How making mountains out of molehills will hinder your rehabilitation
We live in a society where we are constantly bombarded with information, be it on the TV, on social media or in old fashioned printed newspapers. News has reached such a saturation point that journalists and news organizations seem to be predicting a global catastrophe at every opportunity in order to get our attention.
As well as this exaggeration of negative outcomes being rife in the media it also plays a role in the treatment and management of injuries and illnesses. It is well documented how catastrophizing about pain, function or diagnosis following an injury plays a negative role in rehabilitation. Studies have shown that it leads to worse pain outcomes, increased disability and increased emotional stress.
Many of these negative beliefs are a result of real fears and vulnerabilities, which are associated to trying to return previous activity levels. Fear of re-injury and fear of failing to return to a level of function required for a sport or work place, can all create low self-confidence and foster an environment for catastrophizing and even lead to a point where patients can obsess over injuries they may not even have. An example of how this can happen is shown in the table below.
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Logical thought and reasoning. |
-> |
Semi Logical thoughts with increasing fear avoidance. |
-> |
Catastrophising and fear avoidance |
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‘I have a sore back. Maybe I shouldn’t have lifted that table yesterday. I should avoid lifting heavy things for a day or 2.’ |
‘I think I need a scan. I could have blown a disc. I had better rest and avoid all lifting.’ |
‘The disc could be pressing on a nerve and my back feels unstable. I shouldn’t bend or lift anything.’ |
‘My disc has popped out and has compressed a nerve. Any movement could leave me in a wheelchair. I will never be able to get back to work.’ |
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Once a full assessment has been completed and any serious pathology has been ruled out it is important that these psychological issues are addressed as well as the physical impairments. This is true both for the elite athlete returning to an Olympic sport or a retiree returning to a walking group.
One of the best ways to address this is for the patient or athlete to have a clear understanding of their diagnosis and the realistic timeframes involved in the healing process. Knowing the healing time and the healing capabilities of the injured structures and how age, general health and previous injuries will affect this process will enable them to feel more in control of the whole process.
As well as education on the injury, having good communication between the patient and their treating clinicians is also vital. If the rehabilitation does falter it can be addressed quickly, avoiding frustration from the patient which could lead to the negative believes mentioned above and a loss of confidence in the clinician.
As with many areas of health care this sounds very straightforward in theory, but in practice it certainly is not. Treatment plans can get complicated and confusing if there are too many people contributing to it. This is definitely the case when Dr Google or well meaning family members get involved. Also the diagnosis itself is rarely straightforward and often involves more than one structure.
Ultimately having trust in the health practitioners and Doctors that are managing your injury is the key. If you do not have it then you either need to speak to them about it or find a new team.
