Physical Therapy Home Exercises – “They aren’t helping.”

Editor’s note: The following article was written with regards to a complaint of ‘Restless Leg Syndrome. This article, however, relates to any home exercise program you may be doing for All Things PT. Please keep that thought in mind while you are reading. Thank-you.

The trouble with helping people in a virtual world is that I cannot use all of my Physical Therapy Senses to help the patient get better. My PT senses are kind of like Spiderman’s ‘Spidey Sense’. I can observe things that are right in front of me, but they are somehow invisible to the patient.

Hearing, Seeing, Feeling, Thinking, Talking

Those are some of the most important things I do as a Physical Therapist. I get patients every week who insist that PT is not helping their problem, but when I see how the patient is moving, when I hear them describe their pain now (versus a week or two ago), when I touch their injury and feel less muscle spasm, I know with absolute certainty that PT is helping. What I then have to do is make the patient aware of all of the ways that I see they are improving.

This week we are talking about Restless Leg Syndrome. Restless Leg Syndrome presents with a variety of complaints,

  • My legs feel restless and I have to move them.
  • My legs hurt at night.
  • I cannot get to sleep at night because of the restlessness or pain.
  • I wake up in the middle of the night with restless or painful legs.

In the past 24 hours I have had a number of people say they have restless leg problems and that they will try my program. (Sweet! That is why I started this website.) The trouble is these home exercise patients are now beyond my Spidey Sense. I cannot look, listen and feel to know that these virtual patients are improving, and, I cannot advise them in how to modify their program for better results. Or, I cannot tell them, “Yes, you are getting better, and this is how I know.”

When you are working on an independent home exercise program, you need to use all of your senses to know if you are getting better, or not. Has your restlessness decreased? (It may still be pretty bad, but if it is less, it is getting better.) Is your pain less? Does it take less time for you to get to sleep? Do you sleep longer before your restlessness or pain wakes you up? Is it easier to get back to sleep?

If all of the above questions draw a blank and, indeed, the patient is not improving, I have one last question. “Are you doing your exercises?”, and, “Are you doing them enough?” To which I often hear, “Yes I am doing them. I do them for 10 or 15 minutes every night.” When I hear this, then the mean old PT comes out of me (kind of like the Hulk). I have to tell the patient, “10 to 15 minutes a night is not enough to get your restless under control. It might be eventually, but for starters, you need to do them for an hour minimum.”

One more thing, medications. If you, the patient, have stopped or reduced your pain medications, and your pain goes up, you may need to return to your pain meds. Or, if your pain has stayed about the same, but you stopped taking pain meds, then you are probably getting better. Evaluating pain status can get a little tricky when medication doses are changing. I usually encourage my patients to reduce pain meds, as possible, but only when I am certain their pain status is under control.

In closing, the final question is, “Are PT’s really superheroes?” (Yes we are.) No we are not. We are just really good at observing patients, and then using our observations to help them recover. In a virtual world where you, the patient, are in full control, you have to find your Spidey Sense. If this doesn’t work. Ask your doctor for a referral to see a superhero, I mean a referral to see a physical therapist. Good luck.

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The previous post can be read here, “Restless Leg Syndrome and Physical Therapy”