The benefits of physical therapy can be immense, but only when one is an active part of the healing process. The learnings, lifestyle suggestions, and exercises taught by the provider are not confined to the clinic, but must seep into the rhythms of one’s day to day life. Otherwise, the time spent in physical therapy can be fruitless, or at least not as effective as it otherwise might be. Afterall, the time in the clinic only makes up a small fraction of one’s life. What one does outside of the clinic is up to the individual.

Why do so many have trouble bringing these practices home? The most common reasons are lack of time, lack of confidence in one’s own abilities (known as self-efficacy), lack of understanding of or agreement with the recommendations from the PT, the PT giving “too much” homework, forgetfulness, or simply being stuck in one’s habits with difficulty inviting changes to a fixed routine. Additionally, the desire for a “quick fix” to one’s pain or injuries, and subsequent disappointment with the realization that PT is an ongoing process and not an instant cure, can often set up a substantial barrier.

How do we address these barriers?

Establish a Commitment to Oneself

In order for PT to be effective, one must fully commit. The commitment goes beyond simply showing up for scheduled appointments. The commitment must involve willingness to have an open-mind, take on an active role in one’s healing, learn new things, willingness to invite in the new and to say goodbye to what is no longer serving.

Before scheduling a first appointment, one might ask themselves, “Am I willing to fully commit to this? Why or why not?”

A Strong Therapeutic Relationship

As PT is a two-way street, a strong relationship between provider and patient is necessary. This means the ability to engage in deep communication: active listening and responding. As a patient, one must communicate their needs, and be open to suggestions provided by the therapist.

If the patient feels that their needs are not being met, or if they are not understanding the suggestions provided by the therapist, they must make this very clear. For example, if one feels that their PT is giving them too much or too little homework, the patient must communicate this. That way, the two can work together to find a program that best fits the needs of the patient.

It is critical that a patient feels a sense of trust and connection with their therapist. Without this, the therapy is built upon a weak foundation, and it will likely be ineffective. Without trust, the patient will not trust the therapist’s suggestions, and probably will not follow through.

Check out our previous blog post to learn more about what goes into a strong therapeutic relationship.

Self-reflection

Throughout the process of PT, the therapist will help guide the patient towards desired goals. The patient must also continuously engage in a process of self-reflection to ensure they are continuing to commit to an active role in therapy.

Here are some questions a patient could ask themselves throughout the process:

How and when am I going to do it?
- ”It” refers to the suggestions and exercises from the PT
- Establish a firm time and place to carry out the homework

Why am I doing this?
- Focus on the “why” can help provide motivation. Why is this worth doing?
- Remind yourself that you are doing it to better yourself, your health, well-being, comfort, etc. Or to become a better person for those that you love.
- Remember your goals for PT, and write them down

What is going to get in my way?
- What are the barriers? Is it time, space, commitments to other people?
- How can you address those barriers?
- If it is forgetfulness or lack of understanding, work with your therapist to find what helps you with this. This might be the PT sending reminder emails, taking detailed videos of the exercises, or it could be self-reminders by putting sticky notes up at home or in the office, keeping track of your exercises in a journal, or creating events/reminders in your calendar.

When challenges are faced, it is important to be kind to oneself. Every moment of every day is a chance to begin again, re-focus, and re-prioritize this commitment to oneself.

Having a “PT journal” is a helpful tool to keep track of one’s commitment, intentions, progress, as well as for keeping a record of exercises completed and other provided interventions. This could be a very casual notebook, scratch paper, or the “notes app” on one’s phone.

Here is an example of a tool that someone might use. Start by printing out several blank templates of the days of the week, perhaps divided into AM and PM. You could write what you intend to do in each blank, and give it a ✅ upon completion (or only write in the log once you have completed the activity).

After the initial effort of implementing a new practice into one’s routine, after around three weeks, one might find that it no longer takes as much discipline, and one might even look forward to these practices as the benefits become more clear. New habits take a while to fully form. Many have heard from pop psychology that new habits take 21 days to form. However, evidence shows that this is a myth, because the formation of habits is dependent on MANY factors. Generally, the most “simple” an activity is, and the more obvious the reward is (e.g. like drinking water every day), the quicker that habit will form.

On average, habits take about 66 days to form, after which they become “second-nature” or effortless.¹

The best way to create this new habit? Have an external cue (e.g. a sticky note) to perform an activity in a consistent context (e.g. a space in your home), and repeat it. Again and again and again. Perhaps the same time every day. Eventually it will become automatic.

At The Wellness Station, we aim to create a close, trusting therapeutic alliance. We seek to provide learning experiences, so the patient feels “on-board” with the process. We recognize the inherent challenges in this process, and are compassionate towards those who are having difficulty. Through close communication, your therapist will help to address any barriers throughout the therapeutic process, and together you and your therapist will steer the ship in the direction of your choosing.

