I wanted to cry as I left home this morning. I crossed the threshold of my front door on the way to my car and felt tears well up in my eyes. Physical therapy (PT) again?

i want to be here

If I didn’t love all sorts of recreational activities like I do, I wonder if I’d keep showing up for these appointments.   The arduous process of rehabilitating my shoulder is teaching me at a personal level what I’ve known theoretically for years: functional goals are most predictive of successful rehabilitation or training. I don’t like spending up to eight hours a week doing the repetitive, narrowly focused exercises of PT.  But a vision of myself meditatively swimming laps at the Rose Bowl Aquatic Center or with the turtles in Hawaii keeps me inspired to show up even when it’s difficult.

PT is the most challenging exercise I’ve done in my life. The psychological and physical demands of recruiting nerves and muscle fibers to remember how to work is far more intense than training for the 100-mile bike ride of a Solvang century. I don’t breathe hard or sweat during physical therapy, but I do feel an intense straining of my brain as I try to extend my left arm in directions I used to take for granted.

Brain strain is also what people who’ve never enjoyed exercise experience when they attempt to begin a new fitness regime. It isn’t just the motor muscles that get activated in new ways. The brain must also lay down new neural pathways to support the movements and energy expenditure demanded by new modes of physical activity. Anyone who has struggled with exercise resistance knows that the key to rewiring our brains for new functions are more psychological than physical – requiring mental discipline, alongside physical effort.

choosing to show up again...and again...and again

When I strain to lift my arm a little higher or hold it in a difficult position a little longer, my mental focus is more important than the muscles doing the work. My mind must choose the effort demanded to lift higher and hold longer. If my mind isn’t on board, my muscles give up.

Neuroplasticity is the technical term for what occur when we use mental focus and discipline to learn new skills or develop new habits. As recently as the 1990’s neurologists were still being taught that adult brains were unable to change. But experimental and rehabilitative work with various conditions, especially stroke patients, has proved otherwise.

When my supraspinitus muscle sends “warning” signals to my mind in the form of pain, my brain is the conduit of communication. My mental challenge in that moment is to remember what I really want – a fully functioning shoulder. When I remember that this pain is therapeutic and stay with the discomfort, I’m reactivating old neural pathways that went to sleep during my months of inactivity. My mental vision of a fully functioning supraspinitus muscle strengthens the neural pathways of my brain designated for shoulder movement. The mental vision strengthens the brain muscles even when the shoulder muscles lag far behind.

Albert Einstein said that discipline is remembering what you really want. Whether you are awakening old neural pathways that have been offline for a while or building new pathways, keeping your focus on what you really want is essential.

I really want to fully rotate my left arm as I swim freestyle and backstroke this summer. One of my coaching clients really wants to walk the cobble stoned streets of old Italian cities without fear of stumbling or getting winded.

Exercising to lose weight or tone up in order to “look better” (whatever that is) in your swimsuit or wedding dress offers short-term, limited success. A functional goal of confidently swimming in the ocean with your children, nieces and nephews or grandchildren, or of effortlessly carrying your own suitcases up several flights of rickety stairs at an exotic island cottage on your honeymoon is more likely to produce long-term, sustainable behavioral changes.

What do you really want do be physically capable of?

What do you want to be able to do on your own power and strength in six months, one year, five, ten or twenty years?

What mental vision of yourself in motion do you hold as you face the brain strain necessary to strengthen your muscles and train your neural pathways?

What do you focus on as you face the therapeutic pain of your physical therapy or fitness training regime?

Remember what you really want and show up for your therapy or training appointments with yourself or a professional this week. You and those who want to enjoy an active life with you will be grateful that you did.