The Count of Monte Cristo and the Home Exercise Program

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Scene from the motion picture, “Count of Monte Cristo” 2002.

“Probably, if ever I get out of prison!”

“True,” replied Faria, “we are prisoners; but I forget this sometimes, and there are even moments when my mental vision transports me beyond these walls, and I fancy myself at liberty.”

-Count of Monte Cristo, Alexandre Dumas

 

Recently I dug back to a book I should have read in high school to provide motivation, context, and ultimately a model for the mentality necessary for a patient who was struggling to accomplish his prescribed exercises outside the clinic.  Yes, we physical therapists prescribe exercises.  There are no “quotation marks” there because we actually DO prescribe exercise.  The activities are specific to the person they are given to, with the recipient’s goals, physical condition, age, and past medical history all taken into careful account.  The dosage of exercise is dialed in with exactitude based on multiple factors and then titrated up or down based on the patient’s response.  Sounds a lot like medication prescribed by a physician – only these exercise prescriptions do not come in a red, plastic bottle from the corner drug store.

This particular patient was a typical man in the thick of adulthood, juggling a very full plate of professional and family obligations.  From what I gather he works very hard in front of a desktop computer for most hours of most days of nearly every week in a year, in order to provide a comfortable home and life experience for his wife and children.  Given this scenario, he typically leaves very little, if any, time or energy for himself.  How selfless, you say?  It’s the American Dream, eh?  Well, actually,  this all-too typical pattern resulted in weak, painful, and dysfunctional shoulder joints.

After evaluating this patient and working some manual therapy magic on the shoulder and its neighboring joints, this patient’s pain symptoms were 75% improved.  He had notably greater range of motion in his shoulder during the very first visit in the clinic.  But he still had a longer road to walk before this problem would completely resolve.  Enter the Home Exercise Program!  I prescribed this gentleman a concise list of exercises to be performed on his own time once daily – outside of the days of his two physical therapy visits per week in the clinic.  These exercises would take a total of 15 minutes to perform – we actually timed them in the clinic.

You might think that this gentleman would achieve a state of zero pain and fully recovered function in the shoulder within two to four weeks, given his particular body condition and general health history.  But there was a barrier to progress.  The barrier was that he could not find the time to perform any of the prescribed exercises on his own.  The 2 physical therapy visits per week in the clinic were the only devoted time his injured shoulder received–2 hours of treatment in a week versus 166 hours of neglect.  He explained to me that he had no time, and if by chance he did find time he had little energy, so that he could only get in the first few exercises, but not finish all of them.   “What’s the use?” he said.  This fellow needed some perspective.  He needed to learn from Edmond Dantes and the Abbe Faria.  Enter the Count of Monte Cristo, written by Alexandre Dumas!

This book is a classic adventure novel – expertly written by Alexandre Dumas in 1844.  It is set in France, Italy and various islands of the Mediterranean Sea.  In this literary work, the protagonist Edmond Dantes finds himself wrongfully accused of treason during Napoleon’s exile. He is subsequently imprisoned.  Without giving away the entire plot (you really should read it, or at least watch the movie), know that Dantes meets the amazing character, the Abbe Faria in the adjacent prison cell.  The Abbe, said to be an insane, elderly, Italian priest, teaches Dantes to take control and sharpen his mind as well as prepare himself physically for his eventual escape.  At first Dantes resists the very idea that there is hope of escape.  But later, he learns to take hold of the only things he has any control over while in prison–his mind and his body.  In this control he was able to find a sense of freedom.

 

“[U]ntil the day when God will deign to reveal the future to man, all human wisdom is contained in these two words,—‘Wait and hope.’”

 

Through some opportunistic counseling and discussion of this story with my patient (people tend to hear better when they come to the end of their patience with pain) he began to understand that in some ways his busy career man/super-dad schedule was like Edmond Dantes’ prison.  He had very little wiggle room.  If he wanted to continue to function well at his job and at home, he needed to have both shoulders working appropriately.  He needed to reclaim small, seemingly unusable periods of time (the in-between time in the schedule) so that he could become stronger and more robust, so that he could come through for his family.  They depend on him.  He needed to invest in himself for them.

Together we found that he could use part of his lunch hour (which he usually used to eat at his desk while answering emails) to perform his prescribed exercises.  We tweaked the activities such that they could be readily performed in his office.  After a week he saw such significant improvement in his shoulder symptoms that he decided waking up 20 minutes earlier in the morning was worthwhile, so that he could complete his exercise program with no disruption to his rigid schedule.  This patient went from feeling hopeless to feeling empowered – such that he began making time to do the exercises.  Making time–that’s some true alchemy!

When this patient returned to the clinic after making his new 20-minute movement practice a habit, his face had the look of confidence that comes after a victory, rather than the hopelessness of repeated defeat.  He shared with me how he never realized how effective and efficient he could be with only a handful of exercises.  What he had discovered was the ageless axiom that consistency reaps valuable results when applied over time.  This is true in nearly every corner of our existence.  This patient has now moved on from rehabilitative exercises to performance training exercises.  This is the realm beyond recovering from pain – delving into the rare art of moving well.  He was able to begin building additional reserves of usable strength and work capacity that will continue to serve him by making him more resilient and resistant to pain and dysfunction.  In the end, he overcame his shoulder pain by breaking out of his perceived prison.  

This story is certainly not unique.  We all tend to get caught up in the throes of our work and life demands.  Adding one more thing – committing to taking better care of ourselves – can certainly seem daunting.  However, as demonstrated in this case, it is absolutely possible to achieve positive change even in challenging circumstances. So take heart from this example, and If you find that you are having difficulty getting past an obstacle to feeling and moving better – come and see us at Symmetry Physical Therapy.  We’d be happy to assist you in achieving liberty of movement!

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