"I should be able to walk and turn my head without getting dizzy."

"I should be able to shop by myself."

"I should be able to stand on one foot."

I should, I should, I should...

I hear a lot of "I should be able to..." during my time with patients, but I don't like putting emphasis on things we think we should already be doing.

First of all, you aren't in therapy to do the things you can already easily do. While you may be looking at the big picture of what you're not doing and want to be able to do, such as being able to drive to a busy store and get your shopping done, as therapists we are looking at the steps it will take to get you there. We may work on the up and down movement of getting in and out of a car. We may address your ability to scan your environment while moving so you can find the things you need. You might be carrying stuff around the clinic. We might work on single leg balance so you can safely step up onto the curb from the parking lot. In physical therapy, we are really good at breaking down the whole picture into little parts that can be managed, worked on, improved, and measured.

Pressure on ourselves to heal and show progress can increase anxiety and bring on more "shoulds." Added stress and anxiety can actually contribute to the dysfunction of your vestibular system, causing your balance to be worse and making your goals feel unattainable. The Anxiety Vertigo Cycle is a loop we can get stuck spinning in (pun intended). For example, feelings of vertigo can often lead to high anxiety with movements, activities, and leaving our homes. When the different parts of our balance system are not telling us the same things it can create more dizziness and more anxiety. We can start to peel back the layers of your balance issues and start to break things down into manageable tasks. The process of us tackling smaller movements and building on them can promote celebrating the "dids" and looking forward to the "wills" instead of stressing over the "shoulds." We love to tell ourselves what we should be doing without reminding ourselves of what we have done. I think it is important to show yourself some grace and focus on continuing to improve.

Another important reminder is that growth doesn't follow a straight line. People are complex and any number of factors can come into play and make us think we aren't progressing or getting better. Emotions, hormones, stress, sleep, diet, meds, or just being human and having an off day can affect how we feel currently and that can cause us to lose sight of the gains we have made along the way.

The next time you find yourself deciding what you should already be doing, take into consideration what you were doing before therapy and make sure you have realistic goals according to your prior level of function. Also stop and think about the steps you have made and how far you have come. If you're not sure, ask your therapist, we are really good at keeping track of your progress, believe me, we have the notes to prove it.