Physical Therapy Sucks (but have you tried hiding it in some peanut butter?)
The worst part about physical therapy is not knowing if it’s working. The timescale for improvement is dreadfully long and the day-to-day changes are imperceptible.
According to this correlational study, 65% of people who start physical therapy fail to adhere to their prescribed regimen. One of the primary factors cited for non-compliance is: the lack of positive feedback. Physical therapy goes against human nature and our desire for immediate results.
After developing a shoulder issue, I experienced the same thing many people do: performing seemingly useless exercises and hoping my shoulder would improve rapidly. Without noticeable progress, I quickly became one of the 65%. The whole thing just wasn’t satisfying enough for me to want to do it.
What changed, and finally healed my shoulder, was hiding my physical therapy in some peanut butter.
Growing up, my family dog refused to take her pills. But that changed when we started hiding her pills in peanut butter. Remembering this experience gave me an idea for physical therapy.
My previous method (of forcing myself to do these exercises at home) was awful. It was the dog-equivalent of swallowing a pill.
Then I thought, what if I hide my physical therapy in some peanut butter?
Hiding something in peanut butter: surrounding and hiding a difficult task between more enjoyable tasks.
While physical therapy sucks, I do enjoy lifting weights at the gym. I had taken a years-long sabbatical from the gym because of my injury. But I returned when I realized I could work out my lower body without irritating my shoulder. In between squat sets, I began sneaking in some rotator cuff work.
At the end of my workout, I rewarded myself by doing a chest press movement with the lightest of dumbbells that wouldn’t aggravate my shoulder.
I was already in the habit of writing my reps & sets in an exercise journal (thanks Tim Ferriss), so I also started recording my shoulder pain level each week.
What gets measured gets managed. — Peter Drucker
My hope was that while I may not feel a perceptible difference in pain day-to-day, perhaps over time a descending pain level trend would emerge.
Sure enough, that’s what happened. I started at a pain level of ~3.5/10. After four months I became pain free. As author James Clear likes to say in his book Atomic Habits:
What is immediately rewarded is repeated. What is immediately punished is avoided.
My dog hated her pills and didn’t eat them. But hiding them in some tasty peanut butter was an acceptable trade-off for her.
Physical therapy sucks. But doing it between weight lifting sets, which I love, was an acceptable trade-off for me.
Perhaps the reason physical therapy compliance is so low is because too much focus is given to the mechanics of movement, and not enough on how behavior change happens. Hiding a difficult task between enjoyable tasks (for me that’s exercise; your peanut butter may be something else) is one path to effective behavior change. So, if you’re someone who’s struggling with physical therapy compliance, have you tried hiding it in some peanut butter?
I was so excited about this post until I realized the metaphorical peanut butter was also exercise.
I’ve found that watching videos I enjoy while doing PT exercises helps. A key component of this strategy was to get a laptop stand with an adjustable angle so that I can position my screen somewhere I can see it (different places depending on how I’m physically positioned for each exercise).
I appreciate your comment because it let me know that more focus should be given to the general concept of “hiding something in peanut butter”, versus my specific application of it. I edited the post to reflect this. Thanks!
¯\_(ツ)_/¯ What can I say, that’s my peanut butter.
Extrapolating from the general concept, I wonder what other people’s “peanut butter” is? Meaning, what’s a difficult task that people have successfully hidden between doing things they love?
Civ is famous for “just one more turn”—maybe you can hide whatever it is in between turns?
I’ve tried this approach, and although it works well during the early part of the game, in the late game, a single turn can take 5-10 minutes, which is much less helpful as an exercise interlude.
I guess it depends on whether you are trying to maximize the amount of [exercise X] you do, or whether there’s a fixed quantity of [exercise X] that you are trying to force yourself to do. If the latter, obviously it will take longer if you do it while playing Civ but that’s not necessarily a problem.
I don’t enjoy PT or exercise, but mostly because it’s boring / feels like a waste of time. My peanut butter is to do that involve exercise but where the purpose isn’t strictly exercise or where I get some other benefit:
Biking to work every day takes me about the same amount of time as driving and is more fun. Hills weren’t fun so I got an e-bike and with sufficient assist they became fun again. As I get more in shape, I find myself turning the assist down because I don’t really need it.
Biking to restaurants and bars is also fun.
I like going on walks with friends and talking, so why not do that while walking up a mountain?
I joined a casual dodgeball league for fun and meeting people, and as a side effect do the cardio equivalent of two hours of jogging every Sunday.
Indoor rock climbing feels a little bit like exercise, but it’s also a group activity that involves a lot of downtime just talking.
(I’ve yet to find a good way to mix my also-shoulder PT into anything fun, so I just keep exercise bands at my desk at work)
I love peanut butter, so I eat as much of it as I can without getting too chubby for my own satisfaction. Am I supposed to get uncomfortably chubby so I can hide stuff in more peanut butter?
Also, I’m bad at hiding stuff from myself. Can anyone advise me on getting better at hiding things from my own self?
Which is to say, this whole give yourself a treat in trade for hard work sounds weird to me. I haven’t conceptualized it right. I can occasionally do it, but only ad-hoc when I don’t think about it too much. I can make and keep commitments to myself, but I don’t like making commitments that are trades for the above reasons.
I’m also such a rebel that even me trying to boss me around makes me want to do the opposite.
I generally watch videos I enjoy while doing physical therapy exercises. I didn’t conceptualize it as hiding the “reward” from myself as an incentive for exercising; I conceptualize it as making the rather boring, sometimes aversive activity less salient by focusing my attention on something else.
As an example, I find it much easier to hold a plank when I’m focused on the video I’m watching than when I’m just starting at the timer counting down.
Interesting. This specific form of ‘reward’ also works well for me (and I also hadn’t conceptualised it as such), but when people talk about rewarding yourself as an incentive for doing something, it’s usually stuff like ‘give yourself a slice of cake if you’ve had a productive workday’ or whatever, and in those cases, my brain is always going ‘wait! I can have the cake anyway, even though I didn’t do what I planned! It’s right here, I can just eat it!’. I’m not sure why it happens, or why watching videos when exercising works better, but I assume it’s what Seth meant?
This sounded wrong, but I guess is technically true? I had great in-session improvements as I’m warming up the area and getting into it, and the difference between a session where I missed the previous day, and one where I didn’t, is absolutely preceptible. Now after that initial boost, it’s true that I couldn’t tell if the “high point” was improving day to day, but that was never a concern—the above was enough to give me confidence. Plus with your external rotations, was there not perceptible strength improvement week to week?