Mental Health During the Physical Therapy Recovery Process
As a teenage athlete, I had to undergo surgery after suffering two dislocated shoulders. Everyone tells you it might hurt, or offers words of encouragement that things will be better afterwards, or that you will finally have “normal” shoulders.
No one told me about the most challenging part of an injury and rehab—the mental health effects. Not only did I have a surgery at fourteen, I had the same surgery once again on the other shoulder just a year later. At that point in my life, I had no idea what depression was. It was not discussed much in public, and definitely not amongst high school classmates. None of my friends had been through an injury like mine. I lost out on two consecutive lacrosse seasons, had to immobilize my arm for six weeks after each episode, and gained weight due to my lack of activity.
“...being injured not only limited my ability to do the physical things I love, but also seemed to make me feel mentally weak.”
To be honest, I didn’t realize I was depressed until after my initial pain and surgery. It wasn’t so intense that I isolated myself or avoided social activity, but I felt sad way more frequently than normal. There seemed to be a momentum of sadness, not just a thought here or there. The longer the process lasted, the easier it was to have sad thoughts. I always thought being tough would protect me from these feelings, or I would easily find my way out of it. For the first time, being injured not only limited my ability to do the physical things I love, but also seemed to make me feel mentally weak.
Mental Health After an Injury
Mental health is a hot-button topic these days for good reason. It can be a challenge, but we all need to manage our mental health. While the physical side of injury and recovery is easy to see, the weight on the mind is not as obvious. It is easy for medical professionals to throw out stats on how long your injury usually takes to get better or what percentage of people get better from a specific injury, but dealing with an altered lifestyle on top of managing pain is a tough prospect. It’s something I see challenging patients going through physical therapy.
The physical side of injury is fairly straightforward. In most cases, a specific body tissue (muscle, ligament, nerve, bone, tendon, disc, etc.) becomes irritated, inflamed or injured. The initial phase of physical therapy or medical management will require one or more of the following:
Treatments to decrease pain, inflammation, or irritation via relative rest, anti-inflammatory strategies/medications, or hands on techniques. A physical therapist will help provide the optimal environment for this process to happen.
Progressive loading or strengthening via specific exercise. A physical therapist will help make sure the dose of this exercise is perfected.
Surgery due to a tissue that cannot heal itself with conservative management. This is followed by physical therapy and rehabilitation specific to the surgery.
After this initial phase, there is much more variation based on a specific injury or surgery, but a gradual progression towards painful or limited tasks needs to be performed. While this is an over-simplification, these rules apply to almost all injuries and painful conditions.
Challenges Beyond Physical Therapy and Dealing with Them
What is much less simple is managing mental health and the mental side of this recovery process. It is easy to provide firm instructions to not perform a painful activity, but what happens when this activity is a patient’s passion or job? What happens if you are a mover, and you can’t move well? Pain weighs on the mind and many wonder if anything aside from medications that can help change it? Why won’t this pain stop? Will I be the same after this? What will my future look like?
These limitations often result in some form of anxiety or depression. Even if the intensity of anxiety or depression does not overwhelm your life, it is important to acknowledge. In some cases, the mental side of recovery will be at the forefront of recovery, maybe even more than the physical side.
Each persons’ injury experience is different, and the mental side of this will be even more variable. My experience may resonate with you, or you may feel totally different. I did not have much to worry about with my injuries, whether I was naive or due to my injury having a relatively predictable trajectory, or assuming that it would just work out. Many patients I work with have some level of anxiety surrounding their condition due to an uncertain trajectory or future. I experienced more from the depressive side where I felt sluggish and suffered decreased motivation and feelings of sadness. These feelings do not have to come in isolation and often come together.
Tips for Managing Mental Health After an Injury or Condition
While I am not qualified to provide mental health therapy or counseling, I am more than qualified to provide some guidelines that can be helpful in managing mental health while recovering from an injury. The tips I outline below are not specific to an individual case, but are good general mental practices for anyone suffering from an injury or condition. As always, make sure to consult a medical professional (either physical therapist, mental health, general medicine, or orthopedic) to make sure these tips are safe and applicable to you. You can think of these tips like brushing your teeth; everyone needs to brush and a friend might remind you, but if something starts to go wrong with your teeth, make sure to see a professional.
