Greetings to you all at the beginning of 2023. I am getting back on the writing buzz after a short break over the Christmas holidays and todays blog is aimed directly at me as well as you!
This is probably one of the most important topics I might ever write about - consistency. This applies massively to the work of overcoming pain.
It might be a (little) stretch to say this, but, your ability to be consistent over the longer term is likely going to matter as much if not more than the treatment you get or who you work with.
Most people in pain (myself included at times) have been guilty of jumping to the next shiny thing :
New therapist
New treatment approach
New stretches & exercises
That monster vibrating massage gun,
The new spiky foam roller,
The ice baths
The Wim Hoff breathing exercises,
The spiritual guide or faith healer that you’re Auntie Meg swears by…
All of this is done in the desperate search for pain relief and for minimising the amount of effort you need to expend to overcome your symptoms. There is a very dangerous thought that we all seem to have pop up - “f**k it, i’m not seeing results yet, I’m not doing that anymore”.
Or even worse, falling foul of self sabotage due to something that Carol Deck writes about in her seminal book “Mindset” - the fixed mindset. Where people don’t fully try because they struggle with facing the prospect of trying their hardest and for that not to have been enough!
In my opinion, consistency is likely the hardest part of overcoming pain. I see this week in, week out in clinic. People do really well for short bursts and then everything falls apart when they miss a few rehab sessions or when life throws a curveball their way.
Simple things done consistently often make the most meaningful progress.
It is really difficult at times because it’s never just about doing the exercises. It’s about being able to squeeze those exercises into your day when life throws a few jabs and right hooks at you.
I’ve pulled a quote out of this research paper to illustrate that the literature backs this up to a significant degree. 1
”There was strong evidence that poor treatment adherence was associated with low levels of physical activity at baseline or in previous weeks, low in-treatment adherence with exercise, low self-efficacy, depression, anxiety, helplessness, poor social support/activity, greater perceived number of barriers to exercise and increased pain levels during exercise.”
- Barriers to treatment adherence in physiotherapy outpatient clinics: a systematic review. Man Ther. 2010;15(3):220-228
You’ll notice in that quite that “low levels of physical activity at baseline or in previous weeks” is one of the factors they found to be important. This likely hints at a struggle with consistency stemming from the difficulty that we as humans have to build new habits.
This study2 by Schoo et al, 2005, showed that people with osteoarthritis that were regularly physically active were FOURTEEN times more likely to adhere to an exercise plan than someone who was not regularly active!
Additionally, in the same study the authors found that people who adhered well to their rehab plan were 20 times more likely to adhere well to the last 4 weeks of their rehab plan.
That’s like a cheat code for making progress with rehab exercises!
It’s also clear that the opposite is true.
People with that don’t exercise regularly were accurately predicted to have less adherence to an exercise and rehabilitation programme.
What this suggests is that building the habits to exercise regularly is massively important for everyone and especially for someone who is in pain regularly. This might have been a major blockage for you in the past.
Goal Setting
This is something that I speak with my clients about when we are goal setting and helping them to understand how the work they are doing will fit into a longer term process to achieve their goals.
For me - the goal of getting out of pain is usually not enough to create long term change.
Once you achieve the goal (which often happens in a shorter time frame than people assume), all motivation to make positive change disappears and adherence dwindles until old habits re-emerge. Two steps forwards and then you’ve stood still. Over time, symptoms may re-emerge and that is obviously not what anyone wants for you!
I like to set a goal with clients that is a few levels above what they currently think is possible. The achievement of this goal should automatically assume that you have overcome pain, movement restriction and have been able to successfully build the habit of exercising regularly. I once had an online client set a goal to climb Mount Kilimanjaro (instead of overcoming back pain) and he achieved both!
Once the big goal has been set. Then it’s time to chunk down. Breaking that larger target into mini-targets is a great way to give yourself meaningful milestones to work towards. This will likely give you a time frame that you can work towards too.
It’s also important to break your goals into something that you 100% know is achievable. Even if that takes you longer. Better to be able to do the work than setup a “perfect” plan that you can’t realistically put into action.
Structuring things in a simple way that build towards a bigger goal that assumes improvement in your relationship with your body is a much easier way to maintain consistency than just trying to get out of pain. When you are working towards something meaningful for you, you are more likely to get the work done.
The Pareto Principle & Progress
What can you do for 20% effort to give you 80% results - Pareto
Can you do it 80% of the time and not beat yourself for the 20% that you don’t do? - David Mc Gettigan
I’ve added my own addition to the quote because it is something that I think every person in pain needs to understand - one isolated failure or time when nothing goes to plan does not doom a process to failure. Not taking control of your mindset during this time - that might!
