One of the most common questions I get from my patients is “how long is it going to take to fix this?” in regards to how long it’s going to take for the ‘homework’ to do its magic. This is at the same time a simple and complicated question. It’s not really a matter (at least not entirely) of how strong or weak a muscle is in that it needs to be re-strengthened to make the pain and any dysfunctions go away. Instead we are teaching your brain to change its strategy for a certain ‘function,’ which means we are changing one of its’ established ‘movement habits’ to a new habit. Returning strength and endurance to a muscle may be an important part of its return to proper function, but the bigger part is effectively changing a habit and to do this we must show the brain that this new habit is one that is here to stay and convince it to have confidence in the specific muscles and tissues we have told it to use for this habit.

We’re all quite aware I’m sure that changing a habit can be really hard and consistency is the biggest aspect to making it stick. Your body is the same way. If a couple days a year it frosts over where you live and you have to very consciously think about how you walk to not slip, these ice walking skills aren’t really sticking around from year to year. If it was icy for a couple of months every year, do you think those ice walking skills would become better, more natural, and stick around from year to year? If we show the brain a new challenge but don’t show it that learning how to deal with this new challenge is important to accomplish and we will keep facing it, it won’t bother keeping the skills in its movement version of long term memory. This is why consistency is so important to a ‘speedy’ change in our movement habits and stopping the symptoms from dysfunctional movements. If homework is done sporadically without consistency, the brain doesn’t deem it something that it needs to hold onto.

On top of consistency/frequency, the number of times the body/brain is faced with a new or different challenge that requires it to behave different is also a crucial element to changing a behavior. The number that is oft quoted in the rehab world is that a movement needs to be done 3000 times to actually change a pattern/habit. I don’t know how exactly accurate this specific number is, but the idea it represents is big. If the habit (aka compensation strategy your body has chosen instead of the way of moving it was meant to use) is new, like right after an injury, it won’t take that long because it’s a habit that is still forming. If it’s been 20 years then chances are it will take a while! Consistency and frequency are going to be a big deal here to make the transition as complete and as quick as possible.

So the last part of this trifecta to talk about is that the biggest thing we’re really doing is trying to convince the motor control center (the part of the brain that decides how we actually carry out movement and posture) that it should have full confidence and trust in the methods we are telling it that it should use. This is why our homework is a carried out in such a specific way (and yes you can think goldilocks here with not too hot, not too cold) with exercises starting light but being done frequently and consistently. If we overdo the intensity, duration, or resistance, or use the wrong exercises, etc. then we will only reinforce the compensation. Let’s take a look at a metaphor to describe what I’m talking about (we all knew a metaphor was coming at some point in this article!).

If a patient is doing, say, release of the illiacus followed by corrective exercise for the same side psoas, but instead of going to their first fatigue and only executing a set or two, they go until the muscle is burning and they do 5 sets three times a day, then they are definitely over doing it! With our metaphor you’ll see why this is definitely not a productive approach: Let’s say you’ve been on maternity leave for some time, and come back to your job and are getting settled back in. If you’re still getting poor sleep (as happens often with new children!) or just aren’t caught up to speed with the changes that have happened in your job, your boss may not be confident in your ability to fully take over your old responsibilities. If the job is important and fast paced, it is all the more likely. If you mess up or get pushed beyond your ability to do the job when you return, especially if it’s over and over, your boss is just going to keep your temporary replacement doing the work because there really isn’t another choice.

So what is our body/rehab equivalent? We’ve taken your inhibited muscle and shown the MCC (your manager) that you are ready to come back to work, but if every time you go to use it, you over use it and with its lowered endurance/strength/neural connectivity, the MCC has no choice but to put a facilitated compensator back to work. If you take a previously inhibited muscle past its ‘confidence point’ it will be compensated for. This is why we start slow and don’t overdo things: we want to regain the MCC’s confidence to use that muscle in those patterns. By starting with lower intensity and duration we are able to get the muscle ‘back up to speed’ without blowing the confidence of its neurological manage and in the process get the strength and endurance back, and get rid of the related symptoms.

So back to the original question, how long is it going to take? As you probably guessed from the above, it really depends. It depends on how severe the original incident was, how long it’s been (the longer it’s been means the longer it’s going to take), how severe the compensations are, etc. The best thing we can do is be as consistent and exact with the homework as possible and keep progressing things as appropriate. I’ve seen some patients ditch their symptoms after our first session, some after a week of homework, and some after several weeks to find complete relief. This doesn’t mean their homework is done; changing such deeply entrenched habits can take some time, but the long term outcome can be profound and permanent change and improvement.

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