GOAL!

What you perceive today as a struggle is not truly due to the task at hand. It has to do with what the goals of the activity are.

The goal determines how the steps will play out. A worthy goal can bring you through any tough time. If the outcome is not of interest to you, no simple/light task is easy. It's all a struggle if the goal is not meaningful.

Applied daily to your physical therapy practice, this simple concept has repercussions far and wide.

There is a large population that has trouble with this aspect of care. The goal is to be pain free, and past that... their "goal" is to be pain free while doing... well, they don't do anything anymore because of the longstanding pain. So, yeah. It would be nice to complete... Activities of Daily Living a little better. That's as much as you get.

From this we ask limitations, such as "how far can you walk before it hurts?" "one block" they say. So we make a goal to walk 2 blocks, or something more than they do now. We have confused this with a "goal." This may be an increase in activity, but it is not a "goal."

From here movement hurts and there is often little tolerance to the pain of movement. As we know, the goal is not theirs, and not big enough to encourage the struggle that it takes to succeed. It's not a blame thing, as in "why don't you have better goals?" It's just how it is.

We learn about S.M.A.R.T. goals and how that makes a goal a meaningful contribution to the patients chart and recovery, however, if a goal is not bigger than the task of moving through difficulty, then the treatment will fall short. Whether it be hip strengthening to reduce that trendelenburg gait or performing neck ROM drills frequently to reduce tension in movement... without an important goal, you won't get the effort, the struggle.

And there is beauty in the struggle. Value in the struggle. It's what great stories are made of.

Putting 200 lbs on your back and squatting hurts... unless you are invested in the strength outcome. Doing a supine lower trunk rotation hurts, unless something greater is awaiting you at the end. Then that "hurt" gets allocated to a different place.

The pain of destruction is different than the pain of progress.

For that certain population subset; make finding goals a bigger part of your initial treatment. Don't skip over that part lightly. Help find a goal worth working for... and there will be reward for the struggle.

-Matt Dancigers, DPT

Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!

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