posts FROM PROFESSIONALS - 2019
physios supporting physios:
psychological series - episode 4
Dr. Stephanie Allen from Boston PT & Wellness is back! …with another incredible physiotherapist, Dr. Josh Walters from The Human Movement Rehab. In each episode, they will focus on a specific phase of ACL rehab, highlighting the psychological factors that tend to require greater attention during that given phase. They will share some of the ways that physical therapists can positively affect these factors, based both of their experiences and on the best available evidence.
"We truly believe that physical therapists are in a phenomenal position to address some of the psychological issues that arise during the rehab process, and we hope to help all of you out there gain some confidence in doing so with your athletes and patients."
the acute post-op phase
Earlier this week, @stephallen.dpt laid the ground work on ways to foster self efficacy by instilling competence, confidence, and affirming their athletic identity. Here are a couple more ideas to consider to encourage psychological readiness through the rehab process.
1. Lay the foundation- as Steph said before, set criteria or manageable gradual goals to help your clients see their progress, especially on the tough days. Also SET EXPECTATIONS (Peederman et. al., 2016) for future phases by educating about your WHY. They should have as much confidence in the process because they know what the ultimate goal is as well as the ways to get there. Educate about workload management (Eckard, 2018), energy systems, training methods, or whatever the case may be. Having knowledge about the interventions has a strong correlation with improved outcomes.
2. Address the setbacks- As therapists, we are good at making an awesome rehab plan after surgery, however our patients can hit the panic button when the unexpected happens. The person may have had previous experiences that are impacting their pain experience as well biasing their journey (Karos, 2018). Just like Rafiki says, leave the past in the past and address what is at hand. Remind people that setbacks are normal, pain doesn’t always equal damage, and move forward with what you CAN DO.
3. Leave Room to Fail Safely- In addressing the setbacks, there are also the hurdles when the patient comes to you saying “I over did it, what does that mean?” With highly motivated patients and athletes, balancing the line of appropriate challenge for their stage in rehab and not getting too far ahead is a delicate dance. Set them up for success by attempting the challenging tasks in house first before turning them loose. One of my favorite quotes to remind patients of the process is “You play stupid games, you win stupid prizes” .
If they go overboard, go back to point #2 - call stuff down and build them back up.
• The "return to sport" we are referring to is more so as it relates to higher level/elite athletes in this case, but many concepts can be extrapolated to all patients.
• The information presented is not intended to replace any necessary medical treatment or to endorse or recommend any particular type of medical treatment.
• This is more of a discussion about principles regarding some of the “soft skills” and less about exercise selection or practice guidelines
Dr. Joshua Walters is a Physical Therapist and avid exercise enthusiast from Oregon via his home state of Texas. He has a Bachelor’s of Science in Kinesiology, and completed his Doctorate of Physical Therapy at the University of St. Augustine for Health Sciences in Austin, Texas. Josh has been a personal trainer for 7 years. He is a CrossFit Level 1 Certified Coach and Certified Clinical Weightlifting Coach with a background in weightlifting and powerlifting. He is currently competing as a 105+ kg lifter in USAW.
Dr. Steph Allen earned her doctorate of physical therapy from Ithaca College in 2013. She stuck around Ithaca and completed an orthopaedic residency the following year, then decided to give travel PT a try. After almost 2 years of travel PT, she settled in Boston, MA at Boston PT & Wellness. She is now focusing on ACL risk reduction (and educating on the subject wherever possible), as well as strength and conditioning and movement pattern training in youth athletes.