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The Mental Game of Pain

Patient thinking of his pain while recovering from injury
The Mental Game of Pain

Your mind can be your best friend or your worst enemy. It takes time and a considerable amount of patience to build mental resilience. It's a strange saying for a physical therapist to say, since we only deal with physical ailments or impairments (or do we?). But there's more to overcoming pain and injury than just the physical. Oftentimes, I see the "mental game" of returning to a specific sport as much harder than the physical exertion seen in a physical therapy session (yes, a rehab session should be than you laying on a table). I always tell patients, "Yes definitely, the mental game is very real." These words are often repeated when I have an athlete terrified to attempt a similar activity that injured them in the first place. The mental game is very real, and can stall a patient's progress if not acknowledged and understood by your PT.

As doctors of physical therapy, we are the doctors of movement. We are the first line of defense when someone is feeling pain. We know our anatomy and biomechanics very well. But people aren't an anatomy and physiology textbook. People aren't robots. People have feelings, fears and complex emotions. I would argue a large portion of our profession is to listen to patients and acknowledge how they feel. Sometimes just being present and listening to someone will reduce their pain (this is where the "art" of being a healthcare professional comes in).

Healthcare professional listening to physical therapy patient explain his pain

I've seen it countless times, the boxer with a previous shoulder injury being hesitant to throw a punch, a Jiu jitsu competitor with back issues reluctant to do hard sparring again or a basketball player afraid to jump or cut after an ACL tear. It's a very real and appropriate response. It was a traumatic event and is processed in the body as such. It has physical symptoms but also mental symptoms. It's not something to be ignored by any healthcare professional. If your physical therapist doesn't have time to listen or acknowledge these mental roadblocks, find another one.

In a VERY general sense, the physical therapy process can often be boiled down to a certain sequence. This sequence can be broken down into 1.) backing off from certain movements, 2.) modifying your training program/adding rehab exercises, 3.) following specific lifestyle changes and then 4.) gradually reintroducing activities that hurt or injured you in the first place. This process of "graded exposure" is one I often explain to patients. At some point we need to get over the fear of that movement that hurt you in the first place. The physical therapist and patient need to get through it together, it's a team effort. It's often a long process and it will make you more resilient (both mental and physical) day after day. I would dare to say it makes people more mentally strong than physically if reframed in the mind appropriately (it's both but I'm making a point here :p).

Injured patient easing his way back to peak performance

The overall theme of this blog is to remember how the human body's systems always work together. Mental and physical are always working as one. Symptoms are symptoms, both mental and physical. Regardless, it's vital to always remember that you can get back to where you were before as an athlete. Don't let anyone tell you otherwise. You were there before and you can get there again. Find a physical therapist that encourages you, is an overall positive person and values your time enough to listen. This will greatly aid in your recovery journey. The mind will play tricks on you, that's ok. Having a good team around you and a positive mindset is crucial when recovering from injury. I would argue it's a crucial component to getting through all of life's roadblocks.

Comments? Don't Hesitate to share or ask questions below. Also don't forget to sign up for our newsletter :)

Until next time,

Dr. G


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