An over-enthusiastic patient

My first placement was in the musculoskeletal outpatient area. We had patients with a variety of musculoskeletal conditions and compliance towards PT treatment was variable across patients. We had patients attending clinic regularly but wouldn’t comply with their home exercise program and hence slowing down the recovery of their condition. Then we have patients at the other end of the spectrum that does too much in the hope of recovering in the shortest time span. I had one particular patient who initial diagnosis was rotator cuff tendinopathy secondary to a traumatic fall on the shoulder. He has been attending physiotherapy outpatient treatment for the past 6 months and is still attending treatment. Upon reading his notes, it appeared to me that his shoulder recovery has plateau about the 3rd month of PT with minimal improvement of ROM and pain symptoms. Upon subjective questioning, he did report that his shoulder is not much better from the start of his symptoms, in fact it sometimes feels like the pain has worsened. I started to wander if there were possibly any underlying issues apart from just a difficult shoulder.

The first step I thought was to go through his home exercise program and made sure that he was doing them right. Upon checking the exercises that he has been doing at home, he admitted that he was probably doing more than he should. Instead of the prescribed 3 sets of 8 reps, 3x/day, the patient decided to do 3 sets of 20 reps 6-8x/day. This is when I decided to give the patient some education on the possible negative effects of overdoing the prescribed exercises. I then checked to see if the patient was performing these exercises right. Upon doing that, I discovered that when performing the exercises, the quality and the mechanics of the movement was very poor. Part of his HEP also involved motor control retraining of LTrapz which was also performed in a wrong manner. Doing these exercises wrongly plus doing them in so many reps a day could only do more damage to an already compromised shoulder. I then reviewed his HEP, correction was done in stages and to help with proprioception and motor control of the shoulder, I attempted to tape the patient’s shoulder to facilitate LTrapz which had worked wonderfully for this patient. In the 5 weeks I was in this placement, I had seen this patient improved more than in the 6 months he was attending PT Rx. This was simply achieved by doing the right thing that best suited the patient together with some education for HEP.

My lesson in this scenario was that when confronted with a case that doesn’t quite add up when on clinics, it is important that we just do not passed it off as it’s a common thing but to look at things in all angles so that we do the right thing by the patient as well as our profession. Education played a vital role in this case where the patient was doing much more than is expected and doing the ex’s wrongly would have put him at risk of further damage to the shoulder. So a simple thing like reviewing his HEP brought a whole lot of improvement to his recovery.