Why Am I Not Getting Better?

I’ve been asked this question, in varying forms, thousands of times.

It’s that common.

Of course, in my early practice days, I answered in a defensive way by pointing out all the things that had improved.

”Well, you’ve gained 15 degrees of motion, your muscle strength is up 25%, you can get out of a chair now.”

Right. And maybe the client says, “Yeah, well I still can’t run.”

Boom.

The defensive approach rarely works and the reason is that what most people define as “improving”, what they really mean is “why have I not achieved my goal”.

So, let’s back up and start with the factors that are in play when it comes to making progress and achieving your goal.

1. Do you have a comprehensive diagnosis of the problem? Pain is a problem but, in almost all musculoskeletal cases, not the diagnosis. If you’re treating the symptom – pain, stiffness, swelling, for example independent of why those things exist, progress will be slow. And sometimes it can take a while to sort out the various diagnoses involved. For example, if you have hip pain, the symptoms can stem from several orthopedic sources, and/or nerve involvement in the lumbar spine (and I’m excluding the more serious disorders such as cancer or internal organ disease). I’ve seen many clients who were, at first, diagnosed with “hip bursitis” that turned out to have additional sources that produced symptoms. And do your best to not self-diagnose with Dr. Google. Yes, you should be informed, educated on the various possibilities but information is not the same thing as knowledge.
2. Are you doing the right things the right way? If you have shoulder pain, for example, and have one or more weak rotator cuff tendons and you’re stretching your shoulder, even if you’re doing it nearly perfectly, progress will be slow. Why? Well, weakness requires strengthening and not so much stretching. And “doing things the right way” includes dosage. So, if your muscles, for example, need more strength and you fail to produce sufficient fatigue during your exercises, not much will change.
3. Have you modified and/or eliminated the offending variables? That’s professional speak for “have you stopped doing things that produce the very symptoms you’re trying to over come?” Example, you have hip or knee pain and walking more than about 15 minutes causes increased pain and, later on, some swelling. You have a dog and have convinced yourself you have to walk your pup at least 45 minutes a day. So, if you’re walking your canine friend for 45 minutes when 15 minutes is your true tolerance, well, you’re not going to make much progress for a long time. Maybe not at all. Solution? Walk your dog 10 minutes, 3 or 4 times a day. That’s an idea. There are other options but you have to operate within the constraints you have (and I speak from personal experience as I’ve run into this same problem more than once) and get creative. Stop being irritated at what you can’t do and start getting curious about what you might be able to do.
4. Have you established benchmarks and measure against those regularly? All functional goals – return to running, golf, hiking, etc – have certain requirements. It might be that you need a certain mount of mobility or strength and how do you know if you’re meeting those requirements if you don’t measure against them?
5. Have you done your “mindset” homework? This might be the toughest part. Mindset is a way of thinking or an attitude and what I’m suggesting is that you craft your way of thinking about the problem rather than reacting to it. What I’ve found is that you have to accept the situation you’re in to get to the situation you want. And accepting the situation can feel like you’re giving up, quitting but if you refuse to accept things as they are, what will happen? Most of the time, you end up doing things that actually prolong the problem. You’re fighting it. Accepting where you are is not giving up. You’re creating a mental neutral zone. This makes all of the above steps easier.
6. And related to #5  – how’s your relationship with uncertainty? I can raise my hand on this one. I can’t control enough things. I want to make a mark where I am and then where I want to be and, of course, the shortest distance between two points is a straight line (graph 1 below). But guess what? Progress is a series of waves…up, down, up, down (graph 2). Instead of wanting everything to go a certain way, get comfortable with being less wrong tomorrow instead of always right. Stuff happens that will throw you off course. And this is why mindset is so important.

So, if you feel like your progress is too slow, run through the steps above. My guess is you’ll find at least one of them missing from your strategy.

Thanks for reading.

If you like this article, why not share it with a friend? If you’re interested in coaching services, please contact my colleague Laurie Kertz Kelly for a free, 20-minute Strategy Session by, clicking here. To get my Secret Weapon to fight knee, hip & back pain and stiffness, subscribe for free today.

Doug Kelsey has been a physical therapist and human movement expert since 1981. He is formerly Associate Professor and Assistant Dean for Clinical Affairs at the University of Oklahoma Health Sciences Center and the author of several books. He has conducted over 250 educational seminars for therapists, trainers, physicians, and the public and has presented lectures at national and international scientific and professional conferences. His professional CV is here.