Monday, October 17, 2011

Life vs Ergonomics: Part 2

Part 2 of 2

The Aging Body
We know that muscle loss is a huge problem with aging,” says Dr. Bautch, “so we want to be careful with that.” While people who have been exercising aggressively all their lives may be able to continue exercising, aging tends to make people more sedentary. “Our bodies don’t like great changes, so if I get more sedentary and then go out and play softball or football on weekends, the chances of injury become tremendous. We decondition faster as we get older than we recondition.

Compliance: Challenges and Solutions
As doctors of chiropractic know, most patients are compliant as long as pain is the driver. After the worst of the pain subsides, they tend to want to start living like they did before injury slowed them down. To offset this very human desire, doctors need to look at numerous factors involved in helping a patient get better—and stay better.

Dr. Bautch says that when it comes to prescribing a home exercise program, quality cannot be the only criterion.

“I prefer to teach the exercises to my patients so they can gain a kinesthetic feel for them," says Dr. Morris. I prefer to teach the exercises to my patients so they can gain a kinesthetic feel for them. I include errors that patients routinely fall into. If I feel there is a risk that the patient will perform the exercise incorrectly, which is common, I teach him or her to perform it both correctly and incorrectly so the difference between the two can be appreciated. I never allow patients to perform an exercise at home unless they have mastered it in the office, which includes doing it correctly and incorrectly. The percentage of my patients who returned and performed their exercises wrong dramatically diminished after I initiated this strategy.”

Building Patient Motivation: Tips from the Field

  • Dr. Christensen says it’s important not to overload patients with exercises since that will lead to noncompliance. He also asks the patient to agree to perform daily exercise with a regular time set aside. Keeping a journal that records repetitions and sets may also be helpful, he adds.

  • Dr. Kurtz says that clear goals or benchmarks to reach for and someone to hold patients accountable so they will continue to do their prescribed exercises are valuable motivators.

  • “If the doctor looks very fit and looks like he exercises, patients are more apt to perform their exercises.” Dr. Aspegren also looks for patient red flags that may indicate problems ahead, such as smoking, obesity, a blue-collar background, or basic lack of motivation.” When such patients are identified, he says, “We try to spend a little more time with them. We make sure we emphasize the importance of performing their exercises to reduce the need for care and to help reduce the relapse rate that permeates many musculoskeletal-type injuries.”

  • Dr. Bautch says because it takes 21 days to develop a habit, he reminds his patients of what they should be doing every time they talk.

  • Dr. Morris puts his own twist on compliance. “One of the keys to motivating patients to perform their exercises is to find out what they have lost that they are passionate about. I have found that by listening to my patients and letting them explain their concerns, their fears, their frustrations, and their desires, we generally find reasonable rehabilitation strategies together that comfortably motivate them to continue.”
By Carol Marleigh Kline, MA, JACA Online Editor
Chiropractic Home Exercise Programs—Ergonomics & Compliance (Part II)
J Amer Chiropr Assoc 2006 May;43(4):2-6

No comments: