I studied physiotherapy in Scotland and qualified in 2012 –10 years ago. I was playing hurling at the time—hurling (An Irish medieval sport played by lunatics). For my Canadian readers it’s a bit like lacrosse and field hockey combined. Look here https://www.youtube.com/watch?v=TmzivRetelE.
These guys are all amateurs like I was at the time, and we do it for the love of the game our families and our communities. When I was younger, I fractured my tibia in two places, dislocated my elbow and chipped a piece of my humerus and broke the left base of my thumb. These injuries and subsequent physio visits led me to become a physiotherapist. I defined those injuries at the time as serious enough to get checked and to receive physiotherapy treatment.
These injuries were the only major orthopedic injuries I got physiotherapy treatment for at the time. As I progressed through my physio career, I wondered why I never got treatment for the many groin, hamstring, ankle sprains and strains I picked up over my career. The time I broke my thumb I never went to physio treatment at all and the orthopedic specialist said the bone was already healing itself so no need for casting or anything. He word were " Just continue what your doing"
This spurred the question--"why did I get better or do pretty well without any intervention for the strains and sprains and why do some people need lots of physiotherapy treatment sessions and other do not need any.
It did tell me, especially within the Irish community and competitive sports perhaps in general that the competitive edge and "everything will be fine" approach comes with some pros and cons.
Most competitive sports people have mastered their own abilities to get themselves better with little to no intervention—i.e.—they thought their own bodies to release happy hormones like endorphins to modulate their own pain experience –a bit like the runners high one gets or that buzz you get after a good gym workout. You feel good about yourself.
The reason they have achieved this is because in my opinion:
Pros of this approach
1—They have been injured before and know that it usually gets better with time, moderate rest initially and some exercises.
2---They are generally not ruminators and catastrophizers.
3—They have positive beliefs and narratives about their injuries and bodies that allow them to heal within the natural healing process time frame.
4 –They are usually young men or women in this population with little to no comorbidities
Cons of this approach:
1—This population of people are mostly endurance copers—ie they keep persisting and pushing through the pain –this can be problematic for someone with shin splints for example that may develop a tibia stress fracture or compartment type syndromes.
2---There may be something like and ACL tear that goes unnoticed for a while because they are too stubborn to get it checked.
3—Young males' prefrontal cortex (an area of the brain that is associated with thrill-seeking and risk taking behavior) is not fully developed until about age 25 in men and age 16 in women . My wife told me this, she probably still thinks I am 25 years old ha, ha. In other words, we cannot access a situation fully until we are 25 years old—go figure. This is good and bad. It is also probably why young males do a lot of risky things at a young age--not entirely their fault. This amygdala underdevelopment , ego and machoism can be a toxic combination in the young male population.
The prefrontal cortex processes many factors before deciding if we have more danger in me signals (DIMS) or more safety in me signals (SIMS).
To conclude:
So, I was firmly in the first camp of “everything will get better”. Most hurlers would throw themselves under a combine harvester amid battle. We all know how our system can turn down the pain response in the immediate post injury phase. This is due to adrenaline, and it is a buffer system to allow you to get to safety before your body informs you of the true damage. If this was in our past lives it would allow us to possibly survive a tiger attack even after sustaining serious injuries. It numbs the pain temporarily buying us valuable time until we get to safety or find a tourniquet to survive etc. Other examples are when you hear a mother lifting a car off her child foot when it has been rolled over, where did she get the strength to do such a thing. We can override our normal functioning ranges sometimes in extreme situations. This is a good thing but sometimes pain can linger as our protective system remain on long after the tissues that were injured have healed producing a pain signal as the site of injury. The pain is real and not just in somebodies head but this is where pain can become chronic and problematic.
I did not know this at the time, but many hurlers have a super ability to heal themselves and I really felt I was not needed as a therapist, or at least I didn’t know how was needed. I now know I am needed but in a different capacity, so I travelled abroad to learn my craft and to build my brand.
There are times we need to check for other more serious issues lie DVT, osteosarcomas –they are usually very few but very important to catch, some injuries can take time to show their through colors, that is why a subjective history is so important and monitoring over a period of time is beneficial so things cannot be missed. There are also times where pushing through pain is not wise like when you have shin splints, this can result in stress fractures or when you have compartment syndromes (this is where compartments in your legs or arms swell from exercise (blood) and the fascia that surrounds them prevents the pressure from escaping. This can lead to permanent nerve damage if left un checked.
My job now is to triage people and then pick out the endurance copers from avoidant copers and formulate a treatment plan based on their subjective and objective assessments. This may mean scaling back on some activities (reducing mechanical and phycological stressors) for the endurance copers or actually completing painful activity for the avoidant copers despite some levels of pain (habituation). These people usually fall in the chronic pain cohort so I am not talking about acute injuries here but more long term issues.
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