‘Akrasia’: The Physical Therapy Dilemma

I have been a consistent reader of Discover magazine for the last few years.  Often times, I read about advances in medicine and technology in Discover before reading about them in medical journals.  This was the case last week when I came across a great article “my own worst enemy.”  This article did not present a new drug or surgical advancement but instead discussed a very common problem faced in physical therapy…procrastination and lack of will. 


Let me highlight the story of the author, Christie  Aschwanden, to clarify the point.  She reports having a little pain in her knee when going down stairs or running long distances.  She visited a physical therapist who devised a home program to help alleviate her pain.  When she consistently performs the 15 minute home program she is able to run and perform stairs pain free.  When she neglects her exercises the pain returns.  Does this sound familiar? Christie used the term “akrasia” to describe this situation.  Akrasia is defined as the state of mind to act against one’s better judgement through weakness of will.  This is not isolated to the physical therapy field but is commonly studied in psychology.  In his book, Power of Habit,Charles Duhigg describes the human will as being prone to fatigue.  For instance, the act of making decisions, fatigues willpower so that at the end of the day, after fielding tons of questions at work, you lack the willpower to choose a salad over cookies and ice cream.  It takes willpower to make a healthy decision since there is no immediate reward.  The immediate reward of ice cream is sugar and pleasure.  The reward from eating the salad is the long term and less graspable reward of health.   This same principle holds true for physical therapy.  Sitting on the couch and watching Downton Abbey in your pajamas provides the immediate reward of comfort and entertainment while doing your planks and hip abductions provides little immediate reward.  Patients are often surprised when I state that getting other patients to perform their home exercises is challenging.  I love working with those classic “type A” personalities who do everything I tell them and achieve quick optimal results.  The reality…even among “type A” people, is that there are few who actually follow through on the home exercise prescription.   This is the dilemma of the physical therapist.  How can I motivate and educate patients to perform the exercises that are going to rid them of their pain?  Truth be told, exercising itself takes willpower so adding pain to that equation makes the mental hurdle that much higher.  

Tools to Fix Akrasia in Physical Therapy

Recently there has been an increase in websites and apps dedicated to help people stay on track to meet their goals.  Again, Discover magazine and Aschwanden highlighted some great tools to help with lack of willpower. These websites have found a way to make long term goals have more immediate rewards.  By having more immediate rewards, and consequences, you are more likely to stick with the plan and achieve your goals.

1. Beeminder.com

Beeminder is an online tool that helps you track progress towards a quantifiable goal.  For instance, your physical therapy exercises.  This is how it works.  You tell Beeminder that you want to complete 1 set of your exercises every day.  The program then will send you prompts to log your daily performance of exercises.  It can also link with your Fitbit and other devices for more seamless tracking.  As the website states, there is a “sting” for not completing your daily goals.  The consequence for lack of performance is financial payment based on your own contract you created with yourself.  When you start a campaign you decide what price you will pay for not achieving your goals. 

Beeminder has provided you with an immediate reward, not having to pay, and a long term reward of achieving your goals.  This tool could be a great way to be sure you finally end that low back pain that has bothered you at work for the last 3 months.

2. StickK

StickK is very similar to Beeminder.  This is also an online tool that allows you to pick a goal, track it, and set the financial stakes for missing the goal.  It also adds another dimension that has been proven successful at completing goals.  This program allows you to invite a friend to “referee” your submissions and track record.  This helps to keep you honest so you don’t just add data that is not true.  You can even invite friends to your campaign as support. 

This would be great if you are having a knee replacement or rotator cuff repair and you know a friend who is also having the same procedure done.  You can work together, track each other’s progress, and make sure your recoveries are optimal. 

3. Pact

This app provides a unique twist to the options above.  Once you set your goal you track it by taking photos of yourself or log your GPS information to authenticate your progress.  If you meet your goal you get paid!  The unique part is that you are paid by other members who had to pay because they did not meet their goal.

Solving the Physical Therapy Dilemma

Procrastination and akrasia is a part of the physical therapy profession.  It is not going to go away unless we find innovative and creative ways to change human psychology.  The profession needs to find ways to motivate patients to be complaint to achieve the results we know possible based on successful research.  By moving outside the traditional physical therapy avenues such as stick figure home programs and using services like Beeminder, StickK, and Pact we can help patients achieve great outcomes.  Additionally, we need to find a ways to make physical therapy fun and collaborative.  Programs like CrossFit are successful because they are fun, challenging, and competitive.  Hopefully these programs and others can trickle into the physical therapy world and help to motivate people to exercise and alleviate their pain. At Competitive EDGE Physical Therapy we understand the difficulty of sticking with fitness and health goals.  We offer private personal training that keeps clients accountable to their program.  Motivation often times comes after you decide to start on your journey.  We have helped many other people start and achieve their goals of weight loss and physical fitness.

If you are interested in finding out more about our private personal training you can contact call us 408-784-7167 or email kevin@compedgept.com

Don’t let “akrasia” stand in your way of feeling better.

By Dr. Kevin Vandi DPT OCS CSCS

Dr. Vandi is the founder of Competitive EDGE Physical Therapy — with his background in physical therapy, orthopedics, and biomechanics, he is a highly educated, compassionate specialist. Using state-of-the-art motion analysis technology and data-driven methodologies, Kevin has assisted a wide range of clients, from post-surgery patients to youth and professional athletes. When he isn’t busy working or reading research, he spends his time with his wife Chrissy and their five wonderful children, often enjoying the outdoors and staying committed to an active lifestyle.

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