobility training device that allows isometric training of the neck, back and core across a full range of motion. It is a rehabilitation tool for treating neck and back injuries in everyone from elite athletes to desk warriors to active aging individuals.

"Working with the neck in a consistent, repeatable way is a challenge," says Iron Neck inventor Mike Jolly. "We solved that problem for athletes and large sports teams and over the past two years and have refined many of the design features based on valuable feedback from rehabilitation professionals."

Innovating for Consistency in Treating the Neck

Iron Neck fits comfortably on the head, just above the ears and grabs hold of the head through it's Air Bladder Inflation System beneath a soft foam. The resistance comes from connecting the free-gliding truck on the outer track of the Iron Neck either to a cable pulley or a resistance band (as seen below). What makes Iron Neck unique as a rehabilitation tool is that you can develop neck strength and core stability through a full range of motion against a controlled linear and rotational resistance.

"Iron Neck has been instrumental in our ability to treat our patients, strengthening the neck in ways that were previously impossible," says Trevor Shaw, a New York based chiropractor. "We can now provide protocols for 3 dimensional cervical stabilization which helps decrease pain and improve cervical lordosis."

Consistency in Research

There are several ongoing research studies that have included Iron Neck to implement neck strengthening consistently. A first-of-its-kind clinical trial by a research team at the University of Mississippi Medical Center aims to evaluate the effectiveness of aggressive physical therapy as “sensorimotor” training.

These research studies and the innovation seen this past year from rehabilitation professionals, are revealing new applications and treatment strategies with the Iron Neck. Simplifying the education and training process is important to ensuring proper form and position.

Learn Iron Neck on PT-Helper App

We have added six foundational Iron Neck exercises to the PT-Helper app. These movements are the building blocks to Iron Neck treatment protocols and provide a consistent, repeatable way to build neck strength and improve mobility and range of motion. We will be adding additional Iron Neck exercises later this month.

You can find all Iron Neck exercises within the Neck Category of PT-Helper's exercise catalog.

• Iron Neck 360 Spin

• Iron Neck Look Left Look Right

• Iron Neck Diagonal

• Iron Neck Protraction-Retraction

• Iron Neck Figure Eight

• Iron Neck Lock Neck Body Turn

About Iron Neck

The Iron Neck is a strength and mobility training device that allows for isometric training of the neck, back and core across a full range of motion.  It first hit the market in 2013 and has since been refined from a bulky strength training tool for college and NFL football teams to a rehabilitation tool for treating neck and back injuries in everyone from elite athletes to desk warriors to active aging individuals.

Visit www.iron-neck.com to learn more about Iron Neck for injury prevention, health and fitness, and rehabilitation. Try Iron Neck for FREE for 30 days.

Create a New Exercise Within the PT-Helper Mobile App

Why would you want to create a new exercise within the PT-Helper mobile app?

We have discovered that therapist, health and wellness professionals each have their own preferred and unique sets of exercises that they prescribe to their patients and clients. Many times these exercises will be similar to an exercise already within our available list of exercises and you would add the exercise to your Favorites list to represent the exercise that you need to complete. When doing the exercise, you would then follow the instructions of your health professional provided to you to do the exercise as they recommend.

However, if you can’t find an exercise that matches up with your prescribed exercise or you want to make an exercise whose name prompts you to easily recall the exercise, you can easily create a new exercise within the PT-Helper mobile app.

To create a new exercise with the mobile app, first select “Exercises by Category” on the home page and then select “Create An Exercise” at the top of the following page.

This will bring up the Create An Exercise form where you can enter the Exercise Name and Exercise Description. In this example, we will name the new exercise “Dumbbell Fly”.

You can then select “Exercise Category” which will identify where the app will place the newly created exercise should you need to find it in the future. For this example, we have selected “Fitness - Shoulders”.

     
You can then select “Exercise Details” to set the default exercise parameters for the new exercise. Hold Time corresponds to the time required to hold a stretch or the eccentric motion for a dynamic exercise. Recovery Time corresponds to the time between stretches or the concentric motion for a dynamic exercise. Rest Time is the rest period between sets.

