We all have habits, things we do regularly. Some of them are annoying, but others keep us healthy.

We also make certain things a priority. We make time for them in our busy lives and place them in front of other activities.

Last, we create cultures at home, with friends and at work, in which we are able to accomplish the things that matter to us. In these spaces, we are free to express our wishes and desires.

But first, attitude

The biggest frustration for manual therapists, and we can definitely use back pain as an example, is understanding why patients do what they do, or don't do what they don't do. 

We could all be like librarians, bemoaning the fact that people keep moving the books. Wouldn't it be easier to keep the library running smoothly if people would just leave the books alone? Sadly, an attitude like this stymies the opportunity for change.

Instead, we need to promote new ideas, changes to lifestyle, additions to activity regimes, even modification of firmly-held beliefs.

That can be a tough ask.

Habits

Forming new habits gets discussed a lot. Some people say 8 times in a row, others say 18 days.

Brushing teeth is a habit we all have (I hope), and we bemoan our children for not yet having that unquestionable adherence.

Having a glass of wine with their dinner is a habit some people have. Let's not dig too deep into this, but we could easily debate the merits of it.

Spending hours on social media or playing computer games are other activities that become habitual, and again, let's not dig too deep, but when we see people avoiding necessary tasks to scratch their itch, it can frustrate those around them.

Priorities

Perhaps a good way to look at the balance of habits and pastimes is to think about priorities.

Patients often return to clinic for a follow-up and apologise for not having had the time to do all the things that were suggested.

To avoid conflict and a sense of being told off, we often turn the conversation to priorities. We might suggest that what they have not done is make the suggestions we offered a priority. Other items on the to-do list have been tackled sooner.

Spare a moment to think about the other person. It may well be that since our last meeting they've lost their job, started divorce proceedings and been looking after sick children. In such a case, fine! The priority list has been shuffled quite dramatically, we should instead look to support our patient, the person, through their reality.

The example is extreme, but looking at things from a perspective of priorities gives us a framework to question what takes precedence. It also allows flexibility.

Culture

Perhaps the more subtle topic here is culture.

A patient who is experiencing a downward spiral of symptoms because they can't get a good night's sleep thanks to noise from the neighbours or even other family members is in an unhelpful culture.

An office worker who is too afraid to stand up from their desk during phone calls to have a stretch since they fear being rebuked by their boss is in a toxic culture.

An amateur footballer who can't talk freely to their friends about their emotional struggles for a fear of being made fun of is sadly also in a negative culture. They are left to suffer on their own despite being surrounded by people.

Instead, we should all hope to live, play, and work in cultures where we are free to try new habits, alter our priorities, and creatively seek a better reality.

True friends don't judge. Good bosses create great cultures. Families stick together. 

Sadly, it's not always the case.