What is the point of having goals?
As a physiotherapist I spend a large part of my clinical sessions with clients setting and working towards goals. When I say goals, I mean the client’s goals and not my goals for them as it is very easy as a clinician to assume and push your own goals onto the client.
Everyone’s goals are individual and relevant to their own situation and stage of injury, as well as their personal and social situation. In physio land we often talk about SMART goals. This is a mnemonic acronym which helps in the setting of objectives. The goals should be : Specific, Measurable, Attainable, Relevant and Time-based. So goals can vary widely and this doesn’t matter at all so long as they fit into the above criteria. For example a SMART goal for an 80 year old grandmother might be to reduce her back pain to a level whereby she can comfortably pick a grandchild up out of a car right through to an elite athlete wanting to improve his explosive speed out of the blocks in a 100m sprint to qualify for the Olympic games.
Having goals gives a human a purpose to work towards in achieving something important to them and without them we can easily lose focus and drive as well as have reduced mental health. Whether we achieve the goals set for us by ourselves is dependant on many variables including our own personalities, our mindset, mentors, friends and family to name a few. There are also other important financial, social and economic variables. Some people are motivated intrinsically (they don’t need others to help them as much along the way) and others are more extrinsically motivated and work better when others are around. It is important to recognise there is no right or wrong way to be, but more important to identify what works best for the individual.
From a personal perspective I have always been intrinsically motivated to achieve the goals I set for myself both personally, sporting and professionally and whilst I find it useful to have others there to help out, it isn’t essential for every goal I undertake. Easier yes but not essential. Whereas I look at my son who is very externally motivated and struggles to exercise or train unless he has his mates around him. That being said, the accident I had exactly 1 year ago whereby I fractured my right hip made me more appreciative of the influence others can have on helping to reach your goals.
The other thing with goals is that there can be short, medium and long term goals in place for an individual and indeed short term and medium term goals are essential for us to achieve the long term goals, as without them the thought of the long term goal can be overwhelming and seem insurmountable. Again coming back to my hip fracture, my long term goals or the 1 year goal I set myself was to be back on my bike racing at club level. The only problem with that was when I was at the 10 day mark post surgically and I couldn’t even roll over in bed properly this goal seemed almost unattainable, so I had to formulate some shorter term realistic goals that would allow me to tick small milestones along the way to the bigger goal of getting back to what I love doing.
The goal I set myself was achievable but it was achievable only because I also had input from my surgeon David Mitchell, who was monitoring the fracture progress along the way and giving me guidance as to whether what I was wanting to do was within the parameters of the nature of the fracture, the metal hardware he had installed and the degree of healing or deformity that had occurred (due to the fact that my hip shattered into 4 pieces I now have a shorter leg on that side and a completely different length of the neck of my femur). Every fracture heals differently depending on the individual and I can still remember David saying that he had done the best possible job he could putting me back together but now I was “in the hands of the gods”. Depending on how my body responded to the surgery, how much bone was laid down and how it was laid down were unknown quantities. As is often said though, it’s often best to try and control the things we can but you can’t control the uncontrollable.
So my short term goals included things like being able to shower independently without needing a shower chair, putting a sock on without one of the kids starting it as well as being able to walk with just one crutch instead of 2 at the 8 week mark. When your long term goal is racing a bike in a group at speeds of up to 50km per hour, just achieving some of these smaller goals helped but it felt like I would never get there.
Slowly as time passed though, every day would see a little change and improvement in my strength and hip function. Things that really helped were the words of encouragement and support from a person that had gone through 100 times more pain and suffering than myself and is still in daily pain but can ride his bike, albeit in a more limited capacity than he used to. Christian Ashby was an incredible inspiration and support and said to me to focus on those little things that then become the big things. So that I did. Starting with cycling with 1 leg on a chair and then progressing to 10 minutes with 2 legs and then slowly ramping up the pressure on the pedals indoors allowed me the confidence to finally get out on the road after 10 weeks. In the same manner that a few of the guys I ride with took Christian out on his first ride, the Lake Health Group cycling team took me out to help me get over the fear of that first ride on the bitumen. It wasn’t spectacular but I had achieved the goal and was thirsty for more.
The gym played and continues to plays a huge part of my rehabilitation journey. Just 2 weeks after the accident, I spent 3 to 4 sessions a week in the gym to work on my strength deficits and work hard on not punishing the non fractured leg. As physios we know the importance of finding the weak parts of the chain and trying to improve the strength discrepancies. Even now I spend the same amount of time in the gym and it continues to help me improve both my physical and mental health. Also as I’m not getting any younger I recognise that we all lose muscle mass into older age so unless you work on it the classic statement of “use it or lose it” really does apply. I’ll admit some days when the alarm goes off at 5am hauling my skinny white frame out of bed and going to the gym is the last thing I really feel like but that’s when focusing on my goals and knowing what I want to achieve really helps out. The same applies when I organise to meet some of my other training partners for bike sessions. Not wanting to let others down can also help enormously in motivating a person to get out of the house to exercise. I also subscribe to the theory that I can’t expect my clients to do their exercises if I don’t do mine!
So regarding my goals and whether they were reached. I can honestly say from the depths of my darkest days when I was hobbling around on 1 crutch to managing to start training with my team mates, I never thought I’d get back to racing at a similar (not the same yet) level to where I was exactly a year ago. Yes it has taken a lot of work, I’ve had an incredible support crew and network around me in work colleagues, cycling mates, family and friends that have made it possible. Sure I limp, I can’t run anymore and struggle to get out of a low car but my new normal is a lot better than I thought possible and so as I said the little things become the big things. I now will never take for granted being able to move freely and certainly can say I have a real understanding of what it’s like to walk in many of my client’s shoes.
So in a nutshell, setting goals that are SMART is hugely important in your rehabilitation journey and having a qualified professional help set those with you can help keep you on task and provide the help and support that you need to do things you initially thought may not have been possible. Make sure to set short, medium and long term goals and don’t worry if you have a few days where you struggle to get motivated. It’s perfectly normal to feel this way. Just focus on your goals and celebrate the wins and the things you have achieved, not focus on what you haven’t. Good luck and remember goals are hugely important to your success.
Michael Pierce
Sports Physiotherapist
Lake Health Group
