Chapter Thirteen Home treatment programmes
Home treatment should, as far as is possible, mimic your treatment techniques. It is useful to emphasize the short term effect on pain and movement that most passive movement techniques actually cause. It is useful to ensure that the patient understands that prolonged (weeks or months) regular movement and stretching will lead to permanent change and that they must regularly mimic what you did with them.
The patient should assess their functional demonstration (painful movement combination): do their prescribed stretch until they feel the problem getting less painful and freer and then reassess their functional demonstration. This gives them immediate feedback regarding their stretch. If their functional demonstration has not changed they need to do more stretching until it does! This approach encourages adherence as the benefit of doing the stretch is immediately reinforced.
If you train the patient to develop an awareness of what the stretch should do in reducing their hypertonicity and regional hypomobility they can then perform the number of stretches they need to improve their symptoms at the time. Rather than routinely asking patients to do a set number of movements, encourage the patient to do the number of sets and number of repetitions that actually changes their symptoms immediately. Also ask them to reflect on how often, hard, fast and vigorously they are doing their stretches every couple of days. Engaging them in an active approach to their own treatment combats the development of a maladaptive passive coping style. They will be actively treating themselves with the locus of control being firmly with them.