Recovery starts with Acceptance
When talking to a patient just the other day, I realised the 5 stages of grief and grieving are just as transferable to the stages patients go through when they’ve sustained an injury, particularly amongst the athletic population.
Stages of Grief:
When we think of sporting injuries, we rarely consider the psychological aspect of the healing process. As a musculoskeletal practitioner I have learnt the hard way, you can treat the physical trauma, however if the patient hasn’t accepted the injury and moved through the stages as above, then sometimes the hands on work just isn’t enough.
To explain the stages, I’d like for you to image an individual involved in a sport like CrossFit, F45 or various other forms of high intensity resistance training.
Patient X presents to the practice with ongoing shoulder pain. It started some time back however thought it would just improve on its own over time…. And this is where we start…
Patient X for the past couple of months has been training with a “niggle” in the shoulder, which hasn’t gone away and just trains through it.
We’ve all been there. At what point does a ‘niggle’ become severe enough we perceive it to be a problem. We as human beings are designed to survive and this is what denial allows us to do. Denial is the most common defensive mechanism we use, pretending that an uncomfortable thing did not happen…including physical traumas.
As Patient X continues to train, you can see the pain painted across their face, however their mind is saying “you're just cold… just need to stretch into more… it’ll warm up...” Looking for a way to dismiss what is really occurring in order to keep doing what they love doing.
After a period of time though, your body will shut down. When you experience pain, this is your body sending you danger signals to let you know if you keep going, something bad will happen. If you don’t listen, the body will stop you by either increasing the pain or shutting down the body with such things occurring like pain inhibition (Muscles shutting down so as not to create more damage).
Now Patient X at this stage is now becoming frustrated with training and now moves to Stage 2.
We all get angry now and then, and there is nothing wrong with being angry or frustrated when sustaining an injury – it is a very important part of the healing process.
As anger is an emotion without limit, I typically find an individual’s level of anger grows exponentially with their love for their sport. Anger might be directed toward themselves for not listening to their body, for not doing something sooner, anger at their doctor or health practitioner for identifying the injury or not providing a ‘quick fix’, anger at the coaches as they listened to what they had to say and they still got injured... Why me?
Although a necessary emotion to experience, the sooner we move on the better.
As a practitioner, I’ve found this is usually the most frustrating time for both patient and practitioner. During this stage the patient looks to identify ways to get around the injury to continue doing what they love.
For example, Patient X has a shoulder injury, which restricts pressing weight above head. Rather than identifying and accepting there is an issue, which may require rest, Patient X continues to negotiate and bargain ways around pressing.
“…so if can’t shoulder press can I do upright rows…”
Sometimes bargaining may be directed toward the actual rehabilitation provided, such as;
“…if I do twice as much rehab as prescribed I’ll be able to get back to training sooner…”
Like any bargain, usually you get what you pay for... and if you don’t pay your dues, the chance of re-injury increases.
Unlike anger, which focuses your emotional energy on what has happened and what could have been, depression focuses your attention to the present. This is the realisation stage, the stage where you comprehend the extent of your injury and what your limitations truly are. As a practitioner this is a stage, which needs to be dealt with delicately and promptly. We all handle our emotions differently, and if required, additional support is strongly suggested.
In my personal experience with sporting injuries I find this can be a stage you can become stuck in. It may not only affect you, but your friends and family also. I have found myself in this position once upon a time and had to ask myself one question… Is this injury greater than all the things I’m grateful for in my life?
For example, Patient X may be required to perform restricted activities whilst training, however can still train even if restrictions are applied, can still spend time with family and friends and can still smile knowing that overcoming an obstacle such as injury makes you a stronger person.
Which leads us into the final stage…
Congratulations – You’ve Flipped the Switch!
This is the stage when we accept we are injured, we accept we need to do what is required to return to what we love doing; we accept the notion that rest isn’t weakness, but is a true sign of strength. At this stage we can truly start to work on the injury both physically and mentally.
Now we are on the road to recovery!