On my Musculo placement, I was treating a 78 y/o male who presented with low back pain (L>R) and L lateral thigh pain. He was diagnosed with L4/L5 hypomobility and an associated left L4 nerve irritation and was treated with a L rotation in R sidelying PPIVM and a reverse lateral flexion in R sidelying. He responded extremely well to this treatment over 4 treatment sessions. His low back pain decreased from 7 to 2/10 at rest, and experiences only occasional leg pain.
However, the trouble I had with this patient was that he did not seem to understand his HEP! On the first treatment session, I gave the patient lumbar rotation in crook lying (within pain limits). During the follow up session, he came in with an absolutely different exercise. On that session, I spent a considerable amount of time explaining the importance of his HEP and how it will impact on this progress made during the treatment sessions. In addition to this, I also decided to explain in greater detail the pathology of his back pain and how the physio treatment is helping him. (with spine models and pictures). At the end of the session, I wrote out the HEP on a piece of paper (with the usual instructions, stick man drawings, and warnings).
The following session, this patient was able to perform this exercise but was still making a couple of mistakes. For example, going into too much range aggravating his leg symptoms. So, I had to constantly remind and correct his exercises. This is main reason why I only gave him that one home exercise.
On reflection, I realized that I should have spent more time on the initial session explaining the pathology and back ground to his condition and why physio helps. I suppose this comes with experience as I felt I was more focused on thinking about the subjective questioning and the components of the objective exam than actually thinking ahead and explaining relevant findings to the patient. In future, I will strive to explain the patient’s condition as thoroughly and precise as I am able to (given the situation) during the initial treatment session. And I will also write out the HEP or use one of the available HEP handouts with any patient.
1 comment:
You have highlighted a couple of very relevant points. It is very important for patients to understand what is wrong and why what we do as physios can help. If they do not have this basic understanding you will not have compliance to their HEP, particularly if it does not provide immediate relief or change (and many of our Rx's do not)And secondly whatever your reasons are for not providing a written HEP - the patient said they didn't need it, takes too long to write, can't draw - none of these really stand up against the facts that it is one of the best methods of helping patients do the exercises correctly and remembering the exercises
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