Summary/Key Points

Physical therapy is a process that is guided by your therapist, but requires the patient to have an extremely active role

This involves a commitment from the patient to follow the suggestions from the provider, and to work together with the provider to address any barriers that come up relative to home practice
The working relationship between the provider and patient must be built on trust and deep communication.
As a patient, one should ensure they are fully committed by asking themselves why they are doing PT, what might get in their way, and how they will respond to these challenges along the way.
Strategies to help improve participation in the home program might include having a PT Journal for self-reflection as well as for a log of exercises.
Additionally, have an external cue, such as sticky note reminders around the home or office, which provide visual cues to practice exercises. Or perhaps creating calendar events to practice could also be a solid reminder system.
After consistent practice of an activity in a particular environment, the habit will become automatic and effortless, which takes an average of 66 days (though could be much sooner or later).

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3505409/

Throughout engagement in the process of physical therapy, many individuals struggle with parameters of their home program. How often should I do the exercises? How many sets and reps should I do? Should I feel pain or stay away from pain completely?

Notice what all of these questions have in common: “Should”

Traditional physical therapy tends to be very prescriptive. Pre-filled templates with “3 sets of 10” of this, “2 sets of 20” of that. For many individuals, this cut and dry prescription makes sense, and creates a clear structure for engagement with the exercises at home. However, consider what this rigid structure deprives you of.

By the therapist deciding on the exact parameters of your home program, agency may be removed from the individual. The performance of the home program becomes less about facilitating a positive engagement with one’s body, and more about what you should be doing- a task to check off the to-do list.

Okay, so… there shouldn’t be any structure to my home program?

Our lives are a constant dance between rigidity and chaos. Too much structure, we have rigidity, close-mindedness, decreased spontaneity, and limited options. Not enough structure, we have chaos, confusion, and a loss of direction. How do we find a healthy balance?

The structure of one’s home program is highly individualized based on person, environment, and goals. What works for one person may not work for another. What works for you today may not work for you tomorrow.

Sometimes life is busy. Sometimes our environment is not conducive to completing our home program. Sometimes we don’t feel good. Rather than seeing the completion of your home program as all or nothing, how can you modify it to fit into your day regardless of what is going on in your life?

Consider creating a loose structure, with room for adding and subtracting

Perhaps practicing the whole series of movements in your routine can only happen three times this week. However, what about five minutes here and five minutes there to engage with the movements in a way that fits in with the rhythms of your day?

You find yourself lying in bed for a few extra minutes and you try bringing your knees to your chest, or rotating from side to side.

You are standing in the kitchen waiting for the water to boil, and you find your hips gliding.
You are getting up and down from a chair, and you decide to practice three additional sit to stands with awareness of your body mechanics.

Questions to ask yourself

Learning how to direct your own care is ultimately what we aim to teach you at the Wellness Station. Consider asking yourself the following questions to enhance this ability-

If I were my therapist, what might I want to know more information about?

Consider a situation in which you are engaging with physical therapy, but you feel that you “aren’t getting better”, or the exercises aren’t “working”. If you were your own therapist, what would you want to know more about?

How often do I spend time with the movements?

When our home program is a to-do list item, it can be very easy to rush through it and let it slip through the cracks. If you are spending no more than 10 minutes total each day engaging with yourself through mindful movement, and wonder why the therapy is not more effective, then the answer may be that you are not spending enough time with it. If you want to learn the language of your body more fluently, you have to practice.

It may be helpful to have a goal of how long you would like to engage in the movements, perhaps at a specific time each day. For example, 20 minutes in the morning before breakfast.

To further enhance the therapeutic effects, take 10 minutes here, five minutes there, two minutes here, five minutes there, to re-engage with the movements throughout the day.

Am I working “on” my body, or working “with” my body?

We could spend all the time in the world on our home programs, but if we are not doing the movements as intended, they will have little therapeutic benefit. If the way you are engaging in your movements is to accomplish a task, push through pain, or to just do what you think you’re supposed to be doing, then the intention is missed. The completion of the movements is less important than the manner in which they are performed.

The intention of the movements are to be able to pick up on the signals from your body with greater sensitivity, bring stimulation and change into your tissues, and grant agency to know how to respond to pain and discomfort. Keep asking yourself as you perform the movements… “Am I working on my body, or learning how to work with my body?”

In addition to a designated time for my home program, how am I implementing what I’ve learned into what I’m already doing throughout the day?

We live in our bodies 24/7, and we are already moving our bodies throughout the day, whether we are mindful about that or not. This grants us the ability to be engaging mindfully with our bodies pretty much all the time.

Getting out of bed or out of a chair- think about your body mechanics.

Standing in the kitchen- turn it into a dance.
Walking to and from rooms- what is that light from your chest doing?
Picking up a box from the floor- send your bottom back and tuck your pelvis when you come up.

By considering these concepts, your home program will likely become more rewarding, enjoyable, and instrumental in moving towards success in your therapeutic journey.

At the Wellness Station, we will guide you to creating an adaptable structuring that empowers you to direct your care and enhance your wellness, fitness and beyond.