Last Saturday I woke up to a mountain of laundry looking for a home and the realization that there were still some remnants of the holiday season ready to be stored until next November. Equally important was a list of several other tasks waiting to be completed- some fun, some tedious, and all necessary. I looked at the clock and thought for sure that there was no way that 3 baskets of clothing and some miscellaneous Christmas tchotchke’s could be organized and put in their rightful places without disrupting some of the other things I wanted to accomplish.
In true fashion, I started bargaining with myself. Maybe half could get done. Or part of it. But that was the reason these 2 tasks remained in the first place- I had partially done them and postponed them until I couldn’t reasonably ignore them any longer. Under protest, I threw on some music and got through it. As I was folding the last sweater and enjoying my well organized closet, I noticed that only 25 minutes had passed from start to finish. The two things I had put off for almost 2 weeks took me less than a half-hour and had me asking what took me so long to start it in the first place.
Sound familiar? We all have our lists. Work, home, family- there is no shortage of things to do, and there are always tasks that are lower on the priority list. Sometimes it’s the little things that either get forgotten or put at the bottom of the list because they take less time. Other tasks may be important, but since they are not fun or easy they don’t get done as readily. Lastly, there are things we simply dislike (or even dread), which automatically places them in the ‘I have to do this but I don’t want to, therefore I will prioritize every other thing on my list first’ category. Regardless of the reason, too many tasks falling lower on the list results in, well, nothing but the really fun stuff. But inevitably if enough of the less desirable things pile up, eventually the fun stuff will be on hold until we work through the rest of it.
Home exercises prescribed by physical therapists sometimes find themselves in one of the above categories. Patients often identify lack of time as the reason for not doing home exercises. Before dismissing this as an excuse, it’s important to dig deeper to identify potential compliance barriers, including each individual’s perception of the prescribed plan. Perhaps the exercises seem short and sweet, rendering them easy to forget (Kegels, mindful breathing and physiologic quieting). Or maybe they are a little more difficult and take some mental focus because they are targeting those movements that are really hard due to weakness and decreased coordination (new strengthening or coordination exercises). Or as we often see in our practice, perhaps it is painful, uncomfortable or just really inconvenient to have to do at all (dilators, vibrators, self-massage to pelvic muscles).
Getting to the root of the barrier is not the same as taking the responsibility from our patients. Successful rehabilitation requires a skilled clinician, a patient who takes ownership of his or her health, and the willingness of both parties to work together. We should make sure that we are prescribing programs that are therapeutically appropriate and meaningful to our patients while providing them with the tools to push through those parts of the program that effective, if not easy or exciting. Let’s face it- sometimes we just have to do things we don’t want to do in order to get where we want to go. And you have to start to finish.
Until next time,
Sarah