 

Once you have entered the details of the new exercise, press “Confirm” on the Create An Exercise page to add the exercise to your local list of available exercises. You still need to add the new exercise to your Favorites list by selecting “Add to Favorites”.

Once the exercise has been added to your Favorites, you can use the camera symbol at the top left to add pictures and videos to the exercise to provide additional information on how to do the exercise correctly.

You now have a new exercise added to your Favorites list to help you complete your home exercises.

Happy exercising!

5 Reasons Why Your Back Pain Keeps Coming Back

Guest blog by Dennis Treubig

Over 80% of people will experience back pain at some point in their lives.  And many of those people will have recurring episodes of back pain.  The pain subsides, they think they’re out of the woods and then 6 months later it comes back.  And then it goes away….and then only 3 months later it comes back and now it’s not going away so fast.  And so on and so on.

And the person gets increasingly frustrated each time the pain comes back and now they worry about it happening just about every day.  They can’t enjoy the active lifestyle they once had because either they physically can’t do those things anymore or even if they can, they are afraid it will cause the pain to come back.

So why does the pain go away for a while and then come back?  Here are the 5 reasons I have come across most often in my 10+ years of treating athletes and active people:

1. You Haven’t Actually Done Anything To Fix the Problem

This is by far the most common reason people’s back pain cycles on and off.  When I meet people and tell them that what I do for a living (physical therapist), so many people go on to tell me about their back pain and how it’s annoying, frustrating, etc.  And when I ask them what they have done for it, the typical response is nothing…or just take some pain meds!

How can you expect your pain problem to get better if all you do for it is say a prayer at night and hope it will go away on its own!?

And the more people have talked to me about their back problem (really any problem), I realized that a lot of people choose not to do anything because they simply don’t know which of the many options out there is the best choice for them.  And they’re afraid of making the wrong decision or confused of even where to start.  So instead, they live in this paralyzed (not literally) state of indecision and continued pain that limits their active lifestyle. 

This is why I set up my clinic to offer a few different free options to help people BEFORE they commit to us.  It’s a way for people to learn what they can do for their problem and see what option works best for them.

2. The Treatment(s) You Got Didn't Address the Underlying Issue

For those people who got some form of treatment and the pain still comes back, there's a good chance that the treatment they got (i.e. injections, medications, bad PT, etc.) only took care of the symptoms/pain and didn't address the underlying reason for their problem.

It's like having someone help you bail water out of your sinking ship versus having someone help you plug the hole.  It's the difference between constantly having to worry about it happening again and being able to enjoy the things you love to do without worry.

3.You Didn't Follow Through With Your Treatment Plan and/or "Homework"

There are times when someone is getting a good treatment that is working on the underlying cause, but when they start to feel much better, they decide to stop the treatment plan early...and a few months later they're back in with a "flare-up."  And this "flare-up" may have been avoided had they saw their treatment plan all the way through and not quit just when the pain went away.  Remember, addressing the underlying issue is key!

Other times, people don't do their physical therapy "homework" - the tips and advice given to them to do on their own time.  If you see us 2 x week for an hour each time, that's only 2% of your entire week.  What you do in the other 98% will have a HUGE effect on your outcome.

4. You Progressed Your Activity Level Too Quickly

Another classic reason for someone's back pain to come back.  They start feeling a lot better so they decide that a 10 mile bike ride is ok to do...even though they haven't ridden in a couple months.  Or they're feeling good because they're finally back in the gym...and they decide the "boot camp" class that was going on that day was a good idea.  Or a friend asks them to do a charity 5k with them...it's for charity so it's ok, right!?

You're probably chuckling right now...not because the examples are that funny, but because you know you've been guilty of it.

I understand that when the pain starts to go away, you get excited to do things again, but you have to make sure it all makes sense with regards to your treatment plan - both short and long-term.

5. The Rest of Your Life Isn't Healthy

You don't sleep well.  You're stressed.  You work too much.  You don't eat well.  You're overweight.  You're out of shape.  You get the idea.

All those things play a role in your recovery and can affect your expected outcome - both amount of relief expected and the time it will take to get that relief.  If you can't get those things in control, the odds of a successful outcome go down...it's that simple (and I know that simple doesn't mean easy).

