As new grad physical therapists and physical therapy students, we should all be familiar with DOMS. DOMS stands for delayed onset muscle soreness, and it usually causes increased symptoms 24 to 72 hours after a workout.
So why does DOMS matter to us? One of the most important things we can do for our patients is to educate them about their condition and their plan of care (POC), which should include an explanation of the possible signs and symptoms they may experience post treatment.
The value of patient education
In my early clinicals, I felt that while the POC was covered with the patients, the explanation was often too general. The POC education was generally limited to something like "PT 3 times per week week for 4 to 6 weeks."
I have now come to realize that a more detailed POC helps with patient rapport and increases patient buy-in. Co-pays are on the rise - it is essential that we make time during the first treatment session to tell patients what to expect so that they “buy-in” to the POC. We shouldn't just be explaining what to expect on the first day or the last day of PT. The meat in the middle is important too.
Learning from personal experience
My personal experiences with patients have emphasized the importance of patient education. I have also learned that it is critical to provide an explanation of possible treatment side effects.
I had one patient who went home and did her HEP 6 times per day. I had verbally told her 2 times per day and she had a paper copy reiterating my plan. However, she thought that doing more would help her get better faster. Needless to say, she was horribly sore for the next appointment. In fact, she didn’t make the first treatment after the eval due to pain!
On the other end, I have had a patient who did his HEP 1 time per day, and he woke up very sore the day after. He had assumed that he did something wrong and therefore didn’t do anything else until the next week. (He did have the PT clinic contact information, but he didn’t use it.) Being cautious is great, but if I had educated him about the potential of DOMS, this situation could have been avoided.
5 ways to explain DOMS to your patients
Here are 5 different ways to explain DOMS to your patients. With each method, be sure to tell them that DOMS stands for delayed onset muscle soreness!
1. Tell a personal story similar to their own experience
I had a shoulder patient who was working on strengthening her rotator cuff after injuring it by pushing a 600lb bale of hay by herself. She was quite strong from all of her farm work, but her rotator cuff was weak after surgical repair.
I used my own experience with rotator cuff strengthening to provide context to her own plan of care. I explained to my patient that the "belly exercises" where she lifts her arms up at various angles may seem simple at first, but they will get harder as the repetitions increase. I shared with her that the first time I did these at home, I was sore for 2 days around my shoulder blades.
2. Explain how previous patients with the same condition progressed through rehab
I treated two patients with quadriceps autograph ACL tendon repairs. The first I had seen for the entire 8 weeks, but the second I saw for prehab before his surgery.
I told the second patient that my previous patient (obviously no personal identifiers due to HIPAA) had a lot of soreness in his quad when starting quad sets after the surgery. The soreness lasted about 2.5 days, and the exercise was difficult at first. My first patient actually cut in at this point and discussed his experience with the second patient. This really helped to alleviate the second patient’s concerns.
3. Use models during your explanation
For individuals with chronic back pain, it can be difficult for them to visualize the “soda can of the core.” They can also be shocked by the amount of abdomen soreness they experience.
In these situations, I grab the spine model and show patients where the muscles attach, and I used a bolster to show how weaknesses in any part of the "can" can decrease stability.
4. Use an anatomy app to help patients visualize the process
Going one step further than step 3, use one of the amazing anatomy applications available for physical therapists. I know that Greg Todd, a very successful private practice owner, started using Complete Anatomy when explaining conditions to his patients. The sweet thing about this app is that you can actually take off layers of human tissue, add inflammation/arthritic changes, and even show a short clip of how the muscle in question works!
5. Remember that patients are often eager to learn - educate them on your knowledge of the current DOMS evidence
As a physical therapist, you do not initially know the patient’s educational background or areas of interest. I find it to be best practice to ask patients if they are interested in learning more about their condition. If they say yes (I haven’t had a patient say no yet), explain the condition like you would to a non-PT friend or family remember.
Most importantly, DO NOT ask them, “do you have any questions?”. It may seem a bit odd, but trust me on this one. Patients can initially be very hesitant with asking questions. They may be shy, overwhelmed by their situation, in a rush, etc. I know that I have held my tongue several times as a medical patient.
Start educating your patients about DOMS today
Those are my top five recommendations for explaining DOMS to your patients. I have seen that patients benefit from the time spent educating them about their conditions and the associated potential side effects. Feel free to comment below with any of your own suggestions for patient education. I am happy to learn what works for you!