4 Ways to Stick to Your Physical Therapy 'Homework'

Tuesday, 16th August, 2016 12:00 am | by Anna Medaris Miller

When Nancy D. Brown's doctor told her she had hip dysplasia several years ago, her first reaction was: "Humans can get that?" remembers Brown, now a 54-year-old travel writer in Lafayette, California, who had only known it as a condition she should watch out for in her dogs.

But when her surgeon told her she could no longer ski or horseback ride after hip replacement surgery to treat her hip dysplasia, a condition in which the hip joint is in the wrong shape or position, her reaction took a different tone. "I said, 'I'm willing to give up skiing, but I'm not willing to give up horseback riding,'" says Brown, who started riding in first grade and now frequently writes about equestrian travel.

Brown has since had both hips replaced the first in 2012 and the second in July and is sticking to her and her surgeon's compromise: In October, she can ride, so long as she steers clear of horses more likely to buck off their riders.

But first, Brown has to comply with herphysical therapy regimen, going to a clinic twice a week and completing her assigned exercises – such as drawing the alphabet in the air with her foot and lifting her bent knee up and down while lying on her side – at home. She also does water aerobics five days a week, takes the stairs when she can and pulls over each hour to walk around when she's on the road.

"My physical therapy is really about getting me ready to get back in the saddle," Brown says.

Brown is an A-plus physical therapy student. Many people are not. Researchsuggests that as few as 35 percent of physical therapy patients adhere to their at-home regimens.

"The overwhelming majority of folks tend to feel like, 'Oh, I'll just do it' and fail to recognize that it's really hard to change any behavior," says Kevin Masters, a clinical health psychology professor at the University of Colorado Denver. People can also facetime constraints, lack motivation or simply forget, he and other experts say.

But if you want the treatment to work, it's important to follow your physical therapist's orders. In fact, the work at home is just as – if not more – important than the time patients spend in the clinic, says Jessica B. Schwartz, a physical therapist in New York and spokeswoman for the American Physical Therapy Association. "My work can only take them so far," she says. But when patients are completely committed to their treatment plan, they're "going to hit this thing out of the park," she says. Here are five tips on how to do that:

1. Find a purpose.

Brown's goal is clear and compelling: To ride horses again. For Colleen Cornell, a 51-year-old high school business teacher in Oak Ridge, New Jersey, who had complications recovering from her hip replacement surgery four years ago, the goal is simpler. "Getting back to normal," she says.

Identifying a broader purpose for being in good health whether it's going to the Olympics or being able to bike ride with your partner is a great way to stay committed to your at-home regimen, Masters says. When you link your treatment to the kind of person you want to be, it can help you stay motivated for the long haul, he says.

Physical therapists can help patients make the connection between the exercises and their purpose by setting smaller goals along the way, says Schwartz, who doesn't assign patients more than three at-home exercises at a time. "When you can do A, B and C, we'll get rid of A, B and C and prescribe D, E and F," she tells them. And when you can hit D, E and F, then you can start getting back in the pool, the golf course, picking up your grand kids."

2. Meet your match.

For more than nine months, Cornell saw Schwartz, her physical therapist, for an hour three times a week. That's a lot of time to spend with anyone let alone a medical professional so why not spend it with someone you connect with?

For Cornell, Schwartz's sense of humor and listening skills were motivating in themselves. "She made me think, 'Gee, I'd like to see her today,'" Cornell says. "It was a nice place to go."

Not only does a well-matched physical therapist make for a more pleasant appointment, it can also encourage you to comply with your at-home treatment plan, since you'll be motivated to please him or her, Schwartz says. "It's like a student-teacher relationship," she says. Good rapport with your physical therapist can also lead to better outcomes, research suggests.

To build that connection, Schwartz recommends calling offices or clinics and asking if you can see the same person for each appointment. The space should make you feel safe and empowered to ask questions, she adds. For Cornell, it was also important to find a clinic like Schwartz's that was open until 9 p.m. to accommodate her schedule.

"It kills me when folks say, 'I went to physical therapy, and it didn't work,'" when in reality they probably just didn't find the best fit, Schwartz says. "You have to find the right person, the right place for you."

To find a physical therapist near you, try the American Physical Therapy Association's database, which allows you to search by ZIP code and specialty.

3. Be honest.

Face it: You can't tell your physical therapist that the dog ate your homework. Plus, it's not tricky to spot someone who's slacked on their at-home exercises, says Schwartz, who usually asks her patients to show her what they've been doing at home at the beginning of each session.

"Are they uncomfortable? Are they getting flushed? Do they appear nervous?" Schwartz observes. If so, it could be a sign that they're just not doing the work.

Better than keeping mum or lying is simply speaking up. When you're honest, you can better work together to figure out what's holding you back be it pain, time-management problems or just a disinclination toward exercise and how to overcome it, says Sionnadh McLean, a physiotherapist, or expert in movement and function, at Sheffield Hallam University in the United Kingdom who has studied barriers to treatment adherence in physiotherapy clinics. Any good physical therapist won't judge, she adds.

"Everyone finds it difficult to adhere with exercise all day every day, and even just doing a little bit can be helpful," she says. "The important thing that a physical therapist can do at this stage is not to blame the patients and to understand that all exercise behavior change is difficult."

4. Strategize.

In Schwartz's clinic, the No. 1 reason patients say they have trouble doing their at-home work is time. "The time could be for anything it could be familial, it could be personal, it could be professional, even the weather," she laughs. But most exercises don't take more than 10 minutes each day, Schwartz says, so it's more often a matter of not finding time than not having time.

To find it, Schwartz looks through patients' calendars with them and helps them identify moments in their days when they can squeeze in their exercises. "I'm like, 'You've got lunch here? Perfect. You can eat your taco salad, and do your exercise at the same time there,'" she says. It can also be helpful to keep journals, set alarms or use apps to track your progress and report back to your physical therapist.

For Brown, doing exercises before bed and while watching TV fits into her schedule nicely. She also does leg lifts while brushing her teeth. "That's a good one because it keeps your balance and your focus and I'm multitasking," she says.

Masters says the "how" part of completing your at-home physical therapy treatment comes down to being honest with yourself. "Deliberately look at 'How am I going to do this?'" he recommends. "When am I going to do it? What's going to make it worth doing? What's going to get in the way of doing it? And how am I going to deal with that?"

If you can answer those questions, you're well on your way to star-student status, like Brown. "The best thing about it," she says, "is it really does get better every day."