Be a rowboat.

🎧 Sailboat or Rowboat: Motivation vs. Discipline in Rehab

In this episode of the Talking Rehab Podcast, I explore a powerful analogy I shared with my kids: are you a sailboat or a rowboat? Sailboats move when the wind (motivation) shows up — but rowboats move when the person rowing decides to act, regardless of external forces. This concept becomes incredibly relevant in rehabilitation.

I dive into how discipline, not motivation, is the more reliable path forward for those dealing with chronic pain, musculoskeletal conditions, or slow progress in recovery. I talk about the dangers of waiting — for the right diagnosis, perfect treatment, or ideal circumstances — and how that delay often leads to greater pain, disability, and missed opportunities.

We also look at common reasons patients hesitate to act: fear of disappointment, lack of instant results, or waiting for specialists. I share why investing consistent effort — even in imperfect conditions — often yields the best outcomes.

Whether you're a patient, clinician, or someone navigating your own recovery journey, this episode is a reminder that progress is possible — but it starts with you picking up the oars.

⏱ Timestamps

• 00:33 – Parenting, motivation, and the "sailboat vs. rowboat" analogy
• 01:50 – Motivation is fleeting; discipline is reliable
• 04:04 – How discipline applies in rehab settings
• 06:00 – The risk of waiting for ideal treatment conditions
• 07:07 – Why pain, disability, and disappointment increase with delay
• 08:44 – The long referral cycle for musculoskeletal patients
• 10:00 – Understanding the fear of trying and failing
• 11:21 – Short-term vs. long-term treatments: a warning about quick fixes
• 13:00 – The emotional cost of waiting too long
• 15:01 – Muscle loss, missed life events, and poor conditioning from delay
• 16:01 – Final thoughts: build discipline, don’t wait for perfect timing

