Have you ever received a Home Exercise Program (HEP)? They’re usually about 4-6 exercises on a sheet of paper your physical therapist whips through at the end of your first visit. Maybe yours got lost in the back of your car, or folded up in your pocket and ran through the wash, or maybe you kept it out, tried doing the exercises but, boy, were they boring!
The fact is, more patients aren’t doing their exercises than are–lots of studies show 50-75% of people don’t do them. It could be that there’s no time, or you didn’t know if you were doing them right, or you weren’t sure they’d work. Anyway, a sheet of paper that your PT rushed through hardly seems important. But that home exercise program, the one you ignored, plays maybe the most important role in getting you better and keeping you better. I’ll share why.
PTs Use Home Exercises Differently
In my career, I‘ve worked with thousands of patients recovering from back pain, ankle sprain, and shoulder strain. I worked in a big system where my full time job was covering for other physical therapists who were out sick, on vacation, or taking parental leave. I saw how hundreds of other PTs set up (or didn’t) their patients’ home exercises. Some gave paper sheets of exercises, some liked online exercises with access codes, some assigned 2-3 exercises, others provided (no kidding) more than 20 exercises. I used to try reviewing each exercise the prior PT had assigned, but something felt weird–like the exercises were new to patients. So I changed my approach. Instead, I started giving them this prompt: “Show me the exercises your PT has you doing at home.”
Most patients couldn’t. Or they’d show me something that looked like a hamstring stretch but couldn’t tell me how many times they did it or for how long. Even the PTs who were trying to make it easy and giving their patients access codes to online exercises would be surprised to learn many of their patients had never even gone to the website to see what was assigned.
There Are Reasons People Skip Their Exercises
There are a lot of barriers patients will point to for missing their exercises. Studies show some of the top reasons for not following through are lack of time, lack of interest, doubt they’ll work, and their exercises feeling too complex. This is a problem, because it means people are missing the most important ingredient to getting better.
There Are Costs For Skipping Exercises
Across the board, doing your home exercise program means better outcomes–studies consistently show those who do their exercises have less pain, improved physical function, and improved quality of life compared to those who skip them. Those gains are immediate, and they also last. Studies show those same benefits people got immediately were sustained even 5 years later. The improved pain and function and quality of life didn’t go away once those patients were discharged from their formal PT sessions.
There’s Doing Your Exercises, and There’s Doing Them Right
So we’re getting the point that they’re important, right? But there’s more to it than just doing the exercises (the ones that up to 75% of patients aren’t doing in the first place). Doing your exercises is important, but I would argue doing them right is even more important. Doing your exercises correctly means: doing the right number of sets and reps, doing them with the right technique, and, I consider this a big one, doing them at the right speed. If you fly through your exercises quickly and with bad technique, you are not training your body to support you later. Here’s an example: if you get heel raises assigned and you blast through them at 0.5 seconds each and aren’t paying attention to where your weight is as you lift and lower, then you aren’t doing them correctly. They aren’t going to give you the strength and control you’re looking for (the reason your physical therapist assigned them). And this means your painful and weak ankle is going to take even longer to heal. One study found that, of patients who were actually doing their exercises, only 2.7% of them were doing them correctly. That is wild.
It’s A Problem, But There Are Solutions
I promise I’m not trying to make you feel bad, or call you a bad patient. Things were stacked against you from the start. When I worked in the clinic (instead of doing my work online), I had to rush through about 4 exercises I felt were the most important after a jam-packed visit. So much happens during that first PT visit, so a lot of patients couldn’t remember what I had told them about technique, or how to modify the exercise if they hurt, or which band to use with which exercise.
I changed my model so now everyone follows along with me doing a full video of their exercises start to finish. This means my people do their exercises with the right technique and the right pace. Traditional PT clinics don’t really have that as an option, and many are stuck with the paper sheets of exercises or digital exercises that ask you to enter your access code. If you’re working with an in-person PT in the future and you notice you’re slacking on your exercises, here are a few ways to advocate for yourself.
- Ask for clarification if you’re confused. Technique is really important, and you want the right muscles being trained.
- Ask for 3-4 exercises. Studies show that patients do better with 3 or fewer exercises and stop doing them altogether as that number of assignments increases. If you have a list of 10 exercises, that’s not realistic, and you need that list shortened by your PT.
- Ask for your exercises to progress. If you’re doing the same exercises 4-5 weeks into your PT, something has gone wrong. Your exercises should change and advance as your body changes and advances. Your body should need new challenges as you grow.
And if you want to make sure your exercises go well and are being managed, you can always work with me. I do everything online with my online studio, motivPT. And studies actually show that patients are more likely to stick with their exercises when received through telehealth. Which is good news for everyone, because, remember, people who do their home exercises hurt less, function better and have improved quality of life in the short term and maintain those things in the long term.
I, Dr. Alex, am here to support you every step of the way, no matter where you are. Book your free 15-minute consult to talk with me about your concerns and learn more about how we work! Our online physical therapy and personal training can help you regain what you thought you’d lost and go strongly into your future.
At motivPT, we believe your body deserves to feel great.
