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
Step 3: Restore muscle strength and flexibility. Restoring flexibility of the gastrocnemius and soleus is most frequently recommended for treating PF. Strengthening exercises that involve intrinsic and extrinsic muscles of the foot and ankle are also essential.17,18 Helpful exercises include those listed in TABLE 1.9-11 Additionally, an eccentric heel stretch can help to alleviate PF symptoms (TABLE 217,18).
A reasonable timeline for follow-up on newly diagnosed PF is 4 to 6 weeks. While many patients will not have recovered in that time, the goal is to document progress in recovery. If no progress is made, consider other treatment modalities.
Patellofemoral pain syndrome
Patellofemoral pain syndrome (PFPS) is one of the most common orthopedic complaints, estimated to comprise 7.3% of all orthopedic visits.20 Commonly called “runner’s knee,” PFPS is the leading cause of anterior knee pain in active individuals. Studies suggest a gender bias, with PFPS being diagnosed more frequently in females than in males, particularly between the ages of 10 and 19.20 Often, there is vague anterior knee pain, or pain that worsens with activities such as climbing hills or stairs, or with long sitting or when fatigued.
In general, unbalanced patellar tracking within the trochlear groove likely leads to this pain. Multiple contributory factors have been described; however, evidence increasingly has shown that deficiencies in hip strength may contribute significantly to maltracking of the patella with resultant pain. Specifically, weakness in hip external rotators and abductors is associated with abnormal lower extremity mechanics.21 One randomized controlled trial by Ferber et al found that therapy protocols directed at hip and core strength showed earlier resolution of pain and greater strength when compared with knee protocols alone.22
We routinely talk to patients about how the knee is the “victim” caught between weak hips and/or flat feet. It is prudent to look for both in the office visit. This can be done with one simple maneuver: Ask your patient to do a squat followed by 3 or 4 single-leg squats on each side. This will often reveal dysfunction at the foot/ankle or weakness in the hips/core as demonstrated by pronated feet (along with valgus tracking of the knees inward) or loss of balance upon squatting.
There is general consensus that a nonsurgical approach is the mainstay of treatment for PFPS.23 Pelvic stabilization and hip strengthening are standard components along with treatment protocols of exercises tailored to one’s individual weaknesses.
Numerous types of exercises do not require specialized equipment and can be taught in the office (TABLE 324). Explain to patients that the recovery process may take several months. Monthly follow-up to document progress is essential and helps to ensure compliance with one’s home program.
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