Are you doing your physio exercises?
The actual exercises, with the frequency that you agreed?
The figures say that 80-90% of people do not do them. And I know of a physio who when injured admits that she does not do them! So what hope for the rest of us?
Injuries stop us from doing the things that we need and want to do. And the time and hassle of travelling to appointments is a further drain. So, what stops us from doing the exercises that can help us to get better?
Indeed, I was interested in a tweet from a US-based physio at the end of August where he wrote to the Twitter-sphere “I genuinely don’t understand. The activities I gave you help a lot with your symptoms, they take 12 minutes, but you “don’t have time” to do them? Can’t you get up 12 minutes earlier in the morning? Can’t you do them during all of those Netflix programs you tell me I should watch?!” This led to some interesting points on Twitter, and made me want to write this blog post.
We tell ourselves that we do not have time. But is that really the reason? What is underpinning our procrastination and how can we find ways to overcome it?
Are we rebelling against the homework?
This is a moment to be honest with ourselves. When we know that it is doing the exercises consistently and correctly exercises, do we still want to rebel and not do them? Really?
Once we have given ourselves the pep talk to get on with it and ‘eat the frog’, how do we find the mechanisms to help us to do it each day? Some things that work include:
- Scheduling and writing down the time in your diary to do the exercises each day
- Setting an alarm on your phone for the time to do the exercises
- Having a paper-tracker and star chart on the fridge or mirror as a reminder
- Phone-based tracker of the exercises each day, with reminders
- Giving yourself a reward for completing the exercises (eg a cup of your favourite tea)
- Doing them early in the day, so that they do not hang over you
- Being accountable to someone – letting them know that you have done the exercises each day
- Letting the physio know that you really want to spend the first few minutes of each appointment reviewing how the exercises have been going, and then using these insights to progress the exercises after each appointment (you could even email an update to them before each appointment)
- What else could work for you?….
Do we not believe in the exercises and the process?
Often we believe simple narratives and I sometimes think that for injuries, this is ‘the experts will fix me’. This is sadly not true and we need to replace it with a more realistic ‘my body needs daily help with the healing that is required, and I need to do these things every day as there are no short-cuts’.
As we think more deeply about this barrier, we may come to the conclusion that we do not believe in the current path – maybe we think that it is not yet the right diagnosis, or the right treatment plan, or the right person to work with. If these are the issues, then now is the time to talk these over with the physio, or go to see someone else for a second opinion.
I have often seen this loss of belief happen when an athlete has been seeing the same physio for over 6 weeks and is not seeing progress. I would suggest that the longer you leave making a change, the longer it will take to make a recovery – especially as I generally see the adherence to the exercises drop off with longer periods where there is no observed progress and no change in the exercises or approach. Obviously, the first stage is to talk over the concerns with the current physio, but a fresh pair of eyes generally provides a fresh perspective (and scarily frequently a completely different diagnosis and treatment approach!)
Or more simply, we may not understand why we are doing the same exercises, week after week. A good therapist will explain what the goal of the exercises is, and the test for seeing whether your body has made progress against that goal. This context is key – for instance after joint surgery doing the exercises through pain is key to stop scar tissue (which the body throws out in every direction) from forming across the movement planes of the joint and therefore limiting Range of Motion for good. Knowing that helps to push through the pain – but needs someone to explain it!
Do we fear the pain?
Many people do joke that the exercises are more painful than the injury. But really we should be in search of the ‘Goldilocks zone’ (as I blogged about in some detail last week) – enough to push and develop the under-active muscles or release the over-active muscles, but not putting ourselves so deep into the pain zone that we set the healing back, or push the body back into the ‘alert’ state that could lead to more guarding and defence.
In the event that the exercises are very painful, message your physio and when you next see them:
- Get them to watch your form and be very specific on the exact movements and where exactly you should be feeling the benefits
- Bring the number of reps and sets that you have managed to do (including when you have done them early in the day, when you are still relatively unfatigued) and discuss some more realistic targets.
- Bear in mind that every single exercise can be regressed to make it easier – so get them to show you the regressions and agree what the triggers would be to move up through the various progressions.
- Ask if there are ‘warm-up’ movements that you can do to get the releases and mobilisations before the exercise, in order to give your body the best chance of success.
- Then stick with it and do not beat yourself up if you do not manage all of the sets and reps – every exercise that does not put you deep into the pain-zone will help!
Are we uncertain of what we are meant to be doing?
Many of the exercises are quite complex and when we are in pain we do not always listen and watch all of the form points. So if there are videos of the exercises – then watch them again and write down a note of the key points to remember in order to do the exercises correctly.
It may be embarrassing to have to admit that we are not really sure what we are meant to be doing – but it is in our benefit to clarify, so ask away! A good physio should be delighted that you are checking and clarifying. Do this at the start of the appointment, as if you only discuss the exercises in the last few minutes of the appointment, they are under time pressure and need to get you out of the door to get to their next patient.
If it is not any of these reasons, then what is it?
We owe it to our body to get to the bottom of why we are not doing the exercises, and then put in place. So keep taking a positive, inquisitive, collaborative and learning approach to your programme and your rehabilitation.
Good luck – and get those exercises done!