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The Possibilities of a Home Program
By Anita Davis, PT, MSM, CA-AAPM, CEASII
Disclaimer: If you are a patient, consult with your physician about treatment
options that might be appropriate for your condition. Consulting with your
physician is recommended prior to beginning any exercise program. This article
is not intended as a substitute for professional medical advice, diagnosis, or
treatment. Never disregard professional medical advice, or delay in seeking it,
because of something you have read. The author disclaims any liability
whatsoever for any claims or damages from this information. Although pain may
accompany any movement, if you experience a worsening of your symptoms, stop
and consult your medical professional. If you think you may have a medical emergency call your physician or 911 immediately.
Whether you are in a formal therapy program or not, a home program can make a great difference in your condition. While in a structured therapy program you only have two to three hours per week with your therapist, the other 165 hours are under your
control. The idea of setting up a home
program seems easy, knowing that you have so many hours available, but time surprisingly slips away, things get in the way, and before you know it, it has been three or four days since you did your home program.
Sometimes pain, fear of pain, or even anticipation of pain can deter even the best of intentions. In efforts to treat the immediate condition, therapists might often focus exclusively on the primary area. However, the rest of your body has also been affected by CRPS, because your other extremities have been bearing the load of carrying, walking, and moving. Necks, shoulders, low backs,
and hips often bear the brunt of the load. Therefore, a home program should also address these areas. By addressing these secondary areas, you may find less pain and more confidence to continue your efforts in the affected extremities.
Given these factors, here are a few suggestions that might help you get started. You may need to modify this list, based on your abilities.
1. Take a deep breath—making it last for a count of 4. Then exhale for a count of 8. Repeat a few times just to relax.
2. Let your head bend to the right, allowing gravity to slowly stretch the head further to the side. Slowly return to upright, and repeat to the other side.
3. Roll your shoulders in a circle 5 times backwards, then 5 times forwards.
4. Lying on your back, bring one knee toward your chest, using your hand(s) to help add to the stretch, if you can. Pause and hold while taking another relaxing breath.
In order to progress to other activities with the affected areas, there must be some degree of tolerance to movement and touch. If you have not already started a desensitization program, now is the time. This involves touching the affected area with soft textures, like silk, and then progressing to more course textures, like cotton, terrycloth, and burlap. To be successful, the activity must be repeated for 3 to 5 minutes, 3 to 5 times a day. Some resources suggest hourly self-treatment for the best results. If those went well, then you can try a few of these.
For upper extremity involvement:
1. Sit at a table with your arms resting on top. Slide your arm forward as you reach with the shoulder, elbow, and even let the fingers stretch in the reach. Pause and slide the arm back to your starting position. This will allow movement in the whole arm that may have gotten stiff.
2. Prop your arm on the table, or with pillows in your lap, and hold the hand up so you can watch the movement. Bend the wrist forward and backward. Slowly repeat the motion to lubricate the joint surfaces and allow the muscles to learn the movement again. It may even be helpful to let the other hand move at the same time.
3. Stand at a wall with a tennis ball or other ball. Place the ball on the wall and let the palm of your affected hand rest on the ball. Now “palm” the ball on the wall, like rolling up a ball of play dough. You can vary the amount of pressure you use on the ball.
For lower extremity involvement:
1. Sit in a chair with your foot on the floor. Slide your foot forward and backward, keeping your foot in contact with the ground as much as possible. This allows you to move the ankle.
2. Stand with the affected foot on a stool or step. Hold on to furniture or the wall for support. Slowly lean forward, shifting your weight into the forward foot on the step. This facilitates mobility and gradual exposure to weight bearing that you need for walking.
3. Stand between two work surfaces, such as a kitchen counter and a table. One surface will be on your right, the other on your left. Prepare a stack of books, canned goods, or other household items on one surface. Keep both feet on the ground, facing forward. Now move the items from one surface to the other. This exposes the leg to the feeling of weight shifting from side to side with modified weight levels.
Each of these should be repeated for a timed duration of 3 to 5 minutes, to allow the body to accommodate and learn the motion. Frequently performing these tasks is more helpful than occasionally performing them. Less frequent exposure to these types of activities only “confuses” the nervous system, and tends to get interpreted as a flare-up. Consistency is essential. Once you see a little improvement, your confidence will increase, and you will agree that possibilities do exist with a home program.
Anita Davis, PT, MSM, CA-AAPM, CEASII, is a physical therapist at a comprehensive pain rehabilitation program at Brooks Health System in Jacksonville, Florida. She has been practicing for over 20 years. She has presented on CRPS to various groups, including the State Occupational Nurses Association in Florida.
RSDSA Review. 2008;21(1):15,17. |
