I can usually tell within the first 15 minutes of the first visit with a patient how they will do with the physical therapy intervention. It doesn’t matter so much the injury or issue they come in with, rather, it is their attitude on how they are perceiving their issue. While our focus as physical therapists is in biomechanical assessment and intervention, we humans are not robots. So much more goes in to how we feel, how we get injured, and how we recover. We are amazing beings and our bodies are influenced by a multitude of factors.
While attitude is a prominent factor for how an individual will recover from an injury, it got me thinking of other (non-biomechanical) trends I have seen over the years that affect the way someone heals and adapts to a physical therapy intervention. I have been contemplating, reading, and learning about these issues much over the past year. The longer I have been a physical therapist, the more I realize how much we don’t know about the body. We in the medical field also need to appreciate how all the different systems work together and affect one another. But that is the cool thing about our profession: still so much to learn and grow!
With that said, here are the top 3 factors that will affect your recovery from an injury:
- You attitude towards your condition
- Stress management
- Sleep quality and quantity
So what is the top factor that will affect your healing and recovery? Is it glute muscle strength? Core strength? Flexibility? NOPE.
Your attitude towards your condition means everything. What do I mean by this? Lets take a look at two different, yet very real patient presentations:
- Pessimist Peter: Peter comes in with right knee pain with running. He is very distraught. It takes him a while to lighten up and even crack a smile. Peter is training for a marathon in 3 months and is stressed that he will not be able to train full on because of this injury. He has had injuries in the past and had to take months off of running. He gets very stressed if he can’t run. His family knows when he can’t run as he is unpleasant to be around. Peter tells me that “I have IT band syndrome, I’m not sure what you can do for me. I did all the stretches Dr. Google said to do and I have been on the foam roller 6.5 hours per day.” Peter has labeled himself as an IT band syndrome and this is a big part of what identifies him as a runner now. He is not a marathon runner or heel striker or Chi runner, he has caught the dreaded IT BAND SYNDROME and this is the runner he now is. “I don’t understand why this is happening to me, I slowly increased miles and trained on soft surfaces. It is just unfair” Peter will tell me.
- Positive Paula: Paula comes in with right knee pain with running. She has pain, but is overall pleasant to be around and smiles often. She even is able to crack some jokes and laugh at her situation. Paula is training for a marathon in 3 months. While she has been injured before, she knows that this is part of the sport of running and she has plenty of time to get ready for the marathon. Paula realized that she is not a perfect runner and is excited to use this opportunity to learn from a physical therapist to get stronger and help her body become more durable for marathon training. She knows that she must have some bio-mechanical flaw that is creating her knee pain and is looking forward to address this to prevent future injuries. She views this injury as an obstacle that she will undoubtedly overcome and get stronger because of it. She knows she has plenty of time before the marathon to gain fitness and that a little time off of running will not significantly affect her performance.
Who do you think will recover quicker and have a good marathon in 3 months? A mindset toward your injury of “why does this happen to me” and identifying yourself by your injury will undoubtedly slow the recovery process. Taking a negative view of your situation makes recovery slower, makes you an unpleasant person to be around, and does not lead to long term prosperity or durability in your sport.
However, re-framing your injury in a positive light, such as looking at your injury as a way to become better and learn about your body, will lead to a much faster recovery time. Do not identify yourself as an injury, you are so much more than that. Focus on activities you can do to stay fit and active to get your mind off the fact that you may not be able to run or complete whatever activity you want to get back to. When the frustration arises that you are in pain and the injury is preventing you from completing what you want to do, re-frame that negative energy towards actionable steps that get you back to being healthy: your PT exercises, cross training, and other productive interventions that will get you back to your desired activity.
Want more info?
- Check out Obstacle is the Way by Ryan Holliday
- Read anything by Tony Robbins or check out his documentary on Netflix
- Read Man’s Search for Meaning by Victor Frankl (a must read for anyone, really)
- Tuesday’s with Morrie by Mitch Album is a classic to put life in to perspective
- This TED talk on gratitude
If we hit an unforeseen plateau in the recovery process, usually a discussion about stress arises. Stress can take on many forms. Having high levels of life stress essentially puts our body in a sympathetic or “fight or flight” response all the time. Yes, we are meant to tap in to our sympathetic nervous system now and then, however, we need to have the ability to quickly go to the opposing parasympathetic (rest and digest) system.
