Archive for August 2015

Negative Attitudes, Thoughts and Feelings: Some thoughts on the recovery process

glass half full

Over this week I’ve had a couple of in depth discussions with patients who are both struggling with long term injury – and I wanted to share some thoughts about some common themes with both of them.  Perhaps if you are also struggling through an injury or recovery this will help you with some of the barriers you are experiencing too.

One client is a high level hockey player who has recently undergone an ACL reconstruction (and looking at up to a year to return to sport) and the other is a labourer who suffered quite a bad low back injury. My discussions with both of them this week focussed on how they were coping and dealing with the injury mentally and emotionally.  When dealing with clients we know that your mental and emotional state can have a drastic impact on your physical symptoms and recovery – so discussing this side of a client’s recovery is also a very important part of their rehabilitation progress.

Both clients were struggling emotionally with their injury, and I wanted to share some common issues between them (and others we see) and my thoughts on them

Catastrophization

With any injury our minds seem to jump to worst case scenarios straight away.  This week it was “what if I can never play hockey again?” or “what if I can’t go back to work? How will I be able to support my family?”  While these are normal concerns, statistics and research tells us that by and large people almost always recover. Your body is a powerful healing machine and is incredibly good at recovery in its own right.  Also the fact that I am talking to you means that you have also taken proactive, positive steps towards a faster, better recovery.  You are in good hands and are well looked after.  Considering that people can recover from injury eventually without any guidance or treatment, the fact that you are under expert guidance already puts you ahead of the game.

These negative thought patterns lead to negative emotions, stress and anxiety. These mental states have been proven to adversely affect your symptoms (pain) and your recovery. Understand that you (like everyone else) will get past this and you will get back to normal.

And even if you do have a rare injury that won’t recover (like losing a leg for example) it may affect your ability to do certain things, but your life still isn’t over.  Spend 30 seconds on the internet and you will find all manner of people living with significant conditions or injuries who are living life to the fullest and enjoying life every day.

Fear Avoidance

Fear avoidance and chronic pain cycle

Fear avoidance and chronic pain cycle

Fear of pain or fear of damaging your injury further may be normal behaviour, but often to recover you may need to push yourself a little bit.  If you never do anything for fear it might hurt (or damage) your injury – eventually you might not do anything at all.  To paraphrase Finding Nemo:

Marlin (Nemo’s father): I promised that I’d never let anything happen to him

"Not much fun for little Harpo" (Source: Disney Pixar)

“Not much fun for little Harpo” (Source: Disney Pixar)

Dory: Hmmm that’s a funny  thing to promise.  Well you can’t never let anything happen to him. Then nothing would EVER happen to him.  Not much fun for little Harpo.

One client was avoiding bending his back at all because he was afraid of hurting it again.  The other was struggling to wean out of her knee brace because she was afraid it might get hurt again without the support.  In both cases, to be able to improve they need to be able to do those things. It is perfectly normal to bend your back, and it is normal to walk without support.  Normal activity is unlikely to damage you, but fear avoidance can certainly hamper your recovery. Understand that pain does not equal damage – pain is a warning system.  When you have had an injury or surgery, your brain is on high alert for warnings around that area (because of this sudden insult/injury).  So whenever you start to do new things, or increase your activity, you could be setting off more warning signs.  Understand that not all pain is bad pain – and do not fear some pain, it is unfortunately necessary sometimes.

Your identity and self-worth

This was the really big one:

You are not defined by your injury.

Nor are you defined by your ability to do or not do certain things.  You are not just a person with a sore back.  Nor are you just a hockey player.

In both these clients’ cases, they were struggling with feeling of loss of identity and loss of self-worth because of their injury.  One identified themselves strongly as a hockey player, and without playing hockey she felt like she had lost her identity.  The other felt that if he couldn’t work to provide for his family currently, then he was feeling like he was worthless.

In my opinion neither of these is true.  You are not just a hockey player. You are not just a worker, or provider. You are a father, mother, sibling, lover, drinking buddy, partner-in-crime, and confidant. You are someone’s closest friend. You are the love of someone’s life. You are likely the entire world to your children. What you do does not define you or your value.

If you cannot work for a period of time, it does not make you any less of a father, or husband, or friend, or partner.  And like I said, by and large people will recover, so you will still be all of those things, even if you are having some short term difficulty fulfilling all of those roles right now.  None of the people who are important to you will judge you as worthless for not being able to do something. In fact they will (and should) be proud of you for facing pain and adversity and working to overcome it. There is nothing to feel worthless about, nor is an injury anything to be ashamed of.  You are not weak for being injured – you are strong for fighting to recover.

And again, if you find yourself in a situation that the problem you have isn’t going to go away (like losing a leg) you are still every bit a father, husband, friend, etc. that you were before. Sure you might not be as good at hopscotch, but see what is important in your life and appreciate what you have. Even if life takes you in a different direction – you are capable of so many more things than just one career, or one sport.  I’ve read studies that say people change career 7 times in their life – so even if you can’t go back to labouring, there is a whole world of possibilities out there for you to explore. Even without your leg, you are still every bit as capable as a provider and carer.

Have realistic expectations

Recovery takes time.  In the case of my hockey playing ACL injured friend, it is quite normal to take up to a year to return to sport.  This means that for the first few months you will probably feel pretty terrible.  This is perfectly normal.  At our clinic we like to outline from the very start exactly how long recovery is likely to take – and the process we will go through to get you there.  Sometimes this is quite simple and sometimes it can be quite difficult to determine exactly how long recovery will take from the outset.

Remember that recovery is a journey – and not a straight line either.  Often there are lots of ups and downs along the way. Sometimes you will feel worse before you feel better. (I think immediately after surgery my client was definitely feeling worse than before she had surgery). This is all a normal part of the journey.  Pain is also a normal part of recovery.  Just because you are feeling more pain today doesn’t mean you are going backwards, or have damaged it further.  Sometimes it just hurts – and that’s normal too.

Trust in your team

At EMC Physiotherapy, we have over 40 years of combined physiotherapy experience, so chances are whatever you have – we’ve seen it before and know what to do about it.  Having an injury can be scary – you’re suddenly immersed in a previously unknown world of big words and scanning machines and lots of people telling you what to do.  While this is all new to you, it’s quite routine to us.  It’s normal to be worried that what you are experiencing is different from everyone else – but usually it’s not (unfortunately you’re not always as special as you think you are).  If you have concerns please ask – we will certainly reassure you regarding what you’re experiencing.  Allow us to educate you and guide you along your journey towards recovery, and trust us to guide you towards the best outcome possible.

 

As you can imagine, we spend a lot of time talking to/educating our patients and guiding them along their path (as well as providing all the other treatments and services we provide).  This is an important part of the process, and not to be taken lightly.  Hopefully this has provided you with some food for thought – especially if you are struggling through your own injury and recovery.

As always, if we help you with anything at all we are always happy to hear from you.

Happy recovery

 

Julian Bowen

Julian is the owner and Principal Physiotherapist at EMC Physiotherapy.  He has spent  over a decade working exclusively in private physiotherapy practice, and estimates he would have performed over 40,000 individual treatments in that time. He has worked with everyone from Paralympians,  elite athletes, WAFL Footballers, the Defence Forces and weekend warriors, to thousands of everyday people with all manner of issues.  He is passionate about injury prevention and has a special interest in the treatment of headaches, shoulder issues, hypermobility management and exercise rehabilitation for the prevention and treatment of injuries. 

 

*This article first appeared on the South Perth Physiotherapy blog, by the same author

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