Nobody does their homecare

I'll be honest with you about something I'm not particularly proud of.

There was a period in my practice where I basically stopped trying.

Not outwardly. I still showed up. I still did the work. But somewhere along the way I had gotten so tired of giving people detailed homecare plans and watching them do absolutely nothing with them that I quietly gave up. I stopped putting the effort in. I figured it didn't matter anyway. They weren't going to do it. They never did.

I was bitter. Genuinely bitter. Toward my clients.

Week after week the same people would come in expecting me to fix them, and week after week I'd send them home with stretches, with exercises, with instructions, and week after week they'd come back having done none of it. And instead of asking why, I just decided they were the problem.

It took me an embarrassingly long time to realize I had it completely backwards.

The homecare wasn't the problem. The instructions weren't the problem. The problem was something so obvious I can't believe it took me as long as it did to see it.

Nobody likes being told what to do.

Not your clients. Not you. Not me. Nobody.

When someone else hands you a list of things you're supposed to do, it doesn't matter how clinically sound the list is. It doesn't feel like yours. And things that don't feel like yours have a way of sitting on the counter, or in the notes app, or somewhere in the back of your mind labeled "I'll get to that" until they quietly disappear.

But when something is your idea? When you've decided you want it? You don't need a list. You don't need reminding. You just do it.

I watched this play out in my own recovery after I broke my ankle (you can read the full story here if you would like). For months I ground through homecare because I was supposed to. Then the goal shifted. I stopped thinking about managing pain and started thinking about getting back to something I actually missed. And I never missed a day after that. Same exercises. Completely different relationship to them. Because they were suddenly in service of something I wanted, which made them feel like my choice, not my homework.

The homecare didn't change. The meaning behind it did.

Here's what frustrates me.

I taught in colleges for years. I watched curriculum built almost entirely around what to do with your hands. Assessment, technique, protocol. And none of it was wrong exactly. Those things matter. But somewhere in the thousands of hours of training we put practitioners through, the question of how to actually get a client invested in their own recovery never came up.

Not once.

CE workshops aren't much better. We teach more assessment, more technique, more complex protocols for chronic and difficult conditions. Which is fine. Except a practitioner can have the best treatment plan in the room and still watch their client make zero progress, because the client walks out the door, goes home, and does nothing. And nobody ever taught that practitioner why. Or what to do about it.

We mumble something about drinking water and stretching and we call it homecare. And then we wonder why people don't get better.

The truth is that the on the most important things happening in a treatment relationship has nothing to do with what's happening on the table. It's whether the person on the table has a reason to participate in their own recovery. A real reason. Something that matters to them, not to you.

Find that, and the homecare takes care of itself. Miss it, and it doesn't matter how good your technique is.

I learned that the hard way. Through bitterness, through pulling back, through my own injury.

If this landed for you, hit reply. I'd genuinely love to know what comes up.

Best, Dr. Jess

P.S. This is the thinking behind the treatment philosophy I'm building into my in-person workshops this year. If you want to know when those are available, reply with "workshops" and I'll make sure you're on the list.