● Home Exercise Program Review/Instruction: practice and demonstration of new exercises, starting with ROM and progressing to strengthening exercises when indicated. ● Re-measurement of active ROM. This progression fits the concept of a one-hour visit, applying multiple and varied treatment methods. There is emphasis on therapeutic exercise, manual therapy and neuro-muscular re-
education. A key point within this structure is the assessment and documentation of active ROM. The measurements should be taken first rather than after the therapy session, as it is more reflective of actual functional capacity. Reporting the initial daily visit measurement on progress reports avoids a disconnect with measurements performed by other providers in office (i.e., the orthopedist)
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Figure 13
This patient is applying stretch load with assistance from the opposite hip. With early attempts at this exercise, a pillow is placed beneath the elbow. DECISION MAKING FOR PATIENT PLATEAUS
● Post-surgical and post-fracture patients that require an immobilization period and develop an immediate stiffness contracture in the first month after their procedure or injury. For idiopathic frozen shoulder and adhesive capsulitis patients, it is important to define when a plateau in recovery has developed. A plateau is defined as two weeks of unchanged mobility in any motion plane with a patient who is compliant with clinical visits and a home exercise program. These patients often plateau in their progress around 3-6 months into their treatment. Their
Despite a proven high success rate for recovery from frozen shoulder and adhesive capsulitis, studies show there are approximately 5-10% of patients who present as outliers. This group of resistant cases include three primary categories: ● Idiopathic patients who fail to achieve adequate functional recovery. ● Patients who have made initial progress but demonstrate plateau during treatment.
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