The Dog Ate My Home Exercise Program

Dogs have been infamous for chewing slippers and digging up flowers, but eating home exercise programs? Believe me. Someone out there wants you to believe it can happen.

Picture a wise-cracking, spry, 70 year-old patient of yours coming to his next appointment with a note from his 90 year-old mom. It’s mangled enough that you begin to wonder if the dog had chewed on the note. You open it to find an explanation about Fido’s strange gastronomic attraction to home exercise programs. As soon as you’re done reading, your patient frowns at you and says, “You said I’d get better by now. What’s going on? You must not be a very good therapist.”

This didn’t actually happen (at least not to anyone I know). But I’m sure many a patient would find it to be LOL hilarious. Physical therapists, on the other hand…well, we might just grimace a little.

We give patients our best disapproving clinical stare. We harangue them. We even harass them on the phone a few times. But our patients come in with every excuse from the implausible “I had to wash my hair” to the impossible “I didn’t know you REALLY wanted me to do it.” I guess some people just say, “Yes, I understood everything you said” as a reflex. (Remember to assess for this during your next neuro exam.)

Maybe it would help if we think about what our patients think. Mr. Smith comes in looking for a cure. He doesn’t want to be told he needs to do something. He thought you were going to do something to him.

Then you say to Mr. Smith “one more thing” or “in addition to what we’re doing here…” If there’s something that can viewed as “additional” (never mind additional to what), it’s not likely to get done. Associate that “additional” activity with school and you guarantee a “no-go.”

I once had a patient tell me he didn’t want to do the home exercise program because it sounded like homework (which it was) and he hated school, so he didn’t want to do it. So there’s a lesson for you. Don’t remind your patients of school.

Instead, try these ideas:

• Don’t title your home exercise program “home exercise program” or, worse, “homework.” Call it: “Things you can do at home to help you get better faster”
• Orient your patients from day one. They need to know that you facilitate their healing but  they need to take ownership for it…you can’t do their exercises for them any more than a dentist can follow them home and brush their teeth
• K.I.S.S. “Keep It Simple Stupid” Give 3-5 basic exercises, not 15. Make sure the rep and set counts are easy to remember and not too different from one exercise to the next. In other words, don’t prescribe 3 sets of 10, 5 sets of 3 and 1 set of 4.
• Assign exercises that don’t require fancy equipment. Even if patients have access to the gym, the additional trip there is enough to dissuade them from doing anything
• If an exercise requires equipment, provide it. For e.g. cut your patients a piece of resistance band. Don’t tell them it’s available at Target and Wal-Mart. You want them to drive somewhere, find the equipment, buy it, AND do the exercise? Good luck.
• Provide a handout with clear instructions in large enough font and go over it with your patients before they leave 

These guidelines relate more to the reluctant patient. You may get a “zealous” patient who wants thirty exercises not just three. The patient will then go home and do 300 repetitions of each and come back with an arm so exhausted it’s dangling by a single muscle fiber. Again, you’ll get a frown: “You said I’d get better by now. What’s going on? You must not be a very good therapist.” The solution to this problem is in another article that, unfortunately, my dog ate.

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