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
Neck pain
The annual prevalence of nonspecific neck pain ranges from 27% to 48%, with 70% of individuals being afflicted at some time in their lives.25 First rule out any neurologic factors that might suggest cervical disc disease or spinal stenosis. If a patient describes weakness or sensory changes along one or both upper extremities, obtain imaging and consider more formalized therapy with a physical therapist.
In patients without any red flags, investigate possible biomechanical causes. It is essential to review the patient’s work and home habits, particularly in light of COVID-19, to determine if adjustments may be needed. Factors to consider are desk and computer setups at work or home, reading or laptop use in bed, sleep habits, and frequency of cellular phone calls/texting.26 A formal ergonomic assessment of the patient’s workplace may be helpful.
A mainstay in treating mechanical neck pain is alleviating trapezial tightness or spasm. Manipulative therapies such as osteopathic manipulation, massage, and chiropractic care can provide pain relief in the acute setting as well as help with control of chronic symptoms.27 A simple self-care tool is using a tennis ball to massage the trapezial muscles. This can be accomplished by having the patient position the tennis ball along the upper trapezial muscles, holding it in place by leaning against a wall, and initiating self-massage. Another method of self-massage is to put 2 tennis balls in an athletic tube sock and tie off the end, place the sock on the floor, and lie on it in the supine position.
There is also evidence that exercise of any kind can help control neck pain.28,29 The easiest exercises one can offer a patient with neck stiffness, or even mild cervical strains, is self-directed stretching through gentle pressure applied in all 4 directions on the neck. This technique can be repeated hourly both at work and at home (TABLE 4).
Reminders that can help ensure success
You can use the approaches described here for numerous other MSK conditions in helping patients on the road to recovery.
After the acute phase, advise patients to
• apply heat to the affected area before exercising. This can help bring blood flow to the region and promote ease of movement.
• continue icing the area following rehabilitation exercises in order to control exercise-induced inflammation.
• report any changing symptoms such as worsening pain, numbness, or weakness.
These techniques are one step in the recovery process. A home program can benefit the patient either alone or in combination with more advanced techniques that are best accomplished under the watchful eye of a physical or occupational therapist.
CORRESPONDENCE
Carrie A. Jaworski, MD, FAAFP, FACSM, 2180 Pfingsten Road, Suite 3100, Glenview, IL 60026; cjaworski@northshore.org
