We speak to many therapists who ask us “How can I get my clients to actually do their exercises?”
It’s a good question. Chances are often pretty low, so why bother wasting your energy?
Many therapists feel like the client is the problem here. They just aren’t motivated enough, or worse still… they’re lazy!
Well, the truth is, getting anyone to do anything is a skill. An art form even. So here are a few of our most successful strategies for achieving exceptional client adherence.
#1 Choose exercises wisely.
Okay, maybe this seems obvious, but often this is the first mistake.
Therapists often confuse “making an exercise easy for the client to do” for “give them an easy exercise”. It’s a big mistake. Evidence shows that when an exercise is too easy it doesn’t challenge the body to adapt and change. So you are wasting your client’s time when you give an easy exercise (and they instinctively know it!).
Look to make hard exercises easy to do, or fun to do. Aim to find ways to make the tissues adapt and the client will usually understand what you are tying to achieve.
#2 Give good reasons for your home care.
We often see clients with a sheet of exercises from the physio that are all great but the client isn’t doing them simply because they haven’t been told why they should do them. Yet simply educating them makes adherence skyrocket!
Explaining why an exercise will help them is important. You need a good rationale for each exercise you give someone, and they need to know why it’s a steppingstone in the direction of better health.
You don’t need to get into the technical detail though. Instead, keep it simple, like: “Your tissues are lacking strength after that injury. We need to progressively load you up to rebuild it. Here’s what to do though if the exercise hurts, and here’s what to do if you feel it’s not doing enough. Feed back to me in the week about how it’s going and we can always adjust it for you if need be.”
Client’s simply appreciate the explanation.
#3 Flat out ask them if they are going to do it!
We always ask one simple question to our clients. “Out of 10, what’s the likelihood you’ll do this exercise?”
If you get anything less than a 9 then they are not going to do it. That’s right, no less than a 9!
An 8 or less represents a hurdle that the client envisions but may not articulate unless you ask. We’ve heard everything from “I have nowhere in my house to lay down” to “But the dog will just want to lick my face if I do that”.
All reasons for giving a low number are legitimate, so don’t scoff at them. Simple ask “How could we make this a 9 or 10 for you?” and see what they say. Usually they’ll come up with their own solution (like laying on their bed, or locking the dog in another room!).
Once you have a solution, ask the 0-10 question again. If you get a 9 or 10 then have them do it, even if the compromise you made reduces the effectiveness of the exercise. Once they start you can usually improve the exercise quality the following week.
#4 Learn Motivational Interviewing.
This conversation technique is the key to all good therapeutic relationships. Motivational Interviewing teaches you how to listen better to your client’s needs and draw out “Change Talk” from them. Before you know it they’ll be asking you to give them home care, rather than you forcing it on them. It’s a skill well worth learning.
With these four methods we find that our clients almost always do their home care. Sometimes it takes 2-3 sessions to find out what the real resistance is, but as soon as you help them overcome that resistance adherence becomes the norm.