At-home exercises for 4 common musculoskeletal complaints
This pictorial review can help you advise patients on how to reduce pain and increase ROM, strength, and balance following acute injury or in chronic impairment.
PRACTICE RECOMMENDATIONS
❯ Have patients apply ice to an acute injury for 15 to 20 minutes at a time to help control inflammation, and prescribe an anti-inflammatory medication, if indicated. A
❯ Reserve heat application for use following the acute phase of injury to decrease stiffness. A
❯ Instruct patients who have an acute lateral ankle sprain to begin “ankle ABCs” and other range-of-motion exercises once acute pain subsides. C
❯ Consider recommending an eccentric heel stretch to help alleviate plantar fasciitis symptoms. C
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
When and how to apply ice. Applying an ice pack or a bag of frozen vegetables directly to the affected area will help control pain and swelling. Ice should be applied for 15 to 20 minutes at a time, once an hour. If a patient has sensitivity to cold or if the ice pack is a gel-type, have the patient place a layer (eg, towel) between the ice and skin to avoid injury to the skin. Additional caution should be exercised in patients with peripheral vascular disease, cryoglobulinemia, Raynaud disease, or a history of frostbite at the site.4
An alternative method we sometimes recommend is ice-cup massage. The patient can fill a small paper cup with water and freeze it. The cup is then used to massage the injured area, providing a more active method of icing whereby the cold can penetrate more quickly. Ice-cup massage should be done for 5 to 10 minutes, 3 to 4 times a day.
When and how to apply heat. Heat will help relax and loosen muscles and is a preferred treatment for older injuries, chronic pain, muscle tension, and spasms.5 Because heat can increase blood flow and, likely, inflammation, it should not be used in the acute injury phase. A heating pad or a warm, wet towel can be applied for up to 20 minutes at a time to help relieve pain and tension. Heat is also beneficial before participating in rehab activities as a method of “warming up” a recently injured area.6 However, ice should still be used following activity to prevent any new inflammation.
Anti-inflammatory medications
For an acute injury, nonsteroidal anti-inflammatory drugs (NSAIDs) not only can decrease inflammation and aid in healing but can alleviate pain. We typically start with over-the-counter (OTC) NSAIDs taken on a schedule. A good suggestion is to have the patient take the scheduled NSAID with food for 7 to 10 days or until symptoms subside.
Topical analgesics
Because oral medications can occasionally cause adverse effects or be contraindicated in some patients, topical analgesics can be a good substitute due to their minimal adverse effects. Acceptable topical medications include NSAIDs, lidocaine, menthol, and arnica. Other than prescribed topical NSAIDs, these products can be applied directly to the painful area on an as-needed basis. Often, a topical patch is a nice option to recommend for use during work or school, and a topical cream or ointment can be used at bedtime.
Continue to: Graduated rehabilitation