Many things contribute to being excessively stressed: overtraining, work stress, home stress, deadlines, poor sleep, injuries, poor coping mechanisms for when you are stressed, etc. I pretty much guarantee if life stress his high you are in for a long and frustrating recover process.
Being excessively stressed (elevated sympathetic nervous system activity) leads to improper bio-mechanics, high nerve sensitivity, poor tissue resilience, gut issues, improper breathing patterns, cardiovascular disease, and many other non-optimal life experiences. Life stress limits your ability to cope and adapt to physical stress, leading to a very high risk for injury.
What to do?
Well that’s great Craig, but stress is part of life, right? Yes, life stress is unavoidable and natural. However, our ability to understand stress and cope with it can always be improved. When you do have a stressful period of life, consider backing off on your physical stressors (that is, don’t train for a marathon if you foresee a stressful few weeks of work).
Top recommendations for stress management (to help you heal!!!)
- Practice mindfulness and meditate. The Headspace app is a great way to start. Becoming mindful of your thoughts are one of the most powerful things you can do to take control of your life. Bonus, by practicing the correct mental mindspace during training and racing will help you through those difficult races or workouts.
- Read Why Zebras Don’t Get Ulcers by Robert Sapolsky for the biology of stress.
- I also recommend Peak Performance by Brad Stulberg and Steve Magness. This covers many topics and will help multiple areas of life to re-frame your mindset and give you tools to change your life to reduce stress.
I think sleep is one of the most under-valued activities for health in the modern world (proper nutrition is right up there). Want a great way to feel crappy, not reach your athletic goals, lower your testosterone, put on weight, reduce muscle tone, and get injuries? Don’t get quality, regular sleep!
Quality sleep is one of the best performance enhancement activities you can do. And it is legal! Improper sleep affects reaction time, lowers HGH and testosterone (essential for recovery), reduces ability to burn fat, elevates cortisol (major stress hormone), increases sugar cravings, and reduces power and endurance.
So if you want to feel great, be happy, decrease your irritability, recover quicker, and be your best self, aim for 8 hours a sleep per night!
I know, I know, most of you will say you are too busy for 8 hours. Too bad, start to prioritize it. Just think of how much more productive and happy you will be if you get that crucial 8 hours. Your work-life, family-life, and athletic-life will prosper from it.
Ok, Craig, sleep is important, I get it. What do I do?
Glad you asked!
- No screen time (especially smart phones) after dark! Light from our screens stimulate cortisol release, keeps us awake, and leads to poor quality sleep when you finally go to bed. It makes our brain think it is daytime. Read a real book instead.
- I know, this is an unthinkable activity in 2018 and we are only going to get more dependent on screens over the next few years. Screen time for emergencies only. Social media updates don’t count as emergencies.
- Blue-light blockers (glasses or cover for your devices) can help, but still not ideal having those screens out.
- No caffeine after noon. Limit sugar intake all day, but especially after 3p.m.
- Make your room dark, quiet, and cool. No lights in the room. Get black-out shades for you window. Most sleep better when it is cool (cooler than 68 degrees Fahrenheit is ideal).
- Limit stressful activities at night. No work phone calls, driving on the interstate, fights with your spouse, etc.
- Use your bed only for sleep and sex. No TVs, computers, or eating in your room.
- Meditate in the evening to calm your mind.
- Make it a priority to prioritize sleep. If you have to wake up at 5a.m., start your night time routine by 8p.m. and have lights off by 9a.m.
Everyone can do those activities and they are a great way to start to get quality sleep.
Want more information?
- Check out Arianna Huffington’s Sleep Revolution
- Listen to this Rich Roll podcast with Shawn Stevenson and check out his book.
- Why sleep deprivation is toxic
- More info at sleepfoundation.org
So there you have it. The three most common issues that affect your recovery: attitude, stress, and sleep. Three things that are not valued near enough in our medical culture. Imagine how healthy everyone would be if they prioritized a positive attitude, managed their stress better, and had regular quality sleep? Chronic disease and pharmacuetical use would drastically decline. The best part? Aside from a few books to learn more about the issues, those changes are ALL FREE! No, they are not easy changes, but they are all very doable to anyone wanting to make positive changes in their lives.
Thought? Questions? Feel free to email me at CraigDeppDPT@gmail.com