So many of my patients have difficulty following through with their exercises. In speaking with many colleagues about this topic, they agree that their own patients struggle with doing that which is asked of them. And guess what? I have difficulty following through with my exercises! Why can't we do what is best for us? Why is it that when we as humans are in pain or are suffering, and are provided with a tried-and-true solution to our problem that we fall short so often?  We ask for help, someone gives us a freebee, and we throw it in the trash. 

There is complex psychology at play here, however I will try to describe why you may not be able to follow through with your exercise and rehabilitation program, through my own personal experience and the difficulties I have experienced in my own life. Take a seat - let us figure this out together.  

You Aren't Ready  

So many of us are in pain at any given time. I mentioned this before but over 80% of people will experience spine pain at some point in their life. What is the difference between someone who has pain and gets better, and someone else who remains in pain for months or years? 

Pain may have become a part of your identity, and without it, you lack purpose. What does this really mean though? Pain gives you purpose by enabling your brain to focus solely on the experience of pain, instead of everything else that is stressful or pressing in your life. It distracts you from your true purpose, which is living your life to the fullest expression, being of service to the greatest good of all including yourself, your friends, and your family, and engaging with your creativity to become the best version of yourself and contribute to humanity. 

When your back hurts, you give yourself permission to not take care of the laundry list of boring/painful/rigorous/stressful things that every human needs to. Excuses become tolerable, and there is an overall lack of accountability because you can just simply continue focusing on your pain. You justify being complacent. Procrastination becomes acceptable. You reach out your health care providers in search of a quick fix, but as soon as they give you an opportunity to get out of pain that involves a greater personal effort, you cannot find it in yourself to commit. You focus on your pain and palliate it just enough that it becomes tolerable to continue along your well-trodden path of living with pain. 

It's Not an Emergency 

Have you ever experienced feelings of impending doom? Something has happened, and you genuinely believe that your entire world was going to be distorted by the actions of either yourself or another? Sometimes we feel as if there is no way out, that we have no control, as if we are floating in the middle of the ocean alone being carried by currents over which we have no control. During these times of weakness and struggle we can find our most potent strength. 

Unfortunately, it takes too many of us reaching this point before we feel ready to make a change. It would be much easier for us to act before hitting rock bottom, but our brains like to take the path of least resistance and would much rather continue in pain than adopt a new course of action that we perceive as being even more painful or difficult than business as usual. 

Emergencies force us to act. The speed in which we must act is proportional to the severity of the emergency. Do we really need to do 8 sets of 15 repetitions of lumbar extensions daily for the next month to avoid a microdiscectomy? Or can we just do half, or none and our excruciating low back pain will slowly disappear on its own? If your pain level is 8/10 and nothing makes it better, but you were asked to do an exercise that might hurt you the first few repetitions you perform, you may choose to just live with the pain. However, if you have 8/10 back pain with 10/10 leg pain and cannot walk, you will perform those exercises, because getting to the bathroom is hard if your legs will not carry you there.  

You Lack Discipline 

If discipline were for sale, it would be the second most expensive resource. The first most expensive resource would be time. Jocko Willink, retired lieutenant commander in the United States Navy and member of Seal Team 3 is frequently heard explaining how "discipline equals freedom". He has become affectionately known for the phrase "Good.", referring to the notion that if something is difficult, you say to yourself, "Good", because you are thankful for being presented with a challenge that is going to make you a stronger person for overcoming it. 

Discipline gives us the tools to do what we need to do despite not wanting to do it. What becomes possible is anything our heart desires. Discipline takes us from an 8/10 pain on day 1 to a 3/10 pain on day 30. It takes us from couch bound to bicycle bound. It removes the perceived barriers of weakness, ploughing and propelling us forward towards our goals, providing the necessary inertia to continue and in the process, making us anti-fragile. So, the next time you find yourself feeling sorry or lazy, say "Good". Then get after it. You may avoid your prospective surgery.  

You Lack Accountability 

If you do not have someone who is keeping you honest and helping you to show up for yourself, you are already one step behind.  

Some of us have nurturing environments in which we co-exist with helpful and supportive family. Our loved ones love us too. They have our best interests in mind. When we bring home an exercise routine, these folks lay on the floor with their children asking them "mommy, why are you doing this", as their spouses interject: "sweetheart, mommy has to do her exercises to feel better so she can play with you"...while the family dog licks mom's face. 

This is not always the case, however. Another all-too-common example is you arrive back at your apartment with your exercises. You find a quiet place in the corner of the living room to begin your work, and your roommate barges in, shouting "what the hell are you doing?". This casts a shadow of judgement and embarrassment over the entire prospect of doing something for yourself. The reality here is that your roommate may feel intimidated by your commitment to becoming better. You will not find the requisite support from this individual, and they may just become the saboteur of your progress.  

The Bio-Psycho-Social or "BSP" Model 

We can unpack these examples using the bio-psycho-social or BSP approach to healthcare. The "BSP" Model (in a perfect world) is integrated into every aspect of healthcare and is typically established during your visit with the doctor. You are properly examined, your voice heard, questions answered, and the mechanism of your pain and dysfunction explained to you in clear, easy to understand language. 

The "bio" refers to your anatomy, physiology, and the specific tissues and body parts that are contributing to your pain experience. 

The "psycho" refers to your emotional response to your injury, and the compassion and empathy that was deployed by both the doctor and you regarding your condition. You may be fearful of doing too much, to injure yourself. You may also believe you will never recover. Your worldview, beliefs, and cognitive biases all play a role. 

The "social" refers to all individuals who impact your condition. People who co-exist or interact with you, have an impact on your interpretation of said condition and recovery, and potentially your future as it pertains to musculoskeletal health. 

The BSP Model provides both patients and providers the ability to succeed in their endeavors by choosing to acknowledge the multiple influential factors on recovery, setting the stage for healing via discouraging damaging practices or dogma while assisting the patient with their road forward, guiding them through their decision-making process by way of gold standard practices grounded in research, reproducibility, and ethics.  


This sounds harsh. It is tough love. I would explain this to my own family the same way. 

We often have difficulty doing those things that improve our lives or prevent future peril. If we could only shift our mindset to applying as much compassion and empathy as possible for our future selves, we would experience not only a more vital and thriving present but would ensure at a minimum the same for our future selves. 

Motivation and Momentum require the same initial impetus: Action. 


And remember, information represented here is only a beginning - please seek consultation with your medical & health care providers for proper evaluation, diagnosis, and treatment!    

Keep Searching,   

Dr. Nick