Rehabilitation exercises, and the "zombie apocalypse" test.

November 7, 2017

 

Like many therapists, I often give my patients some exercises to do as part of their treatment. A few years ago, I had a realisation: the most common reason that rehabilitation exercises don't work is that people don't do them. 

 

That's not because they're lazy, or because they don't care. Occasionally it might be because they don't understand why it is important, or because they don't feel like it'll work for them. But far more commonly, it's because life just gets in the way. 

 

Here's a fairly typical patient story. Mrs Smith (let's call her) goes to see her physiotherapist / osteopath / sports therapist for her bad back. In addition to whatever treatment the therapist does in the session, they send her away with a sheet containing a few exercises to do. If Mrs Smith is lucky, the therapist will have taken her through the exercises in the clinic first - but this isn't always the case. Mrs Smith leaves the clinic with the best of intentions. She'll start on the rehab plan tomorrow! Tomorrow comes round, Mrs Smith has a crisis at work, and her car breaks down on the way home. She forgets all about the exercises until she's getting ready for bed. Never mind; she'll definitely do them tomorrow. Except that the next day, one of her children is sick and needs to be taken to the doctor, and she ends up working late to finish a report that's due. The day after that, Mrs Smith finally has a look at the exercise sheet after the children are in bed, but she can't remember how to do some of the exercises, and it hurts when she does the others. That can't be right. Besides, she works out that if she does the whole plan it'll take her an hour and fifteen minutes! She's already exhausted! She skips through a couple of exercises quickly; she'll make a better go at it tomorrow. The next day, she has an urgent meeting with her boss, and it's parents' evening... and... you get the picture. By the time Mrs Smith's next appointment comes round, she's done about one and a half exercises twice each. Her therapist asks her "so, have you been doing your exercises?". Mrs Smith guiltily replies "oh yes!". 

 

Mrs Smith's story is depressingly common. For many people, rehab exercises are one of the things that get squeezed out when life gets busy (and somehow, life always seems to get busy). This is a shame, because they are also one of the best ways to help people get out of pain and back to doing the things they want to do. Like many therapists, I used to get frustrated with clients who didn't follow their exercise plans. After all, I'd done my job - it wasn't my fault if people didn't follow my instructions. Or was it? Eventually the penny dropped - if I wanted people to get the benefits of doing the exercises, I'd have to give more thought to how they were going to fit into my patients' already busy lives. 

 

These days, for most of my clients I like to apply the "zombie apocalypse test": if this person was living out of the back of their car in a post-apocalyptic wasteland, would this plan still make sense? (This may not literally be true!) I typically get people to concentrate on one, or maybe two exercises that they can do in 5 minutes, that use minimal equipment or things they can easily find at home. That way it's not an intimidating block of stuff to do that always ends up being put off until "later". This makes me focus, too; instead of throwing a whole bunch of standard exercises at someone without much thought, I have to decide what will give this individual the best return on their investment, and we concentrate on that first. 

 

Some of my patients are really keen, and want to do more. Many of them are sportspeople, or otherwise active, and they want a routine that will fit in with their training plan or gym sessions. I'm happy to help with this, and put together a more detailed plan - but nowadays I will also give them the "zombie apocalypse" edit. If life gets crazy, and you don't have time to do the full plan, make sure you do at least this bit. Because you'd be surprised at how often that happens, even if you're not expecting it to. 

 

Since I started following this approach, I've had more success with the exercises that I've given out. Building the habit of doing little bits of movement, often, can be far more easily achievable for most people than finding time to get round to a big exercise session; and I've found that a couple of exercises done consistently can have astonishingly good results - certainly far better than a sheet of 16 exercises that doesn't make it out of the coat pocket! 

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