My Physio Gave Me Exercises. Do I Really Have to Do Them?

This is the question people most want to ask me and least like to ask out loud. It usually comes at the start of a second appointment, slightly sheepishly, with an admission that the sheet has been on the fridge untouched since we last met.

So let me answer it plainly, and then give you the nuance, because the honest answer is not a simple yes.

The short answer

Yes. For most musculoskeletal problems, the exercises are the treatment. Everything else I do — the assessment, the hands-on work, the explanation, the reassurance — exists to make the exercises possible and to make them the right ones. Physio exercises adherence is consistently linked with better outcomes, and I would be doing you a disservice if I pretended otherwise.

But that yes comes with three genuine qualifications:

1. You do not have to do all of them. If four exercises is unrealistic, two done properly beats four done never.
2. You do not have to do them forever. Most programmes have an end point.
3. If you are not doing them, the answer is not guilt. It is to tell me, so we can change the plan to one you will actually follow.

Why the exercises are the treatment

Tissue adapts to load. That is the entire mechanism behind musculoskeletal rehabilitation. A tendon becomes more tolerant because you loaded it progressively. A muscle gets stronger because you asked more of it. A stiff shoulder regains range because you took it there repeatedly. A back that feels fragile stops feeling fragile largely because you proved to yourself, over weeks, that it could handle things.

None of that can be done to you. Manual therapy, acupuncture, taping and machines can reduce pain and make movement easier in the short term, and I use them where they help. What they do not do is change the capacity of the tissue. Only loading does that, and loading takes repetition over time.

This is why the half hour you spend with me matters less than the ten minutes you spend on the other six days. I can only affect a small proportion of your week.

What actually happens if you do not do them

Not disaster. Usually something more frustrating: nothing much. Pain that improves during your appointment and returns by the weekend. Progress that stalls at the same point for a month. A course of treatment that ends with you feeling it did not really work.

Some conditions do drift the wrong way without work, particularly frozen shoulder, post-operative knees where range is time-critical, and tendon problems that quietly get more sensitive. But mostly the cost is time and money, spent on appointments that could not do their job.

Why people do not do them, honestly

In my experience it is almost never laziness. It is one of these:

Too many. A programme with six exercises, three sets each, twice daily is not a plan, it is a part-time job. This is my fault when it happens, not yours.

No time. Genuinely no time, particularly with shift work, small children or a commute across Merseyside that eats an hour each way.

Uncertainty. You cannot remember whether you are doing it right, and doing it wrong feels worse than not doing it.

Nothing seems to be happening. Two weeks in, the pain is the same, and there is no visible reason to continue.

It hurts. And nobody told you clearly how much discomfort was acceptable.

You simply forget. The sheet is on the fridge and the fridge has become invisible.

Every one of those has a fix.

How to make them actually happen

Cut the programme down. Ask me to give you the two exercises that matter most. I would far rather you did two consistently than nodded at six.

Attach it to something you already do. Calf raises while the kettle boils. Bridges before you get out of bed. Shoulder work while the adverts are on. Habits stick to existing habits far better than to good intentions.

Make it visible. A resistance band over the door handle. The mat left out, not rolled up.

Lower the bar on bad days. One set is not failure. One set is maintenance, and it keeps the habit alive until a better week.

Track it. A tick on the calendar or a note on your phone. It sounds trivial and it works.

Get it filmed or checked. A quick video review during an online consultation is often all it takes to fix technique and restore confidence, without travelling anywhere.

But it hurts when I do them

This is the single most common reason people quietly stop, and the fault usually lies with the explanation rather than the exercise.

As a general rule, discomfort during and shortly after rehabilitation exercise is acceptable if it settles within about 24 hours and is not building week on week. Working into moderate discomfort is safe and often necessary for tendon and arthritis-related problems.

What is not acceptable is sharp, catching pain, pain that lingers into the next day at a higher level, new swelling, or symptoms travelling further down a limb. If any of those happen, stop that exercise and tell me. We adjust it. There is almost always a version of the same exercise at a load you can tolerate.

How long before something changes

Longer than most people expect. Range of movement can improve within days. Strength changes take weeks, with meaningful gains usually appearing somewhere around six to twelve weeks. Tendon problems often need three months of consistent loading. Chronic pain problems improve on a similarly unhurried timescale.

Judging a programme after ten days is like weighing yourself after one salad. Give it six weeks before you conclude it is not working, and then tell me so we can change it.

When can you stop?

When you have hit the goal we set, and you have held it. For many problems that means the strength work eventually drops to a maintenance dose of a couple of sessions a week, often folded into general exercise rather than done as physiotherapy. For recurrent problems, some ongoing work is the price of staying well, and it is a reasonable price.

And please, tell me the truth at the follow-up. I have never once been annoyed that somebody did not manage their exercises. I have often been frustrated that they did not say so, because we spent the appointment progressing a programme that was never happening. A plan you will do beats a perfect plan you will not, every time.

If you would like a programme built around your actual week rather than an ideal one, book at /portal/book or call me on +44 7553 370300. I offer home visit physiotherapy across Liverpool and Merseyside at £90 a session and online video consultations UK-wide at £60, evenings Monday to Friday, plus Saturday and Sunday daytimes, and you can read more about how I work in Liverpool here.