Old habits die hard. New habits are even more difficult to start. When it comes to rehabilitating from an injury, long-term success often depends on developing new positive habits which promote a healthy and active lifestyle. After completing a course of physical therapy or following the achievement of any fitness goal, it is easy to relax and resort back to old habits. These old habits could be spending too much time relaxing in front of the television or losing track of several hours while parked in front of a computer. In order to maintain or maximize positive change from an exercise program, new habits must take the place of the old habits. Out with the old and in with the new.
Intentional behavior change can be broken down into five stages. Research has found that people move through these stages when modifying or changing behavior. The time a person stays in each stage is variable, but the steps required to move through the process is not. These five stages are very applicable to optimizing outcomes in physical therapy.
Stage 1: Precontemplation
The first stage is typically characterized by a resistance to change. During precontemplation individuals do not consider change as an option or they do not see the benefit in changing. Many who begin their rehabilitation are unsure about how exercise and behavior change can help their condition. Perhaps, they are confused about why the doctor has not ordered an MRI? At this point, it is imperative that the physical therapist does not attempt to coerce or force the patient into change. Only through open communication, trust, and a positive working relationship can an individual progress beyond this stage.
Stage 2: Contemplation
During the second stage, the individual begins to see that a change may be beneficial but is unsure how to proceed. Here a patient may begin weighing the pros and cons of following through with their initial home exercise program. It is common for individuals to remain stuck in this stage throughout their rehabilitation. Chronic contemplation or procrastination often leads to unsuccessful courses of treatment or frequent relapses of symptoms. It is imperative that any patient moves beyond this stage before completing their course of care with their physical therapist.
Stage 3: Preparation
Now the individual is ready to take the initial steps towards change. This stage is characterized by the intention to change and taking steps towards change. Developing a plan for change with your physical therapist is very important at this point. Without purpose, goals, and a plan change will never be long-lasting.
Stage 4: Action
This stage is characterized by concrete steps that will lead to the desired change. This may involve beginning a daily walking program or strength training in the gym three days per week. This is where the foundation for lifelong positive healthy habits is built. We like to see individuals progress into this stage before their final few visits in physical therapy.
Stage 5: Maintenance
Maintenance may be the most important stage because it involves effort to maintain the changes made during the action stage. Success will require individuals to make modifications in their lifestyles and work to prevent relapses. While in the maintenance stage, people are less tempted to relapse and grow increasingly more confident that they can continue their changes. This is where positive habits are solidified. Unfortunately, many do not remain in this stage long enough and ultimately resort to old habits leading to relapse. We see this when dieters achieve a weight loss goal only to regain it back, plus more, within 2 years. In rehabilitation, we often see individuals return for the same problem year after year because they were unable to follow-through with this final stage of intentional change.
Some argue that it is human nature to resist change. I disagree. Some of us choose to remain comfortable with routines based on non-productive habits. We will ultimately become what we think about most of the time. If we can’t wait to leave work and relax on the couch, then this is what we will become. If we are serious about our long-term health and life goals, we will take that 30-minute walk instead. Any human being with purpose, goals, and a plan to change can accomplish great things.
One or two months of physical therapy are only the start towards behavior change. Take what you have learned from your physical therapist and consider this one small step towards building healthy habits which will benefit you for a lifetime. Long-lasting intentional change is hard but we all know waiting around for things to change never gets us closer to our goals.