The Lost ART of Programming
In physical therapy and really in life, everything we do either creates a stress or strain on our tissues. Regardless of our intentions adaptation will occur: good or bad. Therapeutically, our interventions being performed should yield an acute adaptation whether it's manual therapy for soft tissue or joint mobility, METs to learn subconscious reciprocal inhibition, or some other technique. This acute adaptation needs to be cultivated and sustained by the home exercise program or rather the exercise prescription that we assign. Our prescription should be geared at sustaining results to create a chronic adaptation. This is the crux of becoming resilient. However, this requires effective programming and integration within the human system.
But when a patient presents with a program as such, I question our intentions with our programming. It’s not that I lose confidence in my profession or how we are facilitating the "healing process", but I rather feel a remorse for the client being given nearly 20 exercises and asked to perform them multiple times a day! I can only imagine the overwhelming feeling of stress and pressure being felt by them each day.
This simply adds chaos to of our already highly dynamic and likely overstimulated system.
Stress needs to be managed effectively to allow for an efficient recovery. Stress comes in many forms, but the body cannot differentiate between types of stress: physical, emotional, psychological, etc. So when someone has 20 exercises to be performed routinely and it is absorbing hours of the day this becomes a psychological stressor, as they are likely now pressed for time to perform and complete other tasks already on their schedule.
Patients aren’t given 20 exercises off the bat, but over the course of treatment their exercises are “updated”. Most patients don’t recognize it as a progression to replace the original exercises, but as exercises to be performed in addition too. This stems from a lack of education on a clinician’s end to inform the patient on how the body adapts as well as how their exercises may simply evolve of the course of treatment. This is an effective way to manage stress and optimize the learning potential of a patient.
Our goal is to teach patients how to regain control of their lives and learn to move efficiently without pain. Poor programming and the induction of a new stressor can actually limit the movement learning potential. An effective-essentialist programming strategy for home exercises is fundamental.
The above was program was reduced to the following. This is still extensive in my opinion, but the patient was under the impression "more is always better." We comprised with this program to allow patient buy-in. Once the patient initiated his revised program he appreciated it because he was able to return to coaching club soccer with his “extra time”. Patient’s appreciate when they themselves as well as their desires are prioritized in their recovery process.
So, be cognizant of the patients needs as well as concise, yet effective with your programming. Be integrative.
