Monday, 10 December 2012

Attitudes Towards Recovering From Injury

This post was spurred by an article I read in the most recent Summit magazine, published by the BMC (Winter 2012 edition) by Hazel Findley, about bouncing back after a fall, whether it injures you mentally, or physically, or both.

Now, I went away to do some reading about this, to come back with some links to journals etc, but with climbing psychology, there are three aspects to discuss:
  1. Risk taking and associated behaviours within rock climbing (encompassed in this is fear behaviours)
  2. Climbing technique and behaviours towards training ("head in the game")
  3. Recovery from injury
Now, the first is well researched, and continues to be well researched. The coaching aspect of both climbing and other sports covers the second element.
However, it was the third I was most interested in, and the most pertinent to this blog. And this was the most difficult to find any climbing related evidence for. 
A lot of the evidence out there is related to whiplash / workplace / low back pain injuries, which is understandable as these are the most common type of issues, especially psychologically as it can come down to compensation disputes etc. when another party is involved.

Therefore, I will have to resort to generic guides around injury recovery. 
There are many theoretical models out there to read about, such as the health belief model and transtheoretical model of change (stages of change model). 
However, I'm going to keep it simple and use a common sense approach. 

If you are injured, then motivation will be lost. There is a link between motivation and functional outcomes during rehab - if you start losing positive functional gains with rehab, due to plateauing or other issue, then motivation will decrease, causing a further reduction in rehab gains. Like I said, common sense.
However, sometimes, as climbers, we have an urge to get back on rock as soon as possible - highly motivated, but not always channelled in the correct way. Sometimes, rest and relaxation is positive therapy - both for the body, and the mind. 

Within physiotherapy, my aim and approach is very much to educate the patient, both in the injury and ways in which the self management can be performed. This then empowers the patient in their own rehab, and letting the therapist guide the patient towards their goals. This way, the patient can fully understand the injury and aims of treatment, and therefore can be more motivated in recovery.

Goal setting is also a method used in physiotherapy, and can lead to an "increase in self efficacy and/or self-confidence as a result of accomplishing a set goal during the rehabilitation process."
I find this very useful too, as, for any patient, the end goal is open and known to all parties. Often, it can become difficult to discharge a patient, but if you identify realistic, timely goals in the first place, this conversation needn't be a difficult, and then everyone is singing from the same hymn sheet. 
It also means a common goal that is aimed for by both the therapist and patient, meaning it is patient orientated, therefore, no-ones time gets wasted! 

That is all I'm going to touch on the matter. I will leave you with the original article I read, and one last nugget of information.

Brukner and Khan (2006) have said that, to "market" treatment, the SUCCESS anacronym can be used - simple, unexpected, concrete, credible, emotional, stories - e.g. someones personal account of recovery rather than words in a book. With that in mind, here's Dave Macleod's personal recovery from foot surgery


BMC Summit Winter Edition 2012 

Brukner P, Khan K (eds) 2012 Clinical sports medicine 4th ed. Sydney: McGraw Hill pgs 267-268

Reese LMS, Pittsinger R, Yang J 2012 Effectiveness of psychological intervention following sport injury.  Journal of Sport and Health Science 1(2): 71-79

Sutherland AG, Alexander DA, Hutchison JD 2006 The mind does matter: Psychological and physical recovery after musculoskeletal trauma. J Trauma 61(6):1408-14.