Procrastination & Rehab: How do you keep the fire going when the pain stops?

If I had a dollar for every time I had a patient say “I was feeling good, so I stopped doing my exercises” followed a week or two later with “I’ve had a set back” or “I’ve been in pain again” 

We’ve all been there, myself included. 

It’s much easier to do something consistently when we see instant benefits – it’s the reason they put a foaming agent in toothpaste and shampoo – we are more motivated to do something when it feels like it’s doing something. 

So when we are in pain, spending time doing our cat/camels and hip CARs feels useful, it decreases the discomfort, it’s doing something.

When our range of motion is limited so much after knee surgery that we can’t lift our leg over the edge of the bathtub, or go down the stairs without turning sideways, it’s easy to do your range of motion exercises because you can see how doing X helps you to be able to do Y, it’s clear that it’s doing something.

How many people have been prescribed antibiotics and stopped taking them (either consciously or subconsciously) once they feel better? 

After we get out of pain, and back to our activities of daily living (walking, going up and down stairs, squatting down to the toilet, getting in and out of the car, putting on pants, tying our shoes, etc) what motivates us to keep going? What takes us from ‘manageable’ to functional? What takes us from functional to performance? 

We know from both research and experience, that rehab continues beyond the time where signs and symptoms are most evident. But that’s where most people stop. You no longer have that constant reminder to do the work. Instead, the little voice inside your head keeps saying,

good is good enough

The problem is, if you stop the rehabilitation process at this point, you’re likely going to: 

a) limit yourself from achieving your best and 

b) have a higher risk of re-injury. 

This is true for both musculoskeletal injuries (bones, ligaments, joints, muscles) and more complex injuries such as concussions. How many football or hockey players go back to contact sport because they “feel OK” but still have cognitive deficits, slower reaction times, early onset of fatigue that not only impacts their ability to play well, but increases their risk for getting a 2^nd concussion AND sustaining a musculoskeletal injury like a sprain or strain?

I’m just over two weeks into my rehab process after a partial meniscectomy of my left knee. The first few days I was over-the-top diligent in my recovery, spending +6 hours a day doing range of motion and isometric strength exercises, using the stim unit, elevating, compressing, icing, etc. When I went back to work, this was cut down significantly but still spent ~3 hours daily for a week introduced manual therapy. Week two switched focus to less passive care and more active activity (biking, dynamic strengthening, etc). Each day I felt a lot of progress which motivated me to keep doing the work. 

Now that I am entering week 3, I’m finding my injury taking up less of my thoughts (and therefore activities!). I no longer get a constant reminder that I’m been still too long, that I’m in pain, that I have limited range of motion. As the swelling continues to decrease, I no longer have a feeling of instability, which means I don’t have a constant reminder telling me I need to continue to strengthen. 

I’ve also been more engaged in my normal daily activities: work, cooking, cleaning, social activities etc that starts taking away from the time I spent doing my rehab. 

But the truth is, my range of motion is still not perfect, my strength still has a long way to go before it catches up to my right side, and I’m still a lot of work to achieving my goal of getting back to weightlifting. 

So what do we do when we no longer get the constant signals from our body? How do we stop procrastinating rehab? How do we get the work done?

Procrastination is human

In his book The Productivity Project, Chris Bailey summarizes a research project by Tim Psychl where they discovered that if the task has one or more of the following 6 attributes it makes procrastination more likely:

• Boring
• Frustrating
• Difficult
• Unstructured or ambiguous
• Lacking in personal meaning
• Lacking in intrinsic rewards (immediate)

For most people, rehab checks a lot of those boxes. 

Are there ways to flip these attributes to make rehab more appealing? 

If it’s boring, are there ways to make your exercises more fun? Getting your kids involved, or doing a session with a friend or working with a therapist. 

Lacking in intrinsic rewards? Reward yourself for doing your exercises. Put $2 in a jar that you’ll use to buy new workout clothes or shoes when you’re back to your sport or taking a weekend getaway.

If you can ‘flip’ these attributes to something positive, you are much more likely to be successful. 

Internal war of getting sh*t done

Bailey also talks about the constant fight between the limbic system and prefrontal cortex.

The limbic system is the more emotional, instinctual part of the brain, that drives short-term, ‘pleasurable’, and immediate rewards 

For example, I’d rather watch Netflix than do my rehab exercises

Whereas the prefrontal cortex is our logical part of our brain that is constantly fighting the limbic system to help us achieve our long-term goals 

I’d rather watch Netflix right now, but if I want to run that marathon in the fall I need to be consistent with my exercises

Unfortunately the odds are stacked against us – research shows that the limbic system is much stronger and we have to work hard to override it. 

We need to exercise our prefrontal cortex. We need to reclaim control of our brain. 

Here are 3 strategies I’ve been using to help avoid the triggers of procrastination, to make sure I don’t get complacent with my rehab:

1. Schedule it into my day like a meeting – each day, I plan the exercises that I will do and I schedule them in. Typically I do some gentle range of motion exercises in the morning and some general movement (biking or walking). At lunch I do a couple more dynamic movements, balance exercises, etc and then I complete my more strength-based exercises as a circuit at the end of the day. 

If I plan in advance, like I would a meeting, it’s a commitment to myself and reminds me that I do have time, I just need to prioritize it

• Source out some accountability – working with someone to help guide you, motivate and encourage you and keep you on track is key. Once we get out of the acute stage of injury management, it’s common that progress slows and you will hit plateaus more often. 

Working with a qualified therapist can help you move past these plateaus both physically and mentally and can provide you some accountability in the process. Even myself, who arguably could design my own rehab plan, is working with an athletic therapist. 

• Keeping my goal in mind – choose what you want most, not what you want right now. This quote really resonates with me as I often find myself wanting to sit and scroll through instagram instead of doing my exercises. It’s easy to give in to what you want in the moment, we’re only human. It can be helpful to not only list the benefits of doing your rehab (improve strength, mobility, decrease pain, get you back to playing soccer, etc) but list the costs if you continue to put rehab off. 

Whether you’re trying to get back to the platform or soccer pitch,  if you’re not consistently doing the work to get strong, increase your mobility and prepare your body tolerate the load of your chosen activities, it’s going to be tough to get there. 

So, each day start the morning with reminding yourself of your goals so it’s in the forefront of your mind, and then each time you venture away or give yourself excuses for why you’re not going to do your exercises, pause and remind yourself WHY you are doing them. Or, use one of the tools or exercises suggested. 

Did any of this resonate with you? Do you use any of the strategies above (or have your own) that keeps you working toward your goal? Please leave a comment or send me a message – I’d love to hear from you. 

If there’s someone in your life who needs to read this, please forward it to them or tag them!