We had the pleasure of hosting Eric Sebo, PT, for an interview on how he helps his patients reach their goals and consistently return to their sports and activities. Eric is the premiere physical therapist for total joint replacements (i.e. hip and knee replacements), practicing in Indianapolis for 25 plus years. He is truly dedicated to his craft and his outstanding outcomes speak for themselves.
Pain management is always difficult. That is, they tend to not understand that the pain they are experiencing from the exercises is normal. So, by coaching and informing them that it is a normal amount of pain but balancing that with not pushing them too far is key to helping them break through and reach their recovery goals. In addition to that, understanding the proper techniques with exercises and activity is paramount. The thing is, when I am not with them, there can be a tendency to compensate due to the pain, which can have a chain reaction effect leading to pain in other body parts. Helping them understand the proper techniques and pain management lead to higher compliance with exercises outside of treatment sessions.
Objectively, the ability to weight bare into the affected limb with position changes (i.e. sit to stand transfer), stability in the joint, and range of motion through the stance and swing phase of the gait cycle. Additionally, the overall quality of movement through a functional pattern (i.e. activities of daily living, exercises) since ultimately the goal for the patient is the ability to return to a safe and independent form of normal function.
Subjectively, I look at the patient’s pain during exercises and during normal daily activities along with their emotional responses as the exercises progress. The mental aspects play a huge role in how a patient progresses.
Again, educating them on pain management and making sure they comply with their doctor’s orders along with resting and icing. If the patient is concerned with pain and damaging what the doctor is fixed, educating them that the pain they experience is normal while doing the correct exercises with proper form puts them completely at ease and willing to push themselves to get the desired outcome. The other side of that, though, is ensuring that they only do the exercises to their tolerance level. If they do that, then their tolerance level gets better every time they come. So, during sessions, I guide them in pushing to and through the pain. Consequently, they will continue to grow their tolerance and push to and through the pain, building the momentum they need to reach their recovery goals.
Education is fundamental to reaching the highest quality outcomes. The most important piece of the recovery is that they understand why, what and how at the beginning of the recovery. If they understand these questions, then the patient’s compliance and tolerance almost always improve and they are properly prepared to reach their recovery goals. In addition to that, when they know they are improving and progressing towards a goal through feedback (i.e. improvements in range of motion, pain, etc.), their tolerance and confidence almost always improve.
I invest myself in my patients’ outcomes and how they progress to their goals. I see it as a personal relationship with each and every patient, and them reaching their goals is just as important to me as it is to them. As a result, they see that I do have their best interest in mind and we build motivation together.
Mental preparation is huge. Again, this goes back to ensuring that they understand the why, what and how of the recovery. I make sure they understand that they are going to have to experience pain in order to get the best outcome possible and that the process is rarely painless. They must be mentally prepared to endure the duration and rigors both with myself and on their own. I work with them so that when they are on their own, they are progressing at the same rate as we do when we are together.
Patients understanding that they are progressing in their range of motion, pain and function is fundamental to building confidence and momentum towards their recovery goals. Having a visual reminder of that progression would be incredible feedback to motivate them to continue to progress and comply with therapy regimens. The more knowledge patients have, the more compliant they are going to be. So, if they can look back and see how their data has changed over time and see the obstacles they have overcome, their motivation should continue to build and they will be better prepared to work through the future obstacles.
Absolutely. This represents an opportunity for the patient to further observe changes in their data as a result of their ability to perform specific movement patterns with quality technique. With this app, they will be able to track both their progress in exercises, pain, range of motion and function on their own. As such, when they are doing the therapies on their own between our meetings, they will be able to track that data and we will be able discuss it together when we meet next and go over the trends as a result of the exercises I have instructed them on how to do. Furthermore, we can, together, see how their ability to perform those functional exercises and activities with isolated quality movement has improved their data and progress.
Ultimately, I think the patient being able to see their progress, as well as their transition back, to their normal, pain free activities could help improve their tolerance, motivation and compliance with the therapeutic regimen.