Gaining the best possible outcome from your physiotherapy treatment requires a little more than just doing your exercises. This brief guide for patients outlines some concepts that can really make a difference beyond your physiotherapist’s treatment.
Any adversity we face stimulates a response, usually in the form of stress. While this may manifest as an emotion it actually triggers a series of chemical (hormonal) changes. Any treatment regime needs to take a holistic approach to both the physical injury itself and the adversity induced by it. Recovery from injury, illness, surgery or any life stress requires two key things:
1. Diagnosis and targeted effective treatment for the cause of the problem.
This means identifying what is wrong and then fixing it.
Example: a patient presents with a ruptured anterior cruciate ligament (ACL) of the knee. Diagnosis is made from history (the patient’s knee gave way), physical examination and sometimes investigations such as MRI).
Targeted treatment comprises of either a specific exercise program to stabilize the knee in functional situations or surgery followed by rehabilitation.
Simple, classical medical intervention is based on reductionism (knowing which structure is faulty and fixing it). This is a proven method and is ideal, however, we often do not have a clear diagnosis or treatment is not as effective as intended. These and other factors can create barriers to recovery. With ACL injuries ‘fear of re-injury’ is the biggest cause of failure to return to sport or previous activity.
2. Making sure we minimise the effects of ‘barriers to recovery’
Physiosouth practitioners look at the whole person, their circumstances and how they react to the stimulus or threat associated with their injury. These factors have the biggest influence on recovery from injury but are often neglected in modern medicine.
All good clinicians are aware of how these barriers can negatively affect recovery outcomes, and how much of a challenge it can be to change them. Taking a pill, doing an exercise or having surgery are single interventions. Managing your internal and external environment (the holistic approach) requires a lot more time and effort because some barriers to recovery are related to long-held beliefs and behaviours that are ingrained into our daily lives. Changing these can require a big effort for some patients, but it always results in positive, long-term change.
To gain the best possible outcome from any adversity or stress, both systems need to be engaged.
You are responsible for your own success in almost everything; rehabilitation is no different. It is well understood that doing your exercises, understanding your condition and sticking to a rehabilitation plan really helps achieve great outcomes. However, there are a number of other factors which also play a very important role in achieving rehabilitation success. This guide informs you of them and offers some solutions to make changes if required.
Rehabilitation is not a procedure or medication, it is a process. It has many layers and stages, and there are many things that can positively or negatively influence a patient’s outcome. We are now at a stage in medical science where we have a huge amount of data to support the holistic approach recommended here.
The Mind Body Link
The world, your body, your mind and therefore your thoughts interact to affect your general health and recovery from any adversity, including injury or illness. The facts are indisputable and the outcomes are dramatic.
An awareness that the mind and the body interact has important implications for the way we view illness and injury, as well as treatment. According to the mind-body model, treatment will be most effective if attention is paid to the mind and the body as well as their interaction with the outside world. This mode of treatment requires multiple factors to be addressed. The following list defines the key domains in the mind-body approach.
Checklist of Mind Body interactions shown to affect health and rate of recovery:
NUTRITION
Eating a well-balanced diet is essential. Weight gain is common with periods of inactivity so reducing total calorie intake is important. However, protein has a special role in terms of recovery, especially when trying to build new muscle. Extra protein before and after workouts is important and making sure you have enough fuel on board to cope with the exercise program is very important. We recommend a healthy diet, avoiding poor food choices and making sure energy levels and nutrition are adequate for recovery. Evidence reports that being no more than 10% overweight and eating regular healthy meals contributes to recovery. You may have some extra time if you are recovering from injury so explore healthy eating and lifestyle options. This can turn a negative into a positive quicker than almost anything else.
SLEEP
Sleep is the ultimate recovery strategy. Good deep sleep promotes hormones like human growth hormone and testosterone. These help build new tissue. A lack of sleep causes stress-like hormones to be released which can destroy tissue and slow recovery. Conversely, too much sleep is just as stressful. Trying to maintain a regular sleep pattern is very important. Simple advice can be acquired from your physiotherapist, or visit your GP or specialist care if this is an issue. There are also really good evidence-based sleep apps such as ‘Sleepio’ that really work. To recover you need good sleep.
