The Case for Complexity: Boosting Outcomes with HEP Innovation

We all know how important home exercise programs can be, and that’s why we prescribe exercises for our patients and clients to perform at home. We also know how challenging patient adherence to a home program can be.1-3 A strong argument can be made for prescribing simple exercises for your patient to possibly increase their compliance. However, human movement is far too complex to approach in such a simple manner.4

Do More, With Less

In most cases, one of the reasons stated for non-compliance of a home exercise program is lack of time.1 One way to save time is to prescribe a lower number of exercises. Instead of prescribing three simple or basic exercises would it be more effective to give ONE exercise that is more complex?

There is evidence to suggest a more complex intervention strategy can enhance patient compliance3 In this context, complex is not necessarily synonymous with complicated. With a simple adjustment, exercises can be prescribed in three planes of movement without making the exercise itself more complicated.

More Complex, Less Complicated

Complexification of exercise adds another dimension to human movement, specifically about the vertical Z axis. The X, Y and Z axes are different than the three cardinal planes of movement we all learned in our physical therapy education programs. The axes suggest movements occur off plane and in diagonals and across multiple planes of motion, which is pretty much every functional position we as humans use on a daily basis.

Some as simple as wrapping a resistance band around the trunk offers significant advantages to prescribed home exercise programs. Using the trunk as a lever to transmit force through the pelvis to the lower extremity provides resistance within the vertical Z axis. Traditional exercise uses linear force with the resistance applied either perpendicular or horizontal to gravity. Traditional methods are not ineffective, but adding another dimension to home exercises could be of great benefit to your patients and clients, as well as saving them time. If your exercise is comprised of another plane of motion, then it may be possible to combine more than one exercise together, making it more complex, but not more complicated!

Below is one example of adding different dimensions to a simple exercise:

To see the complete demonstration, watch the full course – Exercise Prescription for Hip & Pelvis Movement: Part 1

Try adding another dimension to your home exercises by incorporating resistance focused at the proximal trunk. This will create a rotary resistance about the Z axis. If you apply the rotary resistance in such a manner that the resistance is added to the trunk opposite to the stance leg you’ll find you can “spin” the patient into lower extremity valgus and foot pronation. Resistance applied in this manner can create eccentric rotary control to an internally rotating lower extremity. This may facilitate control of the eccentric rotary collapse noted during the attenuation of ground reaction forces.

Take it a Step Further

Learn more innovative ways to complexify your home exercise programs with my Hip & Pelvis course series. These courses look at using the Z axis to create rotation within many traditional exercises you may be currently prescribing to your patients and clients.

  1. Jack, K., et al., Barriers to treatment adherence in physiotherapy outpatient clinics: a systematic review. Man Ther, 2010. 15(3): p. 220-8.
  2. Wright, B.J., N.J. Galtieri, and M. Fell, Non-adherence to prescribed home rehabilitation exercises for musculoskeletal injuries: the role of the patient-practitioner relationship. J Rehabil Med, 2014. 46(2): p. 153-8.
  3. McLean, S.M., et al., Interventions for enhancing adherence with physiotherapy: a systematic review. Man Ther, 2010. 15(6): p. 514-21.
  4. Bekker, S. and A.M. Clark, Bringing complexity to sports injury prevention research: from simplification to explanation. Br J Sports Med, 2016. 50(24): p. 1489-1490.