1. Learn About Your Specific Injury from a Professional You Trust
Fear of the unknown is the worst part of any injury. Fear of the unknown can even be a major part in increasing pain levels. The best way to educate yourself about your specific injury or condition is to first and foremost get an accurate diagnosis from a medical professional. This requires many more factors than an x-ray or an MRI. While hard to believe, a thorough history and physical examination are more accurate than most x-rays or MRI’s. X-rays and MRI’s do not move, walk, talk or explain sensations. If your doctor solely relies on an x-ray or MRI to diagnose you, it may be wise to consider a second opinion.
Once a formal and accurate diagnosis is achieved, a thorough explanation of what is going on should ensue. This should include:
What Is my diagnosis?
Can I get back to full function with this injury or condition? Will anything be different after?
How long does it typically take to get back to my specific goal? This will be different for every case even when the diagnosis is the same.
Why does it take this amount of time? A good medical professional should be able to explain the healing or management process in terms you can understand.
What are the specific steps I need to take to help or facilitate the healing process?
What can you or another professional do to help me get better?
A trusted medical provider should be able to answer each of these questions for you with relative ease. Understanding that you are in the driver's seat of your medical treatment is key. A good professional will give you the tools to understand how they can help, but more importantly what you should expect. This understanding usually helps guide patients and decreases anxiety surrounding their condition.
2. Set Reasonable Expectations
Expectations must be based on your specific diagnosis, current functional level, previous functional level and willingness to complete appropriate treatments. There are some hard facts that cannot be skipped over.
Specific tissues have specific healing times. Nerves can take a long time to heal. A more severe muscle tear will take longer than a less severe strain. These healing times have to be respected. Talk to your doctor or physical therapist if things are taking longer than they told you they should.
Strength cannot be ignored. If you are not strong enough to raise up on your tiptoes, running well will be difficult if not impossible. Even the most simple activities such as standing up from a chair have a certain amount of strength required.
Consistently aggravating an injury will slow down the process in most cases.
You have a chance at getting better without any form of treatment or plan, but this chance is much lower than having a formal treatment and plan that is executed perfectly.
It is easy to be frequently disappointed during rehab or after an injury if you have expectations that are unattainable at the time. Understanding what is reasonable based on your diagnosis and all of the factors that are unique to your body is crucial to having realistic expectations.
3. Set Goals, Both Short-Term and Long-Term
Long-term goals are easy to think about. Once you know what to expect, work with your medical professional to set short-term goals that are achievable. This may be as simple as performing one exercise per day and being able to tolerate it. It is important to set goals that you actually achieve, no matter how low you have to set the bar. Our brains are wired to release feel-good chemicals when we achieve goals. This can help us feel better both mentally and physically. Try to leverage these feel-good chemicals to enhance your healing process.
4. Perform Cardiovascular Exercise
There are a wide variety of ways to perform cardio. In almost every injury, there is some way to perform cardio that will not affect your injury. Cardio is not only important from a calorie burning and fitness perspective, but when our heart rate is elevated for a period of time, our bodies’ internal medicine cabinet opens. We release endorphins, endogenous cannabinoids (some of feel-good pain killers in marijuana), and endogenous opioids (yes we have pain killers already in our body just waiting to be released). These internal feel-good chemicals are great from a pain killing perspective but also from a mental health perspective.
On the physical side, many if not all orthopedic injuries benefit from increased blood flow. If you think a heat pack, massage, or foam roller is good at getting blood into your tissues, think about how great your heart is at pumping blood through your veins. This gets the right nutrients to the right tissues to heal you best.
5. Write Three Things You are Grateful for Each Morning
It is easy to think about all of the negative things when you are injured. There is a good chance you have a few things in lift to be happy about, or at least grateful that they are in your life. Maybe it is as simple as ‘the sun is out today.’ Acknowledging a few positives are a great way to affect your mindset.
6. Stay Social
When things hurt or your function is limited, it is easy to avoid others. Make sure to put effort into being social, even if it is forcing friends or loved ones to come visit you. It may be a task or even painful to do what you normally would do with your friends and family, but some interaction will be better than none. In most cases, the next time you see them you will be better in one way, shape, or form. If not, maybe they can help you get to the right medical professional to help your cause.
Getting Back to “Normal”
Getting back to “normal” may take time. There are challenges along the way after an injury or condition but when you surround yourself with the right professionals and stay focused on getting better, you’ll be amazed with the possibilities. As I reflect back to my shoulder injury recovery, the doctors and physical therapists that helped me get back to playing the sport I love were heroes to me. If you would like to meet for a consultation, just use our simple form or call our office at 908-598-9009 to schedule a time to come in.