How to get your clients to do their exercises
Wednesday, April 04, 2018
There is probably nothing more frustrating to a physical therapist than a client who doesn't do the rehabilitation exercises you've prescribed them.
We all know that those clients who stick to the rehab at home make the fastest and most complete recovery. But how do we relay that to our clients in a way that isn't patronizing but educates and motivates them to knuckle down and do the work?
Here are my top five tips:
1. Keep it simple
Try not to overload clients with loads of exercises. A big long list of exercises can look pretty daunting and takes up quite a chunk of time. Few people have the time now to be spending a half-hour or more every day on a rehab program.
Focus on two or three key exercises. I would much prefer a client actually do a couple of exercises regularly, than do 10 exercises once a week.
Also, try to keep the exercises themselves simple. There is no need to be adding in complicated movements or equipment. Most muscles can be strengthened or stretched in a simple way using either no equipment or something as simple as a resistance band or even a can of beans.
2. Provide written exercise plans
In my experience, it is common for clients to seem like they have picked up an exercise while in your clinic, only then to forget exactly what they were doing once they get home. The exercise either then gets ignored or often gets turned into a variation of what you asked them to do. Sometimes that variation is almost unrecognizable!
This is where exercise handouts come in. I provide a plan for clients that includes a photo, description and suggested rep range for each exercise. These have proved really effective at keeping clients on the right track with their home rehab.
This also helps to encourage them to complete their exercises. If there is something there in front of them with the exercises written down, it serves as both a reminder to the more forgetful, as well as a bit of a guilt trip to those who are just a little lazy.
There are several websites online that, for a small monthly fee, allow you access to a massive database of exercises to pick and choose from. Well worth the money in my opinion!
3. Explain the whys and hows
Someone is far more likely to do something if they know why they are supposed to be doing it.
This starts with explaining exactly what their injury is, what the root cause may be and how you can address it together. Once they understand their injury a little more and they know what the treatment plan is, they can see their part in it.
Explain exactly what each exercise is trying to achieve and how that will improve their pain. Ensure they know what it should feel like, what level of discomfort you want them to work to, how many reps to target and how often they should be doing it.
If an individual is educated in regard to their injury and what it will take to move forward, they value their role in recovery more and are (fingers crossed) more coherent to the program.
4. Demonstrate and check form repeatedly
When first instructing clients in a new exercise, always demonstrate it yourself so they can see how it is supposed to look. Tell them where you can feel it working and emphasize cues such as posture and speed.
Observe them perform the same exercise and adjust their form where necessary, explaining why you are doing so and again using cues to help encourage the correct form at home.
When you see them next, observe them performing the same exercise again — this time without a demonstration. This will ensure you see what they have been doing in your absence. Once again, tweak any issues and explain why.
If they seem to be managing comfortably, consider progressing with extra reps, weight or an advancement in difficulty. This not only serves to improve strength, but also acts as a motivator. People like to see that they are making progress!
5. Give examples of reminder cues
The biggest reason clients give for not doing their exercises is actually just remembering to do them. But there are ways around this:
- Get them to ask someone they live with to remind them — two memories are better than one.
- Encourage them to set an alarm on their phone, for a time of day when they are most likely to be able to do them.
- Tie simple exercises in with daily tasks. For example, a single leg balance can be done while brushing their teeth. Or calf stretches can be performed as they go to walk up the stairs.
- Suggest they set their alarm 10 minutes earlier in the mornings to allow time to get them done.
- Get them to do stretches and simple exercises while watching their favorite TV program in the evenings. After a while, the theme music alone may act as a reminder!
I'm sure there are plenty of other ways to empower your clients into sticking to a rehab plan. These are the tips and tricks that I use most often. Let me know if there's a great method you use that's not already on the list.
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