One of the oft-bemoaned facts in health care is that patients don’t do what’s good for them. I had a conversation with a chiropractor a while ago who said part of why he doesn’t bother assigning homework to his patients for self-care is because they won’t do it anyway. Doctors and PTs complain about their patients not being disciplined enough to follow through on what should be good for them. To some extent, it’s true. It’s tough to convince people (and sometimes even myself when I’m crunched for time or am feeling tired!) that doing exercises at home is important to their health. I think there are two major parts to the problem as it relates to helping people with chronic pain:
- Lack of education about the nature of the problem.
- Lack of effectiveness in the homework that’s assigned.
So let’s talk about issue #1. The current medical treatments for things like, say, pain in your leg, is pretty dismal. Surgery – too invasive and too often unsuccessful. Drugs – don’t do anything about the actual dysfunction. So I try to make it clear to everyone I work with that we are operating under these assumptions:
- Muscular imbalances cause alignment problems (unless you have something truly exotic going on with your skeletal system).
- Alignment problems cause limitation and/or pain.
- No change to the muscles in your body is really permanent (For example: you can build big biceps by working out at the gym for a few months doing bicep curls, but if you stop working out, your biceps will shrink again).
- THEREFORE, if you change the alignment by changing the balance between muscles, you’ve got to continue working to maintain that alignment or else the imbalances are likely to return.
Now, once you’re on board with that (and I don’t think any of that is particularly controversial), you do come up against the problem of effectiveness. What do I mean by that? I mean the exercise you’re given have to be effective for you to want to do them!
Back in college, my right shoulder popped out of place while I was snowboarding. It sent waves of burning, tingling pain all along my ribs and lower back (tracing the latissimus dorsi) and made it impossible to raise my arm over my head to take my shirt off. After several doctor visits over a few weeks, I was eventually referred to a physical therapist to help me with what was diagnosed as “bursitis.” The PT showed me some rotator cuff exercises and also had me doing some theraband exercises that were supposed to strengthen my shoulder.
I wanted these exercises to work. I wanted to get back into hockey and snowboarding. I did the exercises, but the exercises were quite obviously pointless! I could feel zero change in the stability and flexibility of my shoulder. I could feel my shoulder blades behaving totally differently when I lay down on the floor. I could feel how wrong things were, and the exercises weren’t helping it one bit. So, after a week, I stopped.
Yes, I was a statistic. I didn’t do what I was supposed to do, but I didn’t do it because what I was supposed to do wasn’t helping. The exercises weren’t addressing the real problem, and I knew I was wasting my time. Once I eventually was shown posture alignment therapy exercises geared specifically toward my body’s issues that actually did address the dysfunctions in my shoulder blades, guess what — the instability in my shoulder improved, and I kept doing the exercises because I knew they were good for me!
I’m of the opinion that you are your best healer. For most people, it’s not a lack of discipline but of understanding of the problem or of the right tools that kills their motivation.
If you are trying to get out of pain, you’ve got to be part of the solution. Nobody else can completely fix the alignment problems (or whatever other problems) for you (they can help, of course). Once you understand the nature of the issue you’re dealing with and have the right tools to deal with the issue, all it takes is some dedicated effort to get you on course.