CHANGE: The Most Difficult Word in Rehabilitation

Have you ever tried to get into better shape and incorporate the word exercise into your day?

Have you ever tried to lose – or gain – a few pounds? And change your eating habits?

Or, have you ever tried to limit the number of hours you watch TV – and do something ‘more productive’ with your time?

We have all had the experience of trying to get into a new routine or habit and make some type of change to our lifestyle.

Over time, we may not really get anywhere. So, we forget about it for a while, accept the fact that we will not change the situation right now – and move on – or perhaps try again at another point in time.

There is extensive literature on the Transtheoretical Model of Change (TTM)- and the different steps or stages people need to progress through in order to make some type of change to their lifestyle.

One example related to changing eating habits, to better control Type II diabetes could be:

PRE-CONTEMPLATION: What’s the big deal? So I have a little diabetes, am a little overweight and need to take medication.

CONTEMPLATION: Oh, you have diabetes as well? Is that why you are only having one beer and have not eating all the French fries on your plate?

PREPARATION: Well, maybe I should check out the information online about eating more healthily when you have diabetes – or perhaps it would be better for me to meet with a dietician (I feel a little overwhelmed about interpreting all  this information).

ACTION: Eating like this is not really so bad. I think I will start walking around the block several times a day too.

MAINTENANCE: I am feeling better – but I know I may go back to my old ways. I have joined a group of people with diabetes that are in my age group. Meeting with them weekly as we take our walk and share ideas helps keep me on track.

TERMINATION: Yes, it has taken several months, but I now feel better, look better and am finding this new routine enjoyable. My doctor has told me I can reduce the amount of prescription medication I take. Maybe, I won’t have to take any medication for diabetes one day.

The process of change – TTM – is the work a person does to progress though the stages of change .

A person’s motivation to change becomes an action.

But, what if something happens that forces you to change your routine – and your life – immediately?

  • You are involved in an accident and cannot return to work, take care of your young children, or do your household tasks.
  • You develop a medical condition that forces you to take prescription medication that has some annoying side effects, and you must stop doing many of the things you did all the time.
  • Your recovery from surgery is much longer than expected and causes extreme worry, financial hardship, and intrusive visits from home health personnel.

CHANGE is the most challenging word in the Rehabilitation environment.

It does not follow the TTM Model exactly since there is no time to process and progress through one stage to the next. There are times when a change has to be made immediately.


Health providers and exercise personnel can often see or know from experience what their patients/clients need to do to recover or return to their daily routines.

As they observe and assess their new client, health providers  may be thinking:

  1. My new patient has a traumatic amputation as a result of an injury at work

“The femur amputation is at a good distance from the hip. In time, he will be fitted with an above knee prosthesis and he will be eventually be able to do all the thing he did before the amputation.”

  1. My patient has finally had her headaches diagnosed.

“She has been properly worked up for a migraine diagnosis and is taking new medication. I can teach her some relaxation exercises and mindfulness techniques and she will be in better control of her headaches.”

  1. My patient/client has sustained a concussion when she hit her head against the steel wall beam when she fell. She was dazed for a few minutes.

“The new concussion guidelines state that we should not limit ‘quiet time’ for more than 48-72 hours post injury before encouraging the patient to re-engage in their regular activities. But this patient fell 8 months ago. Should I just  encourage her to get back to participate in all the things she did before- or should we take it step by step?”


Change – our ability to modify our outlook on life, our ability to manage life’ with all its stressors is a very individual process.

Some people can do better at it than others.

People working in different occupations may not have the same options to take time off work.

A sudden change can create significant problems with the people in our lives –partners, spouses, children, friends, work mates. And there may be additional strain if there were already challenges with these relationships.

Yet another unseen challenge (especially if you cannot see the physical/medical problem) is the ability to ask for help – not only from your health providers, but also from family and friends.

These are challenges for many of us. We are quick to help others but being on the receiving end can often be interpreted as being weak and unable to take care of ourselves and our families.


It is incumbent on good health and exercise providers to assess patients’ injuries/problems thoroughly while they are also getting to better know and understand what their patient is feeling, thinking, and experiencing.

Not everyone learns the same way. Not everyone has the ability to implement a change to their lifestyle quickly.

Working on small, manageable goals, with adequate explanation, education, and reinforcement will enable both provider and patient to establish a realistic pathway for recovery and rehabilitation.

The rehabilitation pathway may not progress in a straight-forward manner – there are likely to be bumps along the way. The end goal is to enable you to be as realistic, confident, and independent as possible, in spite of the many challenges and changes that have occurred.

Homework: Developing S.M.A.R.T. goals

S specific

M measurable

A achievable

R realistic

T timely

The next blog on Don’t Go to the Ouch! will  focus on goal setting.

A useful way of working on CHANGE  step by step, and for any reason.