Injuries and rehab is hard for everyone. But if you have ADHD, it can feel even more challenging – repetitive, slow and boring that couldn’t be further from the thing you love doing. That’s because standard rehab programs are designed for neurotypical brains.
This post is the third in our series on ADHD and pole dancing. In part 1 we looked at what ADHD is and how it affects training and in the second we looked at ADHD-friendly coaching strategies and what studios and instructors can do to create more inclusive and effective classes. Here, we’re looking at what happens when an ADHD pole dancer gets injured and how physios, coaches and dancers themselves can make the rehab process work.
Whether you’re a physio, an instructor or a pole dancer working your way through an injury, designing and guiding through a rehab plan, this guide is for you.
Why rehab is particularly hard with ADHD
How the dopamine driven brain is motivated
Pole dancing is a stimulating sport. There are new skills to learn, creative challenges to solve, music to move to and a community of people you want to be around. Dopamine flows and the brain lights up, engagement comes relatively easily.
Rehab is the opposite of all of that. It’s slow, repetitive and often feels completely unrelated to anything exciting. For an ADHD brain, this isn’t just boring but neurologically difficult. Research shows that ADHD involves dysregulation of the dopamine system, meaning the brain craves higher levels of stimulation, novelty and immediate reward in order to sustain attention and motivation. The internal reward of engaging, stimulating activity is what drives ADHD engagement and which is why rehab, without that spark, often gets abandoned.
This is sometimes called the interest-based nervous system: ADHD motivation is driven by interest, novelty, challenge and urgency rather than importance or intention alone. An ADHD poler may desperately want to recover and know that their exercises matter but still find it almost impossible to do them.
What the research says
Adherence to a rehab program is hard for everyone. Research shows that non-adherence in the general population could be as high as 70%. Poor adherence is associated with low levels of physical activity at baseline or in previous weeks, low self-efficacy, depression, anxiety, helplessness, poor social support, greater perceived number of barriers to exercise and increased pain levels during exercise.
While there’s growing evidence that structured physical activity has positive effects on ADHD symptoms, adherence to programs have not been evaluated and is expected to be a barrier. There’s an ongoing qualitative study around understanding the impact of adult ADHD on adherence to rehab programs. It’s investigated because clearly there’s a problem. I’ll update the post with the results once it’s released (if I remember that is…).
Research also suggests that the type of exercise matters for ADHD. Cognitively engaging movement, such as activities that pair physical action with mental challenge produces stronger improvements in executive function than simple repetitive aerobic exercise alone, meaning exercises that require skill, coordination and attention tend to be more engaging for ADHD participants than those that don’t.
The best rehab plan in the world is useless if the patient can’t actually follow it. When an ADHD patient abandons their program, the question to ask is not ‘why won’t they do it?’ but ‘does this plan fit how their brain works?’.
Practical strategies for ADHD-friendly rehab
Small adjustments can make a huge difference to adherence and engagement of ADHD patients. Many of these strategies are good practice for all patients, not just neurodivergent ones.
Explain the why
ADHD brains resist arbitrary instructions. Not out of stubbornness, but because without a clear reason, the task has no meaning or purpose. If a patient understands why an exercise matters, what it’s doing, how it connects to their recovery, what happens if they skip it, they are significantly more likely to do it. Take the time to explain.
Compare these two approaches: instead of ‘Do these shoulder exercises every day.’ try ‘These exercises improve the stability around your shoulders so you’ve got a better base to move from in a more optimal way so you don’t end up compensating elsewhere. Get this bit right and you’ll be back to your ayeshas safely, confidently and as quickly as possible.”
The second version connects the exercise directly to something the patient cares about. Linking rehab directly to pole performance improves motivation and creates urgency and relevance, giving the ADHD brain a reason to engage.
When you explain your reasoning, patients are also much more likely to tell you if something isn’t working, which means you can adjust your approach.
Use time or task-based targets
Counting repetitions requires sustained, deliberate attention, which is hard for ADHD brains to maintain. Miss a count, start over. Lose track, give up. It’s a system that sets people up to fail.
Time or task-based targets work significantly better:
- Hold for 30 seconds or until fatigue
- Do this while the kettle boils or whilst you’re brushing your teeth
- Complete 2 sets before shower
- Set a timer for five minutes and work through the list
Attaching exercises to existing habits or time removes the need for willpower-based initiation and makes the task feel more achievable.
