Why Patients Don’t Do Their Exercises

career Apr 30, 2020

“How are the exercises going?” I asked.  There was a pause and a break in eye contact and I knew what she was about to say.

“I really haven’t done them.”

“How come?” I replied trying not to seem too disappointed.  I felt like the last session had gone really well and I was looking forward to following up with this patient all day.

She had started PT elsewhere and I was getting the chance to take over at the three month mark post SLAP repair.  She played on an intramural volleyball team and coached youth softball, she was an active person.  The last session we had eliminated the pinch she felt at end range and she left excited, hopeful, and determined.  What happened in the days since I had seen her last?  Where did that motivation go?  Why hadn’t she done her exercises?

Determined to find out I started asking questions.  Were they too hard? No.  Too easy? No.  Did they hurt? No.  Did you hate them? No.  Did you lose the HEP copy? No. Did something happen? No.  Were you really busy? No.  Didn’t they help you feel better last time?  Yes.  I was at a complete loss.  

“I just can’t get myself to do it,” she said at the end of the questioning.  I could tell she felt guilty about it.  She wanted to do them.  Logically, she knew she should do them.  But, for some reason she could not make herself take action.

I used to think that this was a problem of motivation.  That certain people are just more motivated than others.  But she was motivated when she left the clinic the week before and she wanted to return to an active lifestyle.  Now, the more patients I’ve seen in the clinic and the more I’ve talked to people about their careers, the more I realize barriers are to blame.  Whether a home exercise program or taking a step toward your ideal career, we all meet resistance in some form.  

The reasons patients don’t do their home exercises and the reasons we don’t advance toward our ideal career are one in the same.

 

Barrier:  I don’t believe it will work

We are skeptics at heart.  Why should you believe someone telling you that you can get your ideal career in physical therapy?  Well, why should your patients believe that they will return to sport after ACL reconstruction?  Because you’ve seen it happen time after time successfully. When you tear your ACL, unless it is your second time, you have absolutely nothing to compare it to.  Well, when you go after your ideal career, unless it is your second career, you don’t have anything to compare it to. That is why getting a mentor or someone that has done it can be so valuable.  They can offer perspective and encouragement as you go through the process.  There are people that get their ideal career and if you still doubt me, I can point you to many of them.

What could you accomplish if you believed you could have your ideal career?

 

Barrier: I believe it will work for some people, just not me

Maybe you don’t doubt that you can get your ideal career in PT, but you don’t see how it is possible for you.  Your situation is different, more complicated, or tougher than others that have been able to get their ideal career.  But that is no different than the patient that truly believes his injury is “the worst there’s ever been” or she has “the most pain of anyone else.”  Sometimes your situation is more challenging than someone else’s, but that doesn’t mean that it has to hold you back.  

 

Barrier: I can’t get myself to start

Some of us believe that our ideal career is possible.  We’ve cleared the first two barriers, but still can’t seem to get the momentum to start.  We have an idea of what we should do, we logically understand that it is in our best interest, but when it comes to taking action we come up short or do something else with our time.  It is no different than the patient that feels guilty when she doesn’t do her home exercise program. 

So then, how do we get a patient to do a home exercise program and how do we get moving toward our ideal career?

 The first thing we need to do is stop blaming ourselves and stop assuming we lack motivation.  We either don’t know how to get our ideal career or we can’t get the momentum to start moving forward.  Either way, there are two action steps that we can take to make us “more compliant” with our ideal career.

1. Find a mentor

If we don’t know what to do, we need to find guidance.  A professional mentor can offer perspective and next steps when it comes to finding our ideal career.

2. Find accountability

If we struggle to get started, we may need accountability.  Starting something new is tough and we often are full of doubt, uncertainty, and discomfort.  Having someone there to cheer us on, check in and offer support makes all the difference.

My patient who “couldn’t get herself to do the exercises” needed a nudge.  After each day of performing her exercises, she would send me an email with nothing more than “done.”  It was simple, but an awesome way for her to stay accountable.  I haven’t had to motivate her.  I haven’t had to email her reminding her to do the exercises.  Knowing that I am expecting an email is enough to push her past that early resistance.  The barriers you are experiencing right now may feel unconquerable, but they will shrink with support.  Let us be that for you if you need it.  

What are your current barriers? Post them or email them to us, it is one of the first steps to taking action on them.

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