Dr. Dennis Treubig, PT, DPT, SCS, CSCS

Owner of Modern Sports Physical Therapy

Hello, my name is Dennis Treubig.  Since graduating from the University of Delaware (#1 PT school in the country), I have worked relentlessly to hone my skills and knowledge so that I can be the leading sports injury expert in the area.  Over the years, I have become one of the less than 1% of therapists who have attained the title of Board Certified Specialist in Sports Physical Therapy.

I founded Modern Sports Physical Therapy so that there would be a place where athletes and active people could go to quickly recover from their injury and get out of pain so they could get back to doing the things they love to do.

Physical Therapy Exercises for Frozen Shoulder

Frozen shoulder is used to describe stiffness and pain in the shoulder joint. One of the common causes of frozen shoulder is immobility of the shoulder as a result of other injuries or illness when the connective tissue around the shoulder thickens and tightens around the shoulder joint.

Treatment of frozen shoulder typically involves physical therapy exercises. Steroid injections and arthroscopic surgery is occasionally required to treat the frozen shoulder.

The Harvard Medical School and University of Washington Orthopaedics and Sports Medicine have recommended home exercises for the stiff and frozen shoulder. We’ve added their exercises into a Home Exercise Program (HEP) using the PT-Helper CONNECT platform and presented on the PT-Helper mobile app. These sample exercises can be quickly downloaded into the PT-Helper mobile app using

HEP code: 3AED5619

You can also find these exercises in the Shoulder 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 or physical therapist before engaging in any physical activity and stop if you experience pain or discomfort.

The recommended exercises include:

Passive Range of Motion Flexion - Sit alongside a table with your forearm resting on a smooth surface. Use a pillow case or towel under your arm to make sliding easier. Your thumb should be pointing up. Lean your body forward by bowing at the waist to slide your arm passively until you feel a comfortable stretch. Hold. Slowly sit back up dragging your arm along the table to starting position.

Towel Stretch for Internal Rotation v2 - Place a towel over your unaffected shoulder. Hold the front end of a towel with your un-involved hand in front of your chest. Reach behind your back with your involved arm and grasp the other end of the towel with your thumb up. Pull the towel forward and down with your un-involved arm pulling your other arm further up behind your back causing a stretch in your shoulder. Hold and return the towel to its starting position. Repeat.

Active Assisted Supine Flexion - While lying down on your back, grasp your hand or forearm with your opposite hand. Raise arms up and overhead as far as comfortable to feel a stretch in the affected shoulder. Hold, then return to starting position.

Wand External/Internal Rotation - While lying on your back, hold a wand with your involved side palm up and un-involved side palm down, elbows bent. Using your un-involved hand, move the wand away from your body while keeping your elbow of your involved side at your side until you feel s stretch. Hold then pull the staff back across your body with your un-involved hand. Hold then repeat.

ROM Pendulum (Circular - Clockwise) - Let arm move in a clockwise circle by rocking your upper body in a circular pattern.

Wall Climbs Abduction - Place your involved arm straight out against a wall at your side. Slowly walk up the wall with your fingers as high as you can until you feel a stretch. Your arm should be slightly in front of you (about a 30 degree angle). Try to keep your elbow straight and shoulder depressed. Step in towards the wall as needed. Hold at the top. Slowly walk fingers back down the wall and lower arm to the side.

Posterior Capsule Stretch - Cross one arm over your body and grasp at elbow with opposite arm. Gently pull hand towards opposite shoulder. Hold, then gently release. Your therapist may advise you to perform laying on your side, or leaning against a wall. Do not perform this exercise if you feel a sharp pinch in the front of your shoulder. Stretch should be felt in the back of your shoulder.

External Rotation 30 degrees - Attach exercise band to stationary point at waist height. Place towel roll under armpit. Hold the exercise bands with forearm across your body, thumb up, elbow bent at 90 degrees. Smoothly rotate your forearm outward across your body. Pause, then return your arm to the starting position.

Internal Rotation 30 degrees - Attach exercise band to stationary point at waist height. Place towel roll under armpit. Hold the exercise bands with forearm out perpendicular to your body, thumb up, elbow bent at 90 degrees. Smoothly rotate your forearm in across your body. Pause, then return your arm to the starting position.

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.