There are things I have heard in appointments before that I know I'll hear again. I have had many clients in the past tell me,
"Wait, so you aren't going to hook me up to electrodes and leave me here alone?"
"Why has no one ever explained things like this about my body and injury to me before?"
"So you're telling me I don't have to stop doing the thing I love to be pain-free?"
It can be easy to become caught up in a world of health professionals telling you many different things, saying that only rest can help, spending no more than 15 minutes listening to you, or having them completely ignore your personal goals. I strongly believe than in order for pain or injury rehab to work, there are a few things that must happen. The rehab plan must be individualized, my clients must have at least a basic understanding of why they are hurting and what the contributing factors are, and that exercise, manual therapy and stress/emotional management must be used together to reap the greatest rewards. If you've found yourself saying that it feels like you've tried it all, that things feel hopeless or that it seems that you aren't making progress, there may be a few things wrong with your current treatment plan.
1) You have been given generic exercises
Let's use Cheryl as an example. She has been dealing with chronic shoulder pain following a traumatic injury five years ago. She has been for treatment multiple times, but it seems as though she is given the same set of exercises every time she returns. This is a red flag for several reasons.
First of all, exercises should continue to become more challenging the farther we are from the acute injury phase. About 7-14 days following the initial injury, there should no longer be active inflammation and so long as we are not provoking a significant increase in pain, there is a larger group of exercises that we can pull from to aid in the recovery process. If your practitioner is not taking the time to ensure that exercises are challenging enough, or they are not explaining why a specific exercise will benefit you it is perfectly reasonable to question why your plan looks this way.
The other thing to reflect upon, is if your exercises in some way reflect your goals. In my practice as an Athletic Therapist, there is a large likelihood that I am not going to give a 65 year old woman who's most difficult activity is weeding in the garden the same exercises as a 30 year old who loves to play slow pitch in the summer, even if they have the same injury or pain location. Yes it is true that in some circumstances the starting exercises for a particular injury may look similar, but I would be doing a disservice to my clients if I did not incorporate sport/activity specific exercises or high velocity upper extremity movements for some one like my slow-pitch star. If you feel as though you have been given generic rehab exercises, there may be something wrong with your current treatment plan.
2) You do not understand your injury
Don't get me wrong, if you are not a health care worker specializing in musculoskeletal injuries or don't have a background in human physiology, I do not expect you to know everything about your injury. Once again, it is my job as a practitioner to educate my clients about their bodies. Why did this happen? What are the contributing factors? Which structures are involved? and how do we fix this?
If you have left your initial assessment and still don't know why you have your current symptoms, that is a problem. Lack of understanding can fuel fear or uncertainty, both of which are stressful emotions and when it comes down to it, stress is a contributing factor to pain. Think of your boss at work who became stressed because they didn't know if they could meet a deadline. This leads to more desk work, less than ideal posture held for long periods of time, chronic pain and then more stress. The more stress there is, the worse our pain becomes as it feels like just one more burden to deal with. Not to mention the emotional ties to the limbic system that may be manifesting physical symptoms, but that's a topic for another day. Long term emotional stress means that the sympathetic nervous system (responsible for the fight-or-flight response) is in over drive. Increased heart rate, increased blood pressure, increased muscle tension and sleep disturbances are a recipe for pain.
The next reason understanding is key is all about the buy in. If a client doesn't understand why a home exercise is beneficial for them and their pain/injury, why would they put effort into doing it? If someone asks me why they need to do something and I tell them "because I said so" there is no way they will stick to the plan with the same devotion they would if I simply took the time to explain how the exercise may be helpful. When it comes down to it, rehabilitation is a team sport played between therapist, client and any other practitioners brought in to help. The client's job is to show up on time, perform exercises at home and to ask questions as they see fit. The therapist's job is to keep their client educated and informed, create a individualized treatment plan, and to call in back up when required. If you really don't understand your injury or the purposes of your home program exercises, there may be something wrong with your current treatment plan.
3) You are receiving treatment for symptoms rather than the cause
This is the place where I'll take you back to the dreaded electrodes from the intro to this post. If the most work being done with you during an appointment is 15 minutes with electrical stim strapped to you before being sent home, you are simply being treated for your symptoms. Without addressing the underlying causes of your symptoms how will you find long term results?
From the practitioners side of things, it requires an in depth history and physical assessment to determine the cause or contributing factors to a client's pain. This means we need to talk to you for more than five minutes, to check in at each appointment, and to prioritize the effective application of exercises to eliminate the cause of your pain. Yes it may feel great to have heat and stim applied at your appointment, but the effects of this may be fleeting as we are essentially tricking the brain into not feeling pain, but only while the heat and electricity are attached to you. I have had clients say "you didn't use a machine on me, that's different". In my opinion, it is a good type of different! My greatest tool to give is knowledge, and by identifying contributing factors and teaching my clients how to work at home to correct them is crucial for the success of our team. Yes I do apply treatment to help deal with symptoms, but at least half of my appointment should be used to tackle the causes of your pain. It is my job to help people find long term results, not to temporarily relieve symptoms. If the underlying causes of your symptoms are not being treated, there may be something wrong with your current rehab plan.
So what do you think? Is your treatment plan keeping up? Hopefully this read gave you a bit more insight as to what things may be hindering your rehab process. It's also important to remember that every practitioner is different, but if things just don't seem to be going the way you would like, you are allowed to ask questions! You are number one when it comes to treating your pain or injury, so even if you aren't an expert it is okay to question your rehab plan.
Kristen Huber BaKin, CAT(C)
Owner, The Gentle Athletic Therapist