Physio homework is a different problem

You left the appointment with a sheet of exercises and every intention of doing them. You did them for four days. Then the appointment was three weeks away and the sheet went into a drawer, and now there’s a follow-up on Thursday and you’re considering doing a concentrated week of it beforehand.

This is the most common adherence failure there is, and it’s not the same failure as abandoning a routine you invented yourself. A prescribed routine fails for reasons that are specific to having been prescribed.

Why a prescribed routine is harder to keep than one you designed

You didn’t design it, so you don’t know what’s load-bearing. With your own routine, you know which parts matter to you and which were optional. With a sheet of six exercises you have no such map, which means you can’t shorten it intelligently — the only options that present themselves are all of it or none of it, and on a bad day that resolves to none. The information you’d need to make a smaller version is in someone else’s head.

Doing it is a reminder of the thing that’s wrong. This one is underrated. A routine you chose is associated with getting better at something. A prescribed one is associated with the shoulder, the knee, the back — the reason you had to go. Every session re-raises it. That’s a small daily cost that a self-chosen routine simply doesn’t carry, and it accumulates.

The reward structure is inverted. Your own routine, if it works, you keep. A prescribed one, if it works, you stop — discharge is the goal. So the routine is framed from the start as temporary, which means no part of you is building it into your life permanently. Then the pain settles down, which reads as permission, and the routine ends before the course does.

It arrives as an obligation, from an authority, with homework framing. Whatever your relationship with being set homework was at school, it’s still in there. Obligation produces compliance while someone is watching and very little between appointments, which is where all the sessions actually are.

It’s usually genuinely dull, and dullness is not negotiable here. Your own routine you’d have adjusted until you could stand it. This one you can’t, or shouldn’t. So the ordinary remedy for boredom — change something — is unavailable, and that’s a real constraint rather than an excuse.

The one thing not to do

Don’t quietly redesign it. Shortening, dropping the boring one, halving the sets, doing it every other day because that feels reasonable — all of these are decisions about clinical content, and you don’t have the information to make them. You’ll also then have no idea what the resulting routine represents, which makes the follow-up appointment useless.

The correct move is to make the same change out loud, with the person who wrote it.

Take the adherence problem to the appointment

Clinicians know the compliance rate on home exercise is poor. They will not be surprised, and being told what actually happened is more useful to them than being told what was supposed to happen.

Four things worth asking for explicitly, because they’re rarely offered unprompted:

A minimum version. “I can’t reliably do all six. If I could only do two, which two?” This is the single most valuable question available to you, because it converts an all-or-nothing routine into one with a floor. Most clinicians can answer it immediately.

What to do on a bad day. Not skip — the reduced instruction. Ask what “the smallest thing that still counts” is for your case.

Which parts are time-critical and which aren’t. Some things matter early and stop mattering; some are maintenance. If you know which are which, a missed week means something specific instead of being uniformly alarming.

How long, honestly. “Until it settles” is not a duration you can plan a habit around. A rough horizon lets you decide whether you’re building something for three weeks or three months, and those are different designs.

THE RULE — before you change a prescribed routine

  1. Never alter its content on your own reasoning. Not the
     movements, not the reps, not the frequency.
  2. If you're not doing it, say so at the appointment, in those
     words, before they ask.
  3. Ask for the minimum version and write down the answer.
     That answer, not the full sheet, is your bad-day routine.
  4. Any change to what you do → comes from them.
     Any change to when, where, or what triggers it → yours.

That last line is the whole division of labour. The content is clinical. The scaffolding — cue, placement, floor, tracking — is entirely yours and is where all the adherence lives.

The scaffolding half, which nobody prescribes

Nobody hands you a sheet with “attach this to something that already happens daily” printed on it, and that omission is why the sheet ends up in the drawer.

The sheet does not get filed. Filing is a terminal act. It stays somewhere physically inconvenient and visible, and the mild untidiness is doing work.

It needs a cue like any other routine. The appointment is not a cue; it’s a fortnightly event and you need a daily one. Attach it to something involuntary that happens whether or not you feel like it.

Track it coarsely, and bring the record. A row of marks answers “how’s it been going” with a fact instead of an impression, and impressions in this specific conversation are systematically optimistic. A single mark per day is enough.

Don’t cram before the appointment. It corrupts the only feedback loop in the system. They’re assessing how the tissue responds to a certain amount of loading; if the loading was a panic week, the assessment is about a week that isn’t representative of anything.

What this costs

Asking for a reduced version may mean a slower course, and it may mean the clinician says no, this one is the minimum. That’s a real answer and it’s worth having, because then you know that skipping isn’t a cheap decision — which is different from not knowing.

Being honest about non-adherence also feels like admitting you didn’t do your homework, and briefly it is exactly that. The alternative is a course of treatment being adjusted on the basis of a fiction, which is worse for you and wastes the appointments you’re paying for.

What this doesn’t fix

None of this addresses whether the routine is the right routine. That’s not something this site can speak to, and second-guessing it from the internet is how people end up doing something inadvisable with confidence.

And if the exercises hurt in a way that seems wrong rather than merely uncomfortable, that isn’t an adherence problem at all and no amount of design will make it one.