STRESS
Hormones are released (e.g. cortisol) when our body or mind is stressed. These hormones are toxic to long-term health and recovery as they are really designed for short-term action. Simple injuries like wound healing have been shown to be reduced in humans who are stressed compared to those who are relaxed. Stress management benefits all of us, but when facing a change in lifestyle, reduced physical activity, job threats or uncertainty it is vital to reduce stress, to encourage healing. Physiosouth provides multiple interventions for stress management; from physical activity to managing thoughts and emotions. The relaxation response is almost universally successful in obtaining better than normal recovery outcomes. Relaxation training has been proven to reduce stress levels and improve health outcomes in every condition tested. Simple relaxation, breathing and/or meditation work very well and offer a high benefit for minimal effort.
ACTIVITY
General activity will help with stress, diet management, and sleep as well as assist with recovery in general. Physiosouth believes that rehabilitation should focus on the injury but also include general exercise that is joint or injury-friendly (such as cycling and upper body weights for a knee injury). A good exercise program can address a multitude of mind-body factors. Work with your provider, or use your common sense to ensure you get the minimum of recommended activity whilst you are recovering: 5–7 sessions per week of 30 minutes of endurance-type training (cycling, walking, rowing etc) and two sessions of strength/resistance training (the gym or using home equipment and body weight).
MIND MANAGEMENT
Managing the emotional brain and negative thinking; including fears and uncertainty, is essential. Thoughts generate emotions and emotions generate physical and cognitive responses such as harmful hormones and a series of other harmful physiological responses. Factors associated with the injury or condition, as well as other life situations (relationships, finances etc.) can be stressors. There are solutions to all of these problems and the effect thinking patterns have on our outcomes and indeed our life is very significant. Physiosouth can provide many options and solutions. Disputing these recurring thoughts (rumination) combined with relaxation (single focus) techniques, exercise, and good sleep will make a massive change to your ability to cope and recover. Discuss options with your treatment provider and take the initiative. Barbara Frederickson has published widely on the ‘broaden and build theory’; that is a mind that is relaxed and calm will see solutions and opportunities that a stressed mind will not.
FINDING FLOW AND MINDFULNESS
Having the ability to be totally absorbed in any activity and to be focused on the present moment ensures the mind does not wander to negative thinking, harming your recovery. Keeping firmly locked in the ‘process’ that is the current activity, keeps you engaged and maximises outcomes which are not influenced by emotions such as fear and anxiety. Again, research fully supports mindfulness training in many conditions. There are a lot of resources on mindfulness and it is a strategy which again is well supported by the evidence. Living in a negative past (blaming) and a negative or fearful future (pessimism) will delay your recovery.
TIME MANAGEMENT
Prioritization and goal setting: to successfully rehabilitate you need to be able to focus on key milestones, attend appointments and get through your exercises. Ask for help if you are struggling to organise yourself or find the required motivation. A time management plan should focus on the end point and have mini goals or milestones to achieve, all of which work toward the master goal.
An example would be achieving an increased range of movement before we can start the next phase of strengthening. Knowing what is really important and focusing on that one thing is the best way to achieve huge goals. Aim for one thing at a time but keep heading towards improvement. Knowing when to do your exercises, when to turn up for appointments and setting priorities clearly link to good outcomes – plan and schedule accordingly.
POSITIVE RELATIONSHIPS
Having the support of family, friends, and colleagues is another important aspect of recovery. Our relationships have a profound effect on our stress, thoughts, and moods. Managing these relationships is very important, as is asking for help and support when needed. We are social animals and need a supportive environment to really thrive. Manage toxic relationships so they do not impact your own personal stress and surround yourself with supportive people you trust. Overprotective friends or family can be just as bad. If you cannot change the people (maybe they live with you) you can attempt to manage your internal response as a defence against negativity. We are connected to each other by many things but researchers have identified receptors in the brain called ‘mirror receptors’ that link us directly. Empathy is a classic example of how one person’s suffering can be felt by another. Evidence clearly supports better outcomes when home, work, and social relationships are positive and supportive. We get very stressed when they are not.
POSITIVE HEALTH
The definition of positive health is living a longer and better life. What you do now will have dramatic effects long term. Again, enough research has been done to show what does need to change to live a better and longer life. Positive psychology has defined the Five Pillars of Wellbeing, they are:
Positive emotions
Positive relationships
Find flow or engagement
Goals attainment
Belief in something bigger than yourself
PHYSICAL HEALTH
Having good numbers for the following can contribute to a better and longer life:
1. Blood pressure
2. Body Mass Index
3. Activity levels
4. Sleep
5. Optimism
6. Social network
7. Various blood tests
Long term we can significantly change almost all of these factors to live a better and longer life.
