Habits and Physical Rehabilitation

March 21, 2023

95% of our life is automatic. We have over our life developed lots of mental programmes to do everything, from brushing our teeth, driving a car to how we interact with people and situations.

A central reason for this is that to learn to drive every time we got into a car would make driving difficult and even learning how to type or write and form words would drastically limit communication. So we have programmes or simply put Habits. Importantly Habits become refined over time so we react in the same way.

Now Habits are essential but, they are not always the correct for the task or situation. Habits tend to be categorised “Good” or “Bad” but they are repeated responses to a simple feedback loop and importantly can be changed.

We learn new habits very quickly and refine them with repeated use to be more efficient. Habits form in the same way constantly all of the time 1, Cue 2, Craving 3, Response 4, Reward (as shown in the diagram).

These are split into two phases: The problem phase and the solution phase. The problem phase includes the Cue and the Craving, and its when you realise something needs to change. The solution phase includes the response and the reward, and its when you take action and achieve the change you desire.

Importantly; all behaviour is driven by the desire to solve a problem, it could be something good and you want to obtain it or you are experiencing pain and want to relieve it! Either way, the purpose of every habit is to solve the problems you face.

1% Improvement per Day = 37 times better over a Year

1% or small habit changes due to the continuous improvement compound over time.

1.01365 = 37.8, This equation explains the power of small (one percent) daily changes over the course of a full year (365 days). If we make something one percent better every day for a year, we make it 37 times better.

However if we do not make a change we get 1% worse over a year 0.99365 = 0.03, no change and essentially making the negative 37 times more powerful.

But, why are habits so hard to change? Simply put "Latent Potential" or the valley of disappointment, we give up too soon!

For a habit to take hold it needs to be repeated, more repetitions and a more improved habit with permanent change. Initially we can get to point A reasonably quickly but still have to consciously do all of the elements. Support and focus get us to point B and been tenacious along with time gets us to point C a full habit change.

I work with lots of people who have lower limb issues, particularly, Plantar Fasciitis, Ankle issues, Knee Pain and Knee replacement which all require a new way of walking. This might be a small change like foot alignment or more commonly significant changes to stride length, knee bend, heel strike etc. To help people focus I set a six minute walk test where for six minutes they need to focus on the gait changes they have to make. I ask that they do this at least once a day. A typical change graph for walking is shown and the number of repetitions over time show improvement over time.

However rehabilitation is different as “pain” is usually involved so a change usually brings about relief so the change can happen faster as a desired outcome.

I tend to use habit stacking so break the skill down to get parts habit formed to build upon. In the case of walking I tend to start with foot alignment and heel strike first habit to learn or add. Then drive phase pushing from ball of foot with shorter strides to emphases the changes for more feedback then put it all together with longer strides as the previous two habits have been learnt.

I tend to start this walking at a agreed time with the person so they can also get in the habit of practice. It could be at a specific point in the day, pre work, lunch, or evening but the same time and location helps. I tend to advise home based movements in the morning while making a drink in the kitchen. Stretching or postural movements in the evening and six minutes in the day. This specific time location help with doing the activity and getting in the habit.

Key things to take away with rehabilitation and habits is that if you do nothing it will equal no change and over a year you are 37 times better at doing the same! If you work and persevere with the small changes and put the repetitions in for the movement change, not only pain free but also a permanent change to help prevent the issue happening again and needing treatment.

Habits and movements are in my 5 step rehabilitation process at step 4 and changes are reviewed in step 5 where progress is checked and re checked at step 1. That is how important movement change is in rehabilitation and ultimately habits.

For more information on my 5 step rehabilitation process and how I work schedule a Conversation call: HERE  

Or alternatively if you have a particular pain issue I have a Plantar Fasciitis Masterclass HERE and a Knee Pain Masterclass HERE with loads of help and advice 

About the author

Stephen Grinnell MSc Health and Rehabilitation
Pain and Physical Rehabilitation Specialist
Stephen has had his own Pain and Rehabilitation Clinic for over 11 years where he has treated well over 2500 people with lots of different pain and injury issues. Stephen’s personal physical rehabilitation journey started with a serious injury while on active service with the Royal Marines 25 years ago. This injury resulted in a long journey of complementary rehabilitation and two replacement hips. Stephen has developed his own bespoke treatment protocols using a variety of medical devices to help pain and inflammation resulting in accelerated recovery. Expert areas of focus are Plantar Fasciitis Treatment, Back pain issues particularly Lower Back and Sciatica and hip and knee replacement rehabilitation. Stephen previously had a successful academic career lecturing at a variety of Colleges and Universities in the Sports Science, Rehabilitation and Training areas. Stephen has also worked in The Queen Elizabeth Hospital Physiotherapy department during the Covid 19 Pandemic helping the recovery of COVID patients. In 2022 Stephen has been extensively researching and trialling protocols to treat plantar fasciitis. His Expertise has resulted in the successful treatment of 103 people and counting with a current success rate of 93%

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