When the Rehab Plan Is Boring: Adherence in a Sprinter Nine Weeks Out
A 20-year-old sprinter specialising in the 100 m and 200 m suffered a grade 2 hamstring strain nine weeks ago and has been cleared by the team physician for a return-to-run progression. The plan requires three short prehab sessions weekly - Nordic curls, bridging, hamstring isometrics and sprint-mechanics drills - before the running progression can advance. In five weeks he has completed 6 of 15 scheduled sessions, and the progression has stalled at week two. He tells you the exercises are boring and that he will do them when it feels tight because he knows his body. His 100 m personal best is 10.62 s, conference is in nine weeks, he has two years of eligibility left, and he has mentioned that if he does not run fast this year he is done. He had a previous hamstring strain 14 months ago. His coach wants you to make it mandatory and sit him out until he does it.
1. Explain what is driving his non-adherence and why the coach's mandatory approach is likely to fail.
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This is a motivation problem, not a knowledge problem. He knows the programme; he is choosing not to do it. More information, a stricter tone or a laminated sheet will not fix an autonomy problem, and the coach's proposal - make it mandatory and withhold running - is a threat that buys surface compliance at the cost of the thing that matters: he has to keep doing this when nobody is watching, in season, next year.
Self-determination theory. Behaviour persists when it meets autonomy (I chose this), competence (I can do it and see it working) and relatedness (it connects me to people I care about). A mandate strips autonomy; invisible, boring exercises give no competence feedback; a coach-imposed programme gives no relatedness. The predictable results are rushed sets, skipped sessions and quiet disengagement once he is cleared.
The clinical stakes. A previous hamstring strain is the strongest single risk factor for another one, and the deficits that predict recurrence - eccentric strength, fascicle length, high-speed running exposure - are largely asymptomatic. I will do it when it feels tight is a misattribution: tightness is not a load gauge, and by the time it feels tight he has already lost the adaptation he needs.
The emotional context. If I do not run fast this year, I am done signals that the stakes feel existential. Confrontation raises defensiveness precisely when he is most threatened, and a defensive athlete hides symptoms rather than reporting them. That is the case for motivational interviewing, not a heavier hand.
2. Script the ten-minute conversation you would have with him.
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Open with permission, not a lecture. Me: Can I have ten minutes about the hamstring plan? I want to understand what is getting in the way, not re-read you the programme. Him: It is boring. I will do it when it feels tight.
Reflect rather than correct. Me: So the exercises feel like busywork, and you would rather respond to what your body tells you. Him: Yeah. And I have been fine.
Elicit change talk with rulers. Me: On a 0-10, how important is it to you to still be running in nine weeks? Him: Nine. Conference is everything. Me: And how confident are you that the current approach gets you there? Him: Maybe a four. Me: What would move it from four to six? Him: Actually doing the Nordics, probably. I know that is the thing.
Make the specific ask, built around his goal, not mine. Me: You have nine weeks. What are you willing to do - not what I want, what you will actually do - two days a week? Him: Ten minutes after warm-up, on the days I already lift. Me: Agreed. Two days, ten minutes, anchored to lifting. If you miss one we reschedule it rather than write off the week.
Close with a summary in his own words and a written plan. Reflect back what he said about conference and about the Nordics, confirm the two-day commitment, and put it in writing. Then follow up at the next session: attention is what turns an agreement into a habit, and an agreement that is never revisited quietly dies.
3. How do you restructure the programme and what do you agree with the coach, including how you would measure progress?
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Restructure around what he will actually do. Two 8-10 minute sessions a week anchored to existing lifting, rather than three separate visits. Keep the essentials - a progressed Nordic hamstring exercise, a hip-extension bridge, and sprint-mechanics work that is inseparable from his running progression anyway. That preserves the dose that matters while removing the scheduling friction he is genuinely resisting.
Make progress visible. He needs competence feedback: handheld dynamometry for hamstring strength and side-to-side symmetry, the Askling H-test before full-speed sprinting, and simple sprint-mechanics video. Show him the numbers monthly. An athlete who can see a deficit closing argues far less about the exercise that closes it.
With the coach, agree criteria rather than consequences. Write the return-to-sprint criteria down - pain-free progressive running, strength symmetry within roughly 10%, a passed H-test, no symptoms at high speed - and agree that progression follows those criteria. Explain that benching him as a sanction turns a medical decision into a bargaining chip, will not improve adherence, and may make him hide symptoms next time.
Escalate the right thing. If he still misses sessions after a month, raise it with the ATC and sport psychologist rather than adding volume or pressure. Persistent non-adherence in an athlete with a lot riding on the season can signal fear of re-injury, which is a different problem with a different fix.
Document. Record the agreement, the criteria, the measurements and the conversations, so that any later decision about his season rests on data rather than recollection.