Make rehab interesting
This sounds obvious, but it’s underused as a clinical strategy. Boring exercises are harder for everyone to stick to but for ADHD brains, the absence of novelty and stimulation can be too difficult to overcome. Where it is clinically appropriate to do so, choose exercises that are challenging, stimulating, motivational, skill-based or feel satisfying to perform. An exercise that requires balance, timing or a small motor challenge will hold ADHD attention far better than a simple isolated movement.
Rotate exercises within the same goal category to maintain novelty without losing therapeutic intent. If the exercise starts to feel automatic and boring, switch it. The target tissue is the same but the novelty keeps the brain engaged.
Anchor every exercise explicitly to pole performance, such as ‘this single leg balance work is what’s going to make your outside leg hangs more stable.’
Keep sessions short but more frequent
Long rehab sessions are daunting to start, easy to postpone and mentally exhausting to complete for an ADHD brain. Instead of one longer session, bitesized ‘rehab snacks’ are more achievable, instead of a 10 minute session, three 3 minute sessions spread throughout the day are a lot more manageable and less overwhelming.
Shorter, more frequent sessions also fit more easily around a chaotic or unpredictable day, the barrier to starting is lower and the sense of completion (which provides a dopamine reward) comes around more often. Aim for daily micro-sessions over weekly marathon ones wherever possible.
Use visual and physical tools
A tick sheet or habit tracking app is a simple tool that works remarkably well. A daily list of exercises with a checkbox next to each one does several important things simultaneously. It removes the cognitive load of remembering what to do, it provides a satisfying visible record of completion and it creates a small but real sense of achievement with every tick boosting dopamine. Apps can also be used as a reminder.
Written instructions and videos are a great reminder. Keep it simple – one page printed (stick it on the fridge so it’s visible) or accessible on their phone. Include the exercise name, a brief written cue and a checkbox. Add a link or QR code to a short video demo. These reduce confusion, ‘am I doing it right’ anxiety and support consistency. The fewer decisions required at the point of doing the exercises, the more likely they are to happen. You can even gamify it – unlock special stickers or badges for streaks or progress. Just make sure boundaries are established and they understand that you can do too much of a the good stuff too and overdoing it can be unhelpful (Goldilocks principle).
A phone or Alexa reminder can also go a long way helping remember and establish a routine for a certain time of the day. A resistance band left on the side of the kitchen counter or a dumbbell strategically placed in sight can be useful.
Clear structure with flexibility
ADHD rehab needs to have clear boundaries within the flexibility. If having a bad, still doing something is better than not doing anything. Having a back up plan with minimum expectations can help with adherence.
It’s equally important to set an upper limit. Hyperfocus in rehab can lead to overdoing things just as easily as it leads to avoidance. Be explicit about what too much looks like. An ADHD brain in a hyperfocus state will override common sense unless a boundary has been pre-agreed.
Finally, pre-empt the inevitable setbacks. Rehab is not linear, and ADHD makes consistency harder. Say this explicitly. Normalise missed days without shame. Missed days don’t mean the program has failed. Create a clear back on track plan so that a bad week doesn’t spiral into abandonment.
Create rewarding progressions
Another challenging aspect of rehab for ADHD patients is the absence or slowness of visible progress. For a brain that depends on stimulation and reward to stay motivated, this is can be difficult to overcome.
Make progressions explicit by tracking strength, hold times, range of movement or other metrics. This gives a concrete and rewarding sense of progress that abstract feeling better does not.
Link each rehab milestone back to pole. ‘Your end range shoulder control has improved enough that we can reintroduce shoulder mounts with spotter support.’ The sport is the goal and the rehab is the path. Keep the destination visible.
Communication matters
Nurture an honest, open culture
The most perfect rehab program fails if the patient doesn’t feel safe telling you it isn’t working. ADHD patients often have a long history of feeling like they’ve disappointed people or failed to meet expectations and need explicit reassurance that honesty about non-adherence will be met with problem-solving, not judgement.
Create this culture actively. Ask at every session how they’ve been getting on and if not been able to do the exercises, ask why, then respond to the answer with curiosity rather than frustration. The answer tells you something useful about where the program is failing, where the ADHD barriers are and what needs to change.