🎯 Call to Action
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Transcript

0:00

What is rehab or rehabilitation? My name is Fred, be Garris, a board certified sports and spine medicine physician in Virginia Beach, Virginia. After 10 years of practice, I still find musculoskeletal medicine both fascinating and challenging. I. This podcast is about the lingering thoughts and questions I've had after residency and fellowship. My hope is to spark discussion, challenge, dogma, and share my experiences in musculoskeletal medicine. Welcome to The Talking Rehab Podcast. I. I am the father of 18 and a tween, and my daughter and son. They are fortunately, very, they're great kids, they really are. my wife and I are truly blessed, to have such great children. That being said, I am no stranger to lecturing my children. And as we, if you're a parent out there, you get always know exactly what I'm talking about. No matter what we tell them, they consistently, need a lot of reminding they don't do what they're told. They come up with every excuse in the world to not do something. So I was talking to both my children the other day about, Essentially, what about motivation and discipline? And I use this analogy, of are you a sailboat or are you a rowboat? And I'm not by any means, have any experience on the water. Those are just purely analogy and in my mind, a sailboat does not. rely on the power of the person. It's mainly the wind, essentially. So whether or not I'm right or wrong, just let's just go with it. So sailboat needs wind. A rowboat doesn't necessarily need wind. It is, powered by, two oars. Again, let's, for this particular analogy, and Essentially, I came across this analogy to differentiate the diff the difference between motivation versus discipline. Motivation for me is like wind. it's great when it's there, and it can help move you forward, but when it's not there, what happens to the boat, So motivation can be anything from, Achieving a certain goal, weight loss, and again, from a rehab standpoint, decreased pain. getting back to activities that we love. Maybe even fear. Maybe fear or it can sometimes be a motivation. But I'm not a big fan of waiting to have motivation because at least in my experience, motivation. It comes and goes when it wants, and it doesn't always help someone who is trying to re rehabilitate themselves essentially. But in the analogy with my kids, I'm trying to encourage them to, do their chores around the house, study, things like that. And they always wait for motivation. waiting till the last minute. For a big test. they wait for motivation coming by me reminding them or getting in their ear. That's, that to me is also, a form of motivation. But I try to emphasize, trying to be a rowboat, someone that truly has control over when, where, and what direction the boat moves. Then in this particular case, you do not need. Any motivation to do something. So I equate this to what Discip discipline is. Discipline is definitely an excellent tool for life, but especially in the rehabilitation space because it is something that you can do every single day. You have complete control over that particular component Again. There are certain things in life and certain things in rehabilitation that we can't control. Sometimes we can control pain. Sometimes we control the function of the limb. Sometimes we can control strength. But if you have a stroke, you have a spinal cord injury, you have, poor proprioception, from like a peripheral neuropathy, there's only certain things that you can control. If your parts don't work the best, you have to find other ways to stay moving forward in your rehabilitation journey. And I find that, patients in particular, Needs certain conditions to be met. their pain has to be completely controlled. The diagnosis has to be confirmed. or the treatment has to be quick and easy and or sometimes the treatment has to be the right time, And. Relying on conditions to be there is like waiting for motivation to show up. And in my experience, when you have an injury or a chronic condition, time is of the essence. It would be great if all those conditions are met so that you can con so that all of those painful points. That are getting in the way view moving forward are better managed. But the reality is that a lot of musculoskeletal conditions do not have definitive diagnoses, may have a variety of treatment options, all of which may or may not work because everybody is a little bit different and not all treatments, even the best ones or. are necessarily covered or affordable? for the average person. Those are some conditions that I run across in the clinic and I try to encourage people to look at other options, but I understand, it's great when things are going your way. It's great to want things to be a certain way, but there, but again, life is the way that it is. It's just not that way and discipline. being a rowboat is the way forward no matter what the conditions are. I think it's kind of a mental block that a lot of us have is that we can't make progress unless, and, unless this condition's met, or this is there or this is that. I think that's, that holds a lot of people back in their overall recovery. What's the harm in waiting for the perfect condition, number one, it can increase the pain. We know from study standpoint that people who are in pain for longer periods of time, they tend to have higher levels of pain and lower baseline levels of pain. We know that it also goes along with increased disability, so meaning that when people become. Less active as a way to manage their pain. they are physically able to do less for themselves, but they also develop other side effects. They get weaker, they get joint contractures. Their cardiovascular system becomes compromised. the other harm in waiting is sometimes We seek treatment and the musculoskeletal system is not really owned by one particular discipline, meaning that it's not like this is diabetes. And you see an endocrinologist when you have a musculoskeletal disorder, you might see a primary care physician first. You might see a physical therapist, they might see, send you to an orthopedist there, and then they might end up seeing you to see a spine specialist and then they might. end up sending you to a pain specialist, so waiting for having access to these specialists is certainly a gift and a privilege. But sometimes I find that patients are waiting for these specialists to come to a conclusion, and they often will get disappointed because either the treatment option is. Something that they don't want or just something that, they've been trying to avoid. And then, or the last option is that the specialist says, I don't know what it is, but I know it's nothing bad. How about you go see this person? And so they end up going to see a different specialist, let's say it's like a neurologist, and then they go through a big workup, imaging follow up, and then they come