This week at ProSport Physio, we had to go back to basics…
We had a couple of patients who were experiencing stagnant stages in their rehab plan and in both occasions, it came down to a issue in the first session.
The first case was a lady pretty much looking for a quick fix and the message about what was wrong was not communicated well enough nor a few other minor communication issues which were addressed with my team.
The other case was a bit more frustrating yet really highlights the importance of pain science for sports physios.
The gentleman in question was doing great on ‘paper’ but when we got to the crunch time of getting back to his sport (squash) there was hesitation and resistance.
He had done all his progressions and was flying on ‘paper’ but his confidence was just not there yet.
Was this just all in his head and would take time?
Far from it, this was OUR FAULT…
On those first few sessions my therapists message was not clear enough on helping the patient understand what pain was and was not, what his back surgery mean’t and did not mean.
We addressed this in our weekly cpd session and I’m confident the therapist learned a valuable lesson.
This then got me thinking about the importance of introducing pain science on the first session for the patient if possible…
PAIN SCIENCE SHOULD BE PROACTIVE NOT REACTIVE
Pain science can be hard for new graduate therapists (and even more experiened therapists) to get their head round and realistically the athlete or patient is going to need to hear it a few different times.
Introducing pain science early gives us an opportunity to reinforce key messages throughout the rehabilitation process, especially if the athlete has some kind of set back, loss of range of motion or pain etc.
The more we reinforce the message early doors, the more engrained it will hopefully be when push comes to shove and the athlete or patient needs to return to their sporting activities with ‘thoughtless, fearless, movement’.
Compare this to introducing pain science late in the rehab process when the person is lacking confidence. I know when I’ve reacted to the lack of confidence in my early career, I’ve had the response ‘so you are saying it’s all in my head?’…
And that is actually what we are not saying at all but the reality is, pain science can be hard to implement successfully for some patients and the more reinforcement we can give in each session, the better chance of success we will have when it counts in the end stage rehab and the person truly requires ‘thoughtless, fearless, movement’.
INTEGRATE PAIN SCIENCE WHEN THE ATHLETE HAS A SETBACK
Integrating pain science when the athlete loses range of motion between sessions, has increased swelling or even pain is a great way to reinforce and explain why the body may have reacted this way.
It also gives an opportunity to educate the athlete on the importance of graded exposure and not skipping steps in their rehab. This can help add value to the progressions and ‘earning the right’ to get to the next stage.
Meaningful reassurance specific to the athletes situation they are in now can be well received and meaningful to them rather than a generic explanation which we may use in the first session when the athlete has not experienced any ‘warning signs’ from the nervous system that the load may have exceeded the capacity of ‘perceived capacity’ from the higher centres.
CHANGE THEIR RELATIONSHIP WITH PAIN AND INDEED THE INJURY BODY PART
One of the first things I do with a persistent injured body part is find something good that the body part is doing well.
Changing the persons perception of the body part is very important to instill confidence back in this body part in my opinion and any opportunity we can do this is a good thing.
The chances of the person experiencing pain at some point in the rehab plan is high and pain science may help the athlete to not overreact when pain does occur. The same can be said for when they do return to their sport and may experience pain in the future.
PAIN SCIENCE IN RETURN TO PLAY PROGRESSIONS
Pain can be really useful for us clinicians as a guide with loading and potenital ‘perceived threats’ to the system still present in the rehab process but we should use every opportunity to reinforce key messages about pain.
For instance if an athlete post op is performing an exercise progression and beginning to move with a more protective manner and complains of pain, a simple regression can be implemented to allow the athlete perform some variation free from pain and with more confidence.
However the key message that the athlete’s system is not quite ready for that amount of load yet’ and will adjust to this with the appropriate exposure is of utmost importance rather than seeing this as a ‘failed’ rehab session.
Pain science can be extremely valuable to therapists and I for one am guilty of not paying enough attention to it in my treatment and rehab plans in my early days in pro sport. When used appropriately, it can be just as powerful if not more powerful than any other ‘tools’ or ‘techniques’ we may have.
As my team found out last week, it is important to implement it early and at any opportunity rather than being ‘reactive’ when the person or athlete stagnates.
As always, thanks for reading.
P.S You can request access to 7 Steps To Clinical Excellence below, and I’ll get it straight to you, and you can start learning more about this way of looking at the body, which I’ve used in professional sport and private practice consistently over the last nine years…