This is the simplest way that I can describe making progress:
Identify the 3 or 4 big things that will help you the most - usually this is mindset change, improved movement, tissue conditioning & strength
What can you do to get for 20% (or less of your effort) to get you 80% of the changes you want in those 3 or 4 things.
Can you do it 80% of the time and BE KIND TO YOURSELF WHEN YOU MESS THE OTHER 20% UP?
This is literally guaranteed progress.
If you were guaranteed to make progress with your symptoms - don’t you think that would make you a little more likely to be consistent and take action on a regular basis?
Yes I am!
The inverse of that question likely brings up the most significant blockages that anyone in pain encounter when attempting to make progress:
They don’t know what to do to get out of pain (strategy & process)
They fear failing in their attempts to get out of pain (mindset to navigate the process)
Without solving those two issues, consistency is near impossible right?! More on these in another blog.
Setting Yourself Up for Success
If you haven’t read the excellent Atomic Habits by James Clear, this may come as new information to you. (Firstly, stop what you are doing and click the link above to pick up a copy. You’ll thank me later - it’s excellent!). If you have already read it, you will recognise some of these suggestions from the book!
The easiest way to be more consistent with your exercises or learning (or anything really) is to make it easier to do the thing and harder to not do the thing. Get that happening and you will again make great progress.
So what might that look like?
Set your environment up to succeed
If you are aiming to build consistency in doing mobility or rehab exercises or breathing drills - make it as easy to do those things as you can. Ideally, have a space in your home that is dedicated to doing those things. It can literally be anywhere - as long as you clearly set it up so that you can do the thing without any resistance.
In Atomic Habits, Clear talks about reducing friction. This is a great thought process. Make it as easy as you can to do the thing. Leave out your yoga blocks, resistance bands, kettlebells or foam roller in a place that you will see it first thing in the morning so you can get that work done and out of the way before your life gets in the way.
It might be as simple as setting some alarms on your phone to go off during the day when you are usually less busy. A particulate favourite of my desk-based clients is to set an alarm on their phone every 45-90 mins and this alarm acts as a trigger to do 2-3 mins of work. It also doubles up as a nice little mental break too!
Stack it to be consistent
Another simple idea to make consistency easier to attain is to stack your work right after a habit you have already built. If you always pop the kettle on for a cup of tea in the morning - you’ll find it easier to bang out some reps of your exercises while waiting on the kettle to boil, than you will in finding a time to start a brand new habit.
Where, in your day, could you stack 1-2 mins of exercise to benefit your body, on top of something you already do every day with out fail?
Be specific to be consistent
Which of the following statements do you think is more likely to led to consistent action:
“I’ll do that 3 times per week”
“I’ll do that on Monday morning at 8am, Tuesday evening at 7pm and Friday afternoon on my lunch break between 2-2:30pm.”
Clearly the latter! The more specific you can be in deciding where you slot your work into your week, the more likely it is to get done. Partner a specific time slot with an environment that is primed to make it easy to do the work you want to do and you have a much higher chance of being consistent.
Wrapping up
Consistency is key when it comes to rehabilitation exercises for chronic symptoms. Doing exercises regularly can really help to reduce pain and improve function, but oftentimes it is difficult to stick to a routine.
In today’s blog we covered some useful and practical information relating to building consistency with working your way out of pain. Being consistent is possible when you understand that a few days missed doesn’t equal disaster in your attempts to help yourself. You can approach this in a way that sets you up to succeed and this is likely to be a vital part of overcoming symptoms.
Remember, therapists can help you make improvement, but they can never help you to the same degree as you can help yourself. Change only happens inside your nervous system. Build consistency and watch your symptoms and your relationship with your body transform.
Save this post to come back and read it if you fall off the wagon. If you’ve found it useful, please comment below and let me know what resonated most with you!
Move freely.
David
P.S> If you need help with your symptoms, please check out the online course and community site that I’ve built to help you overcome your pain and live freely again.
Jack K, McLean SM, Moffett JK, Gardiner E. Barriers to treatment adherence in physiotherapy outpatient clinics: a systematic review. Man Ther. 2010;15(3):220-228. doi:10.1016/j.math.2009.12.004
Predictors of Home Exercise Adherence in Older People with Osteoarthritis https://www.utpjournals.press/doi/epdf/10.3138/ptc.57.3.179?role=tab