The same feedback principles that apply in coaching apply in a physio context. Lead with something genuine and positive, give your correction clearly with a rationale and close on something encouraging. For example:
Be patient, expect to repeat things and build it into your approach. Encourage questions and collaboratively find a solution to any barriers. Motivational interviewing can work particularly well by asking what is realistic and reinforcing positive steps and attributes.
Be consistent and considerate
ADHD individuals are often highly sensitive to subtle shifts in other people’s tone or manner. Inconsistency in how you communicate can come across as something being wrong and can trigger anxiety or withdrawal.
If something seems off in a session, name it simply and neutrally rather than leaving it ambiguous. Ambiguity is more distressing than clarity, even when the clarity isn’t entirely comfortable.
Create a sensory-friendly rehab environment. Avoid harsh lighting, strong smells, loud noises and clutter. Set expectations and boundaries and explain how the session will go to avoid uncertainty. Guide and direct where appropriate to reduce decision-fatigue. If a patient is feeling overwhelmed, give space as needed and support the use of fidget toys, noise-cancelling headphones or other helpful items.
If you are an ADHD pole dancer going through rehab
First of all, you are not failing at rehab because you lack willpower or discipline. You’re struggling because standard rehab programs are designed for brains that work differently to yours. That’s a design problem, not a you problem.
Here are a few things that might actually help:
- Tell your physio that you have ADHD. You don’t have to but it means they can adapt your program in the ways described above. If they don’t know, they can’t adjust.
- Attach your exercises to something that already happens in your day. Morning coffee, brushing your teeth, before or after dinner. Don’t rely on remembering to do them but link them to an existing habit.
- Make it easy to know what to do. Write your program on a sticky note on the bathroom mirror or stick it on the fridge. Set a phone alarm with the exercise name in the label.
- Give yourself permission to have a minimum version. On bad days, doing the single most important exercise is still a win. Don’t let perfection ruin it all.
- Remind yourself why you’re doing this. Not just ‘to get better’ but specifically what you want to get back to such as the move you were working on, the class you love or the feeling you miss. You can even put a picture somewhere you can see it.
- Progress in rehab is not linear. There will be ups and downs. This is normal and it does not mean you’re back to square one.
Other posts in the ADHD and pole series:
- ADHD and pole dancing – how it affects training, performance and injury risk
- ADHD-friendly pole coaching strategies – for instructors and coaches
- The ADHD-hypermobility connection – coming soon
- How ADHD traits show up in pole (the fun one) – coming soon
Are you a physio who has developed effective strategies for ADHD patients or a pole dancer with ADHD who has found approaches that work for you? Share your experience in the forum. And if you know someone who’d find this useful, spread the word!
At Polisthenics, our coaching and physiotherapy sessions are adapted for neurodivergent clients, both in how we communicate and in how we structure rehabilitation and training plans. If you’d like support that works with your brain rather than against it, virtual sessions are available to book.
We offer virtual physiotherapy, strength coaching and personalised training programs tailored to pole dancers whether you’re injured, want to avoid getting injured or want to get stronger and achieve your pole goals.
๐ป Book your appointment or message us here or on Instagram @polisthenics!
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References
Jack, K, McLean, S M, Moffett, J K and Gardiner, E. (2010). ‘Barriers to treatment adherence in physiotherapy outpatient clinics: A systematic review’, Manual Therapy, 15(3-2), pp. 220-228. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC2923776/ Accessed: 28 April 2026.
Song, X, et al. (2025). ‘Exploring the impact of different types of exercise on working memory in children with ADHD: a network meta-analysis’, Frontiers in Psychology. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC11808027/ Accessed: 26 April 2026.
Spencer, H. (2026). ‘Understanding the impact of adult ADHD on adherence to rehabilitation programmes: a qualitative study’, ongoing research, available at: https://chadd.org/research-studies/adhd-adherence-to-physiotherapy/ Accessed: 26 April 2026.
Svedell, L A, et al. (2025). ‘Physical exercise as add-on treatment in adults with ADHD โ the START study: a randomized controlled trial’, Frontiers in Psychology. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC12614457/ Accessed: 26 April 2026.
Volkow, N D, et al. (2009). ‘Evaluating dopamine reward pathway in ADHD’, JAMA, 302(10), pp. 1084-1091. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC2958516/ Accessed: 26 April 2026.
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