“Did you do your homework?”. It’s a common question – daily, actually – that we ask our patients. Your Home Exercise Program, or HEP for short, is that collection of boring, mundane, nuanced exercises that physical therapists prescribe for our patients on a daily basis. Come in to the clinic with any number of injuries – shoulder/neck/knee/back pain, shoulder impingement, rotator cuff tear, disc degeneration, stenosis, disc herniation, radiculopathy – and you’re leaving with some “homework”. Admittedly, they’re often not very exciting, not very sexy. But they’re there for a purpose. And if chosen wisely by your physical therapist, should make a big impact on your issue. Let’s dive in.
Doctors of Physical Therapy are trained to evaluate a patient’s deficiencies and limitations across multiple areas. We’re looking at your mechanical capacity to move through a range of motion, your ability to activate appropriate muscles in a particular sequence, and your ability to put those two things together in a functional task in varied situations. As a Certified Functional Manual Therapist, we define these three areas as Mechanical Capacity, Neuromuscular Function and Motor Control. Fancy, right?
Mechanical Capacity can simply be defined as range of motion. Many things may contribute to, or impede, range of motion. Joint mobility, muscular length, nerve tension, fascial restrictions and visceral mobility all play a part in every joint’s functional excursion. After identification of the restriction, an “exercise” may be prescribed to address the issue. However, some issues may only be treated by your skilled manual therapist with hands-on work.
The next domain, Neuromuscular Function, is the appropriate activation, sequencing and timing of the muscles around a joint. A good example is the rotator muscles of the shoulder. These four muscles should activate first and maintain good control of the shoulder as the arm moves in space. While rotator cuff exercises aren’t exciting and rewarding in and of themselves, they play a big part in overall shoulder health – be it preventative, or to address issues like shoulder impingement syndrome or a rotator cuff tear. It’s the same story with cervical and lumbar pain – your HEP should have stabilization components. Regardless of your injury area: if you have pain, your most basic exercises are often the most important ones!
The efficient performance of a task – from reaching for a coffee mug to a push-press in CrossFit – is termed Motor Control. The task requires appropriate range of motion and good muscle sequencing and timing. How do we work on motor control? Motor control is improved primarily through two things: Repetition and Resistance. I’d like to throw in a third: Mindfulness. To improve motor control, we need to be able to learn from our mistakes, noting that there is a continuum of movement progressing from poor to fair, to good, to excellent.
A common phrase of mine is: “I’d rather see you perform 10 repetitions like a rock-star, than 30 that you banged out mindlessly on a commercial break”. There’s many adages, and any performing artist or athlete will confirm: Practice does not make Perfect; Perfect Practice makes Perfect. Your brain will store the successful programs in the movement pattern “storage drive” in your brain. Why not make every single one count?
So, to sum up: that clump of exercises that you may or may not be doing consistently is vitally important to your recovery and ability to get back to your meaningful task. This is evidenced in the following exchange:
Patient: “How long do you think this will take?”
PT: “A lot of that depends on you.”
Let’s get to work!
Mark M Lusk, DPT, OCS, CFMT