Discharge instructions are not always something we take seriously. Sometimes they just end up in the recycle bin. But paying more attention to the post-treatment weeks can contribute to your full, pain-free recovery, according to Dr. Patrick Donovan, owner and physical therapist at Heather Lane Physical Therapy in Denver.
“You may be thinking, ‘I finished physical therapy, so I’m done,’” Dr. Donovan says. “But the movement strategies and exercises you learned in your PT sessions can do you a world of good even after you’ve finished the formal treatment.”
How long to continue the exercises?
The time frame for continuing to do the exercises depends on:
- The length of your PT course. According to Dr. Donovan, the rule of thumb is that the longer you were in physical therapy, the longer you should expect to repeat the exercises at home after treatment ends.
- Your age. The older you are, the slower you’ll heal. “Older adults, especially, can benefit from continuing to do the movements,” Dr. Donovan explains. “This is true because the aging process naturally weakens muscles, decreases muscle elasticity and increases joint stiffness.”
- The type of problem: acute injury vs. chronic injury. An injury to an otherwise healthy joint or part of the body probably will require a shorter-term home followup than treatment for chronic pain. “If you come in the week after a sprained ankle, I may recommend you continue to do your exercises for only another two weeks after our sessions end,” Dr. Donovan says. “But if you’ve had shoulder pain for years, you should continue to do the exercises at home until I see you for a followup appointment.”
Maintenance and prevention
After you’ve achieved relief from the pain, the movements you learned in physical therapy can be valuable in staying healthy and pain-free.
“It’s not just a cliché that an ounce of prevention is worth a pound of cure,” Dr. Donovan says. “I tell my patients that all the time. Often, they’ll come back in because their back pain has returned. I ask whether they’ve been doing their exercises, and in most cases, they haven’t been.”
If you’re older, you may have suffered slight injuries years or even decades before a greater pain surfaces. “Every small injury compounds to create a greater deficit,” Dr. Donovan explains. “The nerves and joints change your physiology. ‘Knee pain’ is often the result of multiple aggravating factors at work, compounded over time.”
Your PT exercises can help correct that slight injury pattern, and continuing targeted exercises indefinitely can help you to avoid repeating the injury. In addition, checking in with your physical therapist regularly is a good way to prevent pain or manage chronic pain. For maintenance conditions, Dr. Donovan recommends seeing your practitioner two to three times a year.
“With regards to maintenance, your physical therapist is like your dentist,” Dr. Donovan advises. “If you’ve been in PT for six months to alleviate chronic pain, it’s helpful to return every four to six months for a checkup. Your PT will observe how you’re moving and how easily you can accomplish the exercises. You may need an upgrade to your regimen, or you could be at a good place and not require any adjustments.” And if no adjustments need to be made to your exercise program, that ounce of prevention was worth the office visit.
How does an exercise “expire”?
An “upgrade” to your home program means that your physical therapist will increase the degree of difficulty to stimulate your strength or flexibility.
“If you’re doing strengthening exercises regularly, eventually they’ll get easy,” Dr. Donovan says. “That indicates they’ve stopped making you stronger; they no longer are providing the desired strengthening effect. It’s as if that exercise has run its course and is now ‘out-of-date.’ The exercise is effective if you need a break after performing 8-12 repetitions. If you can do it 20 times, you’re working at an endurance dosage, not a strengthening dosage.”
For example, if you can easily do 20 reps of a bicep curl with 8-pound weights, your physical therapist may have you perform two sets of 8 reps with 10- or 12-pound weights.
“Finding the right dosage for an exercise is like prescription medication,” Dr. Donovan adds. “It may take some tinkering with.”
Even patients with the best intentions of continuing their regimen at home can undermine their efforts by performing the exercise improperly. If you’re reproducing instead of reducing your symptoms, you’re doing the exercise wrong!
“I see this time and again,” Dr. Donovan says. “Patients do it right when they’re in my clinic, but they tell me it hurts their back when they do it at home. That’s an indication they’re doing it incorrectly.”
To avoid that, your physical therapist may give you a cue to remember when you correctly replicate the exercise on your own. The cue could be a location-specific stretch or the exertion at a certain spot on your body. If you feel the exertion somewhere else, you’re probably performing the movement incorrectly.
Dr. Donovan triples his efforts to combat this problem:
- He presents patients with written instructions.
- He has patients use their phone to take a video of the exercise being performed correctly.
- He refers patients to the Heather Lane YouTube channel, where some of the exercises are demonstrated.
Everyone is busy! The trick is to create a habit of doing the exercises. It can be waking up 15 minutes earlier to do them first thing in the morning, taking a mid-afternoon break from work, doing them before you go to bed or scheduling in “exercise snacks” multiple times a day—whatever works best for you.
Although your physical therapist may modify the exercises so that you won’t have to purchase equipment, you may find it helpful to buy some light weights or other equipment you used during your therapy.
“If a patient has had a good result at the clinic from using a foam roller and wants to buy one to prevent another injury, that can be a good idea,” Dr. Donovan says.