Patient Persuasion = Adherence over Compliance

A great citation from themanualtherapist.com, these approaches can take your patients from non-compliance to compliance… or better yet, adherence! (our goal for home exercises):
I wouldn’t call these real life arguments, but they were very quick “aha” moments to patients who were less than compliant.

1) The Professional Cello Player

  • Pt: his question was how long does the HEP have to be reinforced?
  • Me: For as long as you want the improvements to last, keep introducing the positional and movement variability into your system to change the repetitive positions playing for 2-3 hours at a time does
  • Pt: I hate monthly adjustments, but I feel like I need them, are they necessary?
  • Me: If you practiced Cello once a month, would there be any carry over?

2) The Marathoner

  • Pt: How long do I have to keep up these exercises?
  • Me: Treat the homework like you do your training, and make it part of your training. Put the same intensity into your homework as you do your training and your condition will continue to improve

3) The Professor

  • Pt: Exercises ten times hourly? That’s crazy!
  • Me: Do they make you feel better?
  • Pt: yes
  • Me: For how long?
  • Pt: maybe an hour or so
  • Me: If they make you feel better, and they last that long, logically, I would say you would have to be crazy, not to do them
  • Pt: Hmmm, I never thought of it that way, that’s true

4) The Personal Trainer/Runner

  • Pt: I love training in vibrams
  • Me: You have a moderate loss of ankle mobility, plus in your previous profession, you wore heels (drug rep)
  • Me: Your hip and back pain could be from all the training and running, the reaction force from the ground is going up the chain and unloading the back when you squat, jump, and run
  • Me: Try going to a 8-12 mm drop on both shoes while you and I work on the mobility (she was a slow responder) and see how you do
  • Pt: All my hip/lower back pain is now gone after switching to 12 mm drop shoes

5) The Parent/Grandparent

  • Pt: You told me to avoid bending for now, but I need to hold my kids
  • Me: As a parent, I know that, make your homework (backward bends, press ups, chin tucks etc), a game that everyone needs to do. Kids love to move, and they love to see mom/dad/grandma/grandpa look silly in the process!

What you need to do is find everyone’s motivation, feed their need to improve compliance. Greg Rose, gave some great advice at the SFMA 2, “Don’t take away things from patients if you can, tell them if they keep up with the exercises, they will be able to do the things they need to do better.”

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