Most of us know that exercises are an important key to full recovery of spinal function. Unfortunately, I have found that the more knowledgeable doctors are in rehab procedures, the more likely they are to overwhelm their patients with exercises. The result is frequently a long laundry-list of exercises given to each patient. This often includes stretches for all of the tight muscles, strengthening for all of the weak muscles, and (of course) stabilizing, proprioception, and coordination exercises. In the real world, though, patients have a limited amount of time (and willingness) to exercise. One of the most important concepts in designing an effective rehab program is this: don’t overwhelm your patient with exercises.
Unfortunately, patients don’t get better from the exercise recommendations we give them. In order to get the benefits of active exercising, the patients have to actually do the exercises. If they don’t do the exercises, they just won’t get any better, even when they have been given beautifully planned programs. Exercise recommendations must be designed so patients can realistically follow them. Overload happens when a patient is advised to do six to ten (or more!) exercises once or even twice a day. The doctor or therapist strongly believes in the benefits to be gained from these various exercises, and the patient is gung-ho to get better. Problems begin by the second day, when the patient realizes that this amount of commitment is simply not compatible with real life.
Take a Walk in the Patient’s Shoes
The best way to avoid this problem is to recognize that our patients have their own lives. We must advise and treat our patients the same way we would treat ourselves. Since we often have a hard time finding an extra hour or so each day to do the exercises we know we should be doing, we can’t expect our patients to have an easier time. Do you regularly perform the spinal strengthening and flexibility exercises that you recommend for your patients?
An informative study looked at home exercise performance in adults over 65 years of age (an age group that has previously been found to have difficulty with exercise compliance). Volunteer subjects aged 67 to 82 years were instructed in either two, or eight exercises to be done daily. When they were checked ten days later, the group who had been shown only two exercises performed significantly better than the group who had been shown eight exercises.1 While the results may seem self-evident, many doctors and therapists apparently need this evidence-based reminder.
Getting Started is First
The most effective way to begin an exercise program is small, but consistent. This means that the patient starts with the one or two exercises they really need, and they perform the exercises frequently (daily). Once-a-day exercising is the quickest and easiest way to establish a regular exercise routine. Patients are allowed to fit the exercise(s) into their daily schedules whenever it’s best for them — mornings, during lunch breaks, or evenings. Initially, we are not asking our patients to do heavy resistance, muscle tear-down exercises, so the traditional “day of rest in between” is not needed. We want to establish a new habit of regular, consistent exercising of the problem area.
The Next Step
As patients begin to respond, and a routine has been established, we can add one or two more exercises to address adjacent or more involved areas. Even so, it is vital that we continue to monitor our patients’ levels of compliance and commitment, and provide praise and recognition. We all do better and are more motivated when we have achieved some small success before we tackle larger projects. The confidence that comes from succeeding at the initial exercises makes it much easier to, then, integrate more complex or time-consuming exercise routines.
Patients should begin with a graduated exercise program that starts with minimal commitment, and then builds upon the exercise habit that they establish. This should be integrated into our early phases of chiropractic care, in order to gain the most advantage from the benefits of exercising problem areas. We should avoid giving exercise recommendations that overwhelm or ask too much from patients. And we really should try out the exercises ourselves for a week or so, to see how much time and effort is really required to follow our exercise programs.
John K. Hyland, D.C., M.P.H. D.A.C.B.R., D.A.B.C.O., C.S.C.S., C.H.E.S. is board-certified in two chiropractic specialties, and is also certified as a Strength and Conditioning Specialist and a Health Education Specialist. He has 20 years of clinical practice; for eight years he specialized in chiropractic rehabilitation. He is currently a Research Associate at Parker College of Chiropractic, and an Adjunct Professor of Clinical Sciences at the University of Bridgeport’s College of Chiropractic. You can contact him at
1. Henry KD, Rosemond C, Eckert LB. Effect of number of home exercises on compliance and performance in adults over 65 years of age. Phys Ther 1999; 79:270-7.