The Importance of Fascial Home Interventions, Part 1

Part 1: How Are These Different From Other Home Exercise Programs?

Written by Derrin Kluth, PT, DPT, RMT

One of the more overlooked aspects of any Fascial Therapy is what a patient can be doing for themselves at home in order to help the progress of their healing journey.  Many of us are familiar with the (perhaps dreaded) “Home Exercise Program” that Physiotherapists and some other therapeutic professions are famous for.  Although there are some similarities, the application of Fascial Home Interventions are distinct enough from the former that I feel they warrant a deeper discussion.

The first major difference is the idea of what I call the “tool box.”  While many traditional Home Exercise Programs are meant to be done daily for some indeterminate amount of time (three weeks?  forever?  who knows?), Fascial Home Interventions are meant to be more like a metaphorical “tool box” that you as the patient add to and then use as you need any time in the future.  Each intervention that we as the treating therapist gives you is like a new tool to add to your tool box, and it is totally up to you to utilize it in any way that best works for you. 

For instance, I teach all of my patients how to use an air filled rubber ball to do simple compressive fascial releases for their major trigger points.  I recommend that they utilize this “tool” daily as long as it takes to progress to a point where their symptoms are more under control and less easily provoked.  This may take a week, or it may take months.  But at some point they will most likely be feeling better enough that they don’t need to do this as a daily intervention any more.  From there on, they can pull out this technique as needed to help control any flareups that might occur doing their daily activities and get back to normal more quickly and effectively.  And I can build on their learned skill with this technique to add more specific and advanced “tools” that can be used to target and control their symptoms even more effectively. 

Shoulder trigger point release with air filled rubber ball.

The second major difference is that when we do prescribe “exercises”--as in, do this motion this many times per set, this many times per day, etc—the focus of these types of “tools” is to change bad motions or other patterns or habits that a person may be doing to contribute to the onset or provocation of their symptoms.  The changes these “tools” initiate and refine are meant to be eventually applied to all motions, whether sitting in a chair, picking up a heavy load, walking for hours, playing with the kids on the ground, or going to the gym and working out.  Once your body has “learned the lesson” of these types of exercise and changed to a better way of using the body, then it is up to the patient if they would like to keep doing the exercise to refine the change or if they feel they can “put the tool away” to use as needed in the future.

For example, I like to teach many of my patients how to properly use their shoulder blade muscles to avoid activating trigger points that are causing symptoms in the neck, head, shoulders, or arms.  This requires the patient to learn and refine better patterns of muscle activation and posture through repetition, and then build on each one to create a series of “steps” in which each exercise imparts a progressively more effective ability to prevent the symptoms from coming on in the first place.  “An ounce of prevention is worth a pound of cure,” as the old saying goes.

Another major difference is that traditional Home Exercise Program interventions are usually each focused very specifically on strengthening or stretching one joint or muscle in order to “make it stronger,” and usually miss the critical step of integrating all of the parts into a greater whole.  Having knowledge of how the Fascial System connects everything in the body together allows us to more effectively use these kinds of interventions to address problems that are causing problems “up or down the chain”- or in other words see how one area above or below may be affecting the area of symptoms indirectly. 

Take this scenario many of us or a loved one may be able to relate to:  after a surgery in the hip it is common for a patient to be given a pre-generated smorgasbord of knee, hip, and ankle exercises to do with little explanation as to why and sometimes even as to how.  Now, these may be relevant exercises in the beginning or for a time, but what happens if the patient is still having problems with pain during walking or limping a few weeks or months down the road?  Maybe the problem is significantly contributed to from a lack of control in the core.  Maybe their habit is to hold their tight shoulder too far forward from years of computer use and they can’t keep their upper body straight on the lower body during walking.  Maybe the joint of the big toe bone is stuck in too tight fascia for years from an old injury and makes the ankle twist too far in, which has made the muscles on the outside of the foot weak and unable to perform their role in supporting the knee joint and muscles and further the knee’s role in supporting motions at the hip which is a major contributor to the pain and limping.  Maybe all of the above!

One can begin to see how even though traditional home exercises can be important and useful, the ability to utilize them more effectively in a big picture sense allows practitioners with knowledge of the Fascial System to find and fix problems in order to make the patient return to normal activity much  more quickly and efficiently.  And the best part is that practitioners with this knowledge understand that when an exercise has accomplished its job and made its change, the vast majority of the time it is no longer necessary to perform it daily and the patient can get on with living their daily life using the correct motions all the way up and down the chain, symptom free!

There are other reasons that a Fascial Home Intervention Program can be much more effective than a traditional Home Exercise Program, but now at least we have outlined the major differences well.  I hope I have made readers less apprehensive to utilize these very useful programs at home.  In the next instalment of this series, I will detail more specifically the broad groups of Fascial Home Interventions and how they each can specifically contribute to helping a patient along their healing journey towards satisfying and symptom-free motion!

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