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If you have been following along with the Netflix series, Stranger Things, perhaps you've also had Kate Bush's "Running Up That Hill" stuck in your head on repeat.
Something that I have found fascinating for several years is how we often let our own thoughts and fears determine our actions.
Much like the Stranger Things characters, most of our toughest battles often take place within our own heads.
Your patient can be in the best physical shape of their life but if their mindset isn't right, then their chances of success are minimal.
Whether that is returning to sport after injury or fighting off Vecna and the monsters from the Upside Down.
A 2016 study by Forsdyke et al. looked at the psychosocial factors associated with outcomes of sports injury rehabilitation.
Researchers systematically reviewed 25 studies containing 942 injured athletes.
They discovered that physical and psychological recovery doesn't necessarily occur at the same time. Essentially, just because your patient has passed all of their return to sport tests, this doesn't mean that they are in a head space where they feel ready to get back on the field.
So what do we do about this?
The authors outlined 3 areas that we need to pay attention to:
1) Injury-related emotions: Most athletes won't want to disclose their anxiety around pain, re-injury, falling behind, missing out and underperforming.
If they won't open up to you, their families or team mates, try using other methods of reflection such as asking them to keep a journal of their progress and thoughts. This way they can look back at 3 months ago and read about how terrified they were to do a single leg squat for the first time and now they are hopping, jumping and sprinting.
2) Injury-related cognitions: Nothing quite knocks your self-confidence like a long term injury.
Restoring self-confidence can be assisted through an outcomes chart. Each time that the patient achieves a rehabilitation phase goal (eg. 10 single leg squats), they get to tick that box or cross it off. It is important that it is a physical chart that they can hold because the action of them crossing it off has an important psychological effect of creating feelings of competence and autonomy.
3) Injury-related behaviours: If this is their first injury, then your patient won't know how to cope and could easily spiral into negative thought patterns and behaviours. It is important that you implement problem-focused coping strategies.
Reframe the injury as an opportunity for growth and development. Example: If they have an upper limb injury then we'll get them fitter than they have ever been.
Insufficient social support is closely linked with unsuccessful rehabilitation so encourage them to still attend all team-building activities. If they have an upper limb injury then they can still attend fitness sessions. If they have a lower limb injury then they can still attend certain sessions focused on drills, strategy and planning.
So yes, this is definitely more work - but a patient who feels wholly supported and encouraged is far more likely to become a raving fan who can't stop telling others about their experience with you.
And we all know word of mouth is the most powerful form of advertising.
Who knows, you might just become known as the go-to person in your field for dealing with patients that have a "mental-block" to getting back to exercise. Stranger things have happened.
References
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Written by Kyle van Heerden
Online Educator at Research Raconteur
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