When the exercises don’t work!

When the exercises I’ve prescribed don’t work I often find I do my best work. Ok, let’s be clear, I don’t love the fact that a client might not be getting better, but I do love the dialogue that’s opened up because it gives a free rein to investigate what’s going on.

Good exercise prescription is an art form. Ask any osteopath or physiotherapist and they will tell you that one of the biggest challenges they face is – Exercise compliance eg getting a patient to do the damned exercises!

I think actually it’s something I’m quite good at and I think the reasons for that are quite simple. I follow some simple ground rules.

1. I never prescribe an exercise that I wouldn’t do myself if I was in the client’s shoes.
2. Never use generic exercise handouts. Exercises must be specifically tailored to the patient’s requirements.
3. Exercises should be simple.
4. Never give more than 2 exercises at once, and if possible I will keep it to one exercise.
5. I always get the patient to do the exercise in my osteopathic clinic before they leave. It’s crucial they feel ‘something’ happening in the area that we are targeting because it’s crucial they believe the exercise is going to help them.

But, with all that said I do sometimes, get clients come back and tell me the exercises aren’t working. My first instinct used to be to apologise but over time I’ve realised the incredible power that this situation can open up. It tells me the patient is fully committed. They have persevered with something that hasn’t worked. This is valuable because it opens up the possibility for honest two-sided dialogue. I don’t have the answers to all my clients’ problems at my fingertips. Often, we need to go through a process of exploration and discovery to find the thing that does work. Good osteopathic treatment is often like going on a journey with a patient. I need them to be able to say to me when something isn’t working or doesn’t feel right. We need room for thorough and honest exploration, together, to find the thing that will work.