One of the key principles to recovering from an injury or surgery is that the thoughts, attitudes and beliefs we hold about the surgery or injury can play a huge role in, and heavily influence our recovery time. If you are thinking about your injury in an unhelpful way, this can greatly increase your recovery time and not allow you to get back to work, sport or other functional activities you enjoy doing or are required to do on a day to day basis in the time it should normally take. As physiotherapists, our priority is to address the injury on a prompt basis to prevent it from becoming a chronic dysfunction.
When I was on a working holiday in Canada, I remember treating a young girl who had been in a motor vehicle accident. After a few treatment sessions and less than a week later, she was back to work and had returned to her regular activities. She came to see me a week after that and her pain was worse than ever. She was catastrophising about her neck pain and was nervous to drive. All because a work colleague of hers still had pain from a whiplash injury twenty years ago and convinced my patient that the same thing would happen to her.
My patient was experiencing a Cognitive Distortion.
Cognitive Distortions are the ways in which we think that cause us to get “the wrong end of the stick”, assume the worst and jump to incorrect conclusions. These unhelpful ways of thinking can turn a six-week ankle sprain recovery into a few years of ankle trouble!
Common Cognitive Distortions are Catastrophising, Mental Filtering, Black or White Thinking, Disqualifying the Positive, Jumping to Conclusions, Emotional Reasoning, Rigid Rule Keeping and Overgeneralising.
Catastrophising can be taking a minor injury and imagining all sorts of terrible things resulting from this injury. Try to acknowledge catastrophic thinking for what it is and try to recognise your thoughts as they occur. Take a step back and put things into perspective. Did the young lady mentioned above have a similar accident? Was she given the same treatment and advice early on as the woman with a 20-year history of neck pain? Consider the facts. Is there enough information to conclude that the young lady will head down the same path as her work colleague? The young lady could cope better with the situation by focusing on the fact she had made huge improvements in less than a week and was receiving correct advice early on to ensure an optimal recovery. Ideally, she could focus on what she could do to cope with the situation and use the skills and knowledge of the treating physiotherapist to ensure the best recovery.
Pain and disability associated with injury can result in anxious thoughts, leading to mental filtering, where we focus on the negative aspects of situations without considering the positive. If your usual physical activity for the week is four, 10 kilometre walks and a few weeks after you sprain your ankle, you are walking five kilometres, twice a week with discomfort after the walks, your natural tendency may be to negatively focus on the fact that you are performing half of your usual activity and are still in pain. To tackle this, take time to collect evidence and ask the physiotherapist if this level of activity is normal for this stage of recovery and hence attempt to contradict your negative thinking. This will enable to you to celebrate your achievements along the way, prior to achieving your end goal.
Black or White Thinking
Can you relate to the following? Your physiotherapist may set you up with a treatment plan on how to rehabilitate that strained shoulder muscle, only for you to go back to baseball too early and strain the muscle again. When things are black or white, we are either perfect or a complete failure and there is no middle ground. If we consider the shoulder situation above, the patient may consider that they have completely failed their plan and never go back to baseball again! To tackle this, consider that nobody is perfect. Realise that most people make mistakes and, as they feel pain-free and strong again, may return to activity too early. Consider and re-establish your goal, forgive yourself for the slip-up and resume your treatment plan.
Disqualifying the positive
Disqualifying the positive is about processing information in a very biased way. A positive event can be changed into a negative event very easily. For example, if you may have a lower back injury that will not go away and worsens every time you sit in your chair at work. Even though your lower back pain is improving and you are getting stronger each week, you tell yourself that your physiotherapy treatment is not working because your work chair flares your symptoms. Instead of feeling pleased with yourself that your pain levels are decreasing and you are getting stronger, you feel disappointed. Start paying more attention to your responses to the positives and work with your physiotherapist to modify the factors that aggravate.
Jumping to Conclusions
A patient may ‘jump to conclusions’ when they make a negative interpretation or prediction when there is no clear evidence supporting their conclusion. We may have a new patient present to the clinic with a sudden bout of back pain. They may have read that their back may take “months” to get better (according to Dr Google!). We encourage these patients to take a step back and ask their physiotherapist for an accurate diagnosis and timeline for recovery.
If we depend on our feelings as a guide, this can lead us along the path of despair and can lead us away from a realistic timeline of recovery. If you are dealing with a chronic injury that you don’t feel is improving at the rate at which you expect, you may feel apprehensive, like something more sinister is going on. Feelings are not the best way to measure reality, especially if you are not in the best emotional state because of your injury. Check in with your physiotherapist to discuss obtaining concrete evidence that supports your interpretation of your feelings. Is there actually any evidence that suggests something worse is happening? Could there be a better explanation of why your recovery is slower than expected? Practice asking your physiotherapist for the facts in order to lessen your emotional reasoning about your injury and set a realistic timeline for recovery.
Rigid Rule Keeping
“When I injure my lower back, usually every three months, I attend the physiotherapist three times and it is fixed”. What if your physiotherapist was to advise you that in order to treat your back and decrease the likelihood of the pain and dysfunction coming back, they wanted to see you for twelve weeks for a course of clinically prescribed exercise rehabilitation? The inflexibility of the demands you put on yourself by taking yourself through those three appointments, often means your recovery time may continue on for years instead of a few months. Adopting flexibility and being open to the fact that your physiotherapist is the expert and can in turn reduce your recovery time in the long run. Pay attention to your language used: replace “I need (three sessions…)” with “I would ‘prefer’, ‘want’ or ‘wish’ for a full recovery.
Based on something you have heard from someone in the past with an injury similar to yours, you make the assumption that your injury will follow a similar pattern. You may hear that your cousin’s friend’s mother’s sister ended up in a wheelchair after a lower back disc injury so you, in turn, conclude that all patients diagnosed with a disc related injury would follow the same path. Put things into perspective. How true is it that everyone with a disc injury ends up in a wheelchair? In fact, over 80% of lower back injuries are disc related and most are 90% better within a couple of treatment sessions!
We know that every diagnosable injury and rehabilitation post surgery comes with a predicted timeline of recovery and we also know that this timeline can be heavily influenced by our thoughts, attitudes and beliefs.
In order to lessen Cognitive Distortions getting in your way of optimising your recovery path, make sure you:
- See your physiotherapist and get the right information EARLY! If you injure yourself on a Wednesday; see your physiotherapist on Wednesday! Or the earliest convenient. Don’t wait until your injury “might get better”.
- Ask your physiotherapist questions, LOTS of questions. Obtain all the facts and make sure you have all the evidence to avoid a cognitive distortion creeping in!
- Work with your physiotherapist to set up CLEAR GOALS. SMARTER (Specific, Measureable, Action-orientated, Realistic, Timed, Evaluated, Reviewed) goals ideally should be set, with realistic timelines. WRITE these goals down and LOOK at them often!
- A CLEAR PLAN needs to be set, incorporating the goals mentioned above.
- CHECK IN with your physiotherapist regularly. Pick up the phone, write an email or pop in to see your physiotherapist. Ask those questions!
Written by Como Physiotherapy’s Director, Lauren May. Lauren has a particular interest in chronic pain, more so, an interest in the “roadblocks”, or the negative thought patterns and beliefs that prevent people from achieving their goals.
Come and have a chat with Lauren today!