The Hidden Challenge of Physical Therapy Adherence
As a doctor of physical therapy, I see it all the time—patients come in with low back pain, eager to feel better, but a few weeks later, they’ve stopped doing their prescribed exercises. Some drop out of physical therapy (PT) altogether.
It’s frustrating, both for patients and for those of us trying to help them. We know that exercise-based PT is one of the most effective ways to reduce back pain, restore function, and prevent future issues. But the reality is, many patients don’t follow through. In fact, a study found that only 43% of patients adhered to their prescribed PT plansThat means more than half of people struggling with back pain aren’t giving their bodies the best chance to heal.
Why does this happen? More importantly, how can we fix it? Let’s break down what the research says about PT adherence, the most common barriers, and simple strategies that can help you stay on track.
Why Do Patients Quit Physical Therapy?
If you’ve ever found yourself skipping exercises or dropping out of PT, you’re not alone. Research shows that there are several common reasons why patients don’t stick with their programs.
1. Pain and Discomfort
Many people assume that if an exercise hurts—even a little—it must be making their condition worse. But this isn’t always true. Some discomfort is normal as your body strengthens and adapts. Avoiding movement out of fear can actually prolong your pain.
2. Lack of Motivation and Slow Results
It’s natural to want quick relief, but PT is about long-term healing, not instant fixes. Many patients lose motivation if they don’t feel dramatically better within the first few sessions. However, research shows that consistent exercise is one of the strongest predictors of long-term pain relief.
3. Busy Schedules and Life Responsibilities
Between work, family, and other commitments, it’s easy to push PT to the bottom of your to-do list. Long treatment plans that require multiple appointments per week can feel overwhelming, leading many patients to quit before they see results.
4. Lack of Guidance and Accountability
Many patients struggle with staying consistent outside of their PT sessions. If you’re not sure you’re doing an exercise correctly—or you’re not seeing immediate benefits—you might lose confidence and stop altogether. Studies show that patients who lack proper supervision or follow-up from their therapists are less likely to complete their programs.
5. Psychological Barriers: Fear, Anxiety, and Doubt
Fear of pain, fear of reinjury, or even self-doubt about whether therapy will work can all impact adherence. Depression and anxiety can also reduce motivation and make it harder to stick with a structured exercise program.
What Helps Patients Stick to Physical Therapy?
Now that we know why people struggle with PT, let’s talk about what actually works. The good news is that research also points to clear strategies that improve adherence.
1. A Strong Patient-Therapist Relationship
One of the biggest predictors of adherence is having a supportive, engaged physical therapist. Patients who feel their therapist listens to their concerns, personalizes their exercises, and provides encouragement are more likely to complete their program.
2. Education and Pain Reframing
Understanding that movement is safe and necessary is key to overcoming fear-avoidance behaviors. Research shows that patients who receive clear explanations about their condition and how exercise helps are more likely to follow through.
3. Setting Clear Goals and Tracking Progress
It’s easier to stay motivated when you can see your progress. Setting small, achievable goals—like improving flexibility, walking longer distances, or reducing pain levels—can keep you engaged. Using an exercise log or tracking progress with your therapist can also make a big difference.
4. Social and Family Support
Patients who have support from family, friends, or a therapy group tend to have better adherence rates. Whether it’s a spouse reminding you to do your exercises or a friend joining you for a daily walk, having accountability partners makes a difference.
5. Making Exercise a Habit
The best way to ensure you stick with your PT exercises? Integrate them into your daily routine. If you make stretching part of your morning routine, or add core exercises while watching TV, you’re more likely to stay consistent.
The Bigger Picture: Why Adherence Matters
The truth is, physical therapy only works if you stick with it. When patients quit early, they’re more likely to:
- Experience chronic pain that lingers for months or years
- Rely more on medications (including opioids) to manage symptoms
- Develop worse mobility and reduced function
- Need more invasive treatments, like injections or surgery
On the flip side, patients who complete their PT programs are more likely to:
- Reduce their pain levels over time
- Improve mobility and strength
- Regain confidence in movement
- Avoid unnecessary medical interventions
Following through with PT isn’t just about temporary relief—it’s about building a foundation for long-term health.
Fixing the Adherence Problem
If you’ve been struggling to keep up with your physical therapy, you’re not alone. The key is to recognize the barriers, find the right support, and create habits that make it easier to stick with your program.
- If pain is holding you back, talk to your therapist about modifying exercises.
- If motivation is an issue, track your progress and set small goals.
- If life feels too busy, find ways to incorporate PT into your daily routine.
Physical therapy is one of the best tools we have for long-term back pain relief, but it only works if you commit to it. If you’re feeling stuck, let’s talk about how we can adjust your treatment plan to make it more manageable.
Because at the end of the day, your health is worth the effort—and I want to help you succeed.
Reference
Shahidi, B., Padwal, J., Lee, E., Xu, R., Northway, S., Taitano, L., et al. (2022). Factors impacting adherence to an exercise-based physical therapy program for individuals with low back pain. PLoS ONE, 17(10), e0276326. https://doi.org/10.1371/journal.pone.0276326