to the same conclusion. So sometimes the waiting is actually, For the right specialist, and or the quote unquote right specialist. Sometimes there's a list or a line of specialists that's actually who I see in my clinic on a day-to-day basis are folks that I. I know that I could have helped them if I saw them first, but when you see specialists, their scope of interest is very limited, or I shouldn't say limited, but very focused. And again, sometimes musculoskeletal disorders, they need someone with a wider lens. You can't look at it as just, is this a surgical issue or not? It's great if it is, but what? again, a lot of the people I'm seeing and a lot of the people with chronic pain. And mobility issues, surgery may not be an option or it is a very risky option. And so they're left with, these are my options. If you don't like it, then maybe we, this other specialist can come up with a different treatment plan. So there is a risk in waiting and I often, I think about this. A lot about, what's the harm of actually trying? I think that, I'm obviously very biased. but I have to consider, the patient, what is the harm in trying, and these are, these are some of the options that I've, some of the harm of trying, I think comes from disappointment. I. I think we all want the treatment to work like a charm. And when we put all of our effort into it and we get disappointed, it's a very human thing to not, to not want to try things. If we have that sense that we're gonna be disappointed. And if you are a person with chronic symptoms, you've seen a lot of specialists and. It's sometimes hard for me to get people to try things that I know are gonna work because they've failed it in the past. And not to say that the treatment isn't gonna fail again, but sometimes they're at a different point in their condition where this treatment may be more effective or may be necessary to tackle a separate problem. The other big thing is there's no immediate effect, and again, this goes to. Again, a very human aspect. we like things to be done. We like results quickly. especially in the pain world. You want the pain to go away completely as soon as possible. We're looking for the treatment to make the pain go away soon as possible. And this is where I, even though I do injection, this is where, injections have to be done. Judiciously, medications, anything in medicine, where pain relief can come immediately. I always take pause because that will obviously attract people to, to your practice if you can make things go away quickly. But knowing the way musculoskeletal conditions go is that a lot of these things do have a tendency to come back and I don't. I don't always like people to respond too well to my treatment because. I know from my standpoint, the goal is to lower the pain so they can do the rest of the work so that the problem doesn't come back. But a lot of times patients don't necessarily look at it that way. They like the short term effect and they want to move on. They don't want it to think about it, and the next time it pops up, they want the short term effect again. But I've just done this too long, that it doesn't always work out the way. At some point, the short term effect, Starts to become less helpful, or it doesn't last as long. And ultimately They're left with the same treatment options that they never considered because the short term benefit option was working really well. But I, I also think it also goes to, people don't like to invest. Time into this kind of stuff. time is a commodity. It's something we all don't give back. So who wants to really invest in something that may or may not work? And you have to actually put in a lot of time and a lot of effort, and you'll see if it works. It's not really a great sell. And again, I understand why people would elect. For motivation to show up, for the perfect condition to show up, wait for the perfect, amount of wind, to push you in the right direction. and I get it, that is a very human, a human response is to want to avoid disappointment, want to avoid painful conditions. But the reality is that, life isn't that way and the body doesn't always respond. To a very passive and, a passive approach where there isn't some discomfort, some pain. And I'm not here to say that, pain isn't a real thing, it's all in your head. I just want to highlight the difference between taking control and being proactive in your overall movement health. Versus waiting for the perfect conditions to be there before you actually do something. It's one of the saddest things that I've seen when I see people have all the options in front of them and they choose to wait, essentially they tell themselves the only way I'm gonna do something is if the pain is unbearable and or if I can barely move, that's when I'm going to do the thing. And from my standpoint, that's like the worst strategy. while I understand there's, it's a more complex picture, but, waiting for that particular point in time, waiting for those particular conditions where you are at your worst before you do something it leaves you further behind in your own journey, essentially. I understand why people do that, but I believe they think that. There is a magic bullet that is gonna be there when they can't stand it. And sometimes it works like a hip replacement. Knee replacement is a great example. But the reality is that once the hip is replaced or once the joint is replaced, the pain is better. But they have lost muscle mass. They have lost, their general cardiovascular conditioning. They've lost, life events. In the process because they're waiting for the, a particular trigger, a particular motivation, a particular condition before they take action. And I, I just hope that people who are listening to this will maybe resonate with this. I don't expect people to just be super disciplined and be, and, take charge all on their own. I, that's why I'm here, that's why I'm available, for my patients, is I wanna help come up with systems that will make sure that they stay disciplined. it's one of the reasons why I follow up with people periodically, to basically to just say, Hey, are you doing what you need to be doing? And if not, let's figure it out. The fir, my first tool is never to just offer an injection and then I'll see you later. It's always to make sure that they're doing the hard work and the hard work has to get done. That's, there's just really just no other way around it. But anyhow, I hope you like that analogy. Are you a sailboat or are you a rowboat? Motivation versus discipline? It helps in life, but also in rehabilitation. Thanks again for your time. Take care. Thank you for listening to The Talking Rehab podcast. I hope that this podcast stimulates you to question your own practice and how you approach rehabilitation. I truly appreciate your time and attention. If you enjoyed listening, make sure to like and subscribe to the podcast. I wish you a movement filled day. Take care.