Tips to Lessen the Psychological Burden of Injury

Nothing is quite as humbling and empathy-inducing than that of a health practitioner 'walking the walk' of an injured client.

Injuries are painful, disruptive, frustrating and just generally sh*t on all fronts.

The psychological burden of injury for musculoskeletal trauma, as well as the psychological burden of injury on athletes, has been well documented. Whilst a lot of the literature focuses on highly traumatic orthopedic injuries and athletic populations, even lower grade injuries &/or injuries to those who aren't elite athletes can still have a profound impact on an individual.

 The purpose of this article is to shed some light on things that we can & should consider when we are managing an injured client. These considerations have the potential to greatly influence the trajectory of our client's injury recovery, either positively or negatively, both physically and mentally.

It can be a double-edged sword, we as clinicians also need to ensure we don't project our negative beliefs onto a client.

Do you follow best-practice guidelines?

What are your thoughts, beliefs and opinions regarding injuries?

Do you have a healthy relationship to pain?

In light of a decent assault to my 4 MTP joint capsule & the collateral ligament, with the subsequent days enlightening me to the fact this is a recovery that will be weeks not days, as my initial denial/optimism was hoping for. It has been a great reminder of things we as clinicians can, should (and often fail) to discuss and address with our clients.

The Impact of an Injury

Injuries are disruptive, there is no doubt about that, but the scope of disruption can extend to all aspects of a person's life.

Yes there is the obvious physical impact, and for some the impact is more than others. We would be remiss if we fail to appreciate the psychological impact injuries can have on the individual as well.

When you have someone present to your clinic, it is important to consider what elements of a person's life this injury has the potential to impact. Zooming out and away from just the musculoskeletal injury itself, do you consider how this body part being out of action (to whatever degree) will impact their day-to-day life?

How will it impact their activities of daily living, their responsibilities at home, their recreational activities and also their occupation.

This is very much where we need to remind ourselves to treat the person, not just the pathology.

Occupational

A musculoskeletal injury can impede a persons ability to engage in their usual occupation. If the injury is not a compensable work-related injury, in most circumstances an employer won't have a legal obligation to provide suitable duties for their employee if they're injured. If someone has an injury and it doesn't impact their ability to work or place the individual at an increased risk of an adverse event, think work health and safety here, then the impact of the injury may be minimal.

However, if a person is injured to a point that they are unable to work and doesn't have sufficient accrued sick-leave or their employment arrangement doesn't include sick-leave entitlements the financial impact and subsequent stress can be profound.

Should a person with a musculoskeletal injury be able to engage in their usual occupation, either in their usual role or engaging in suitable duties, there are still impacts that the injury can have on their role whilst recovering from the injury.

For example, the disruption to work routines if they need to take breaks at work more frequently as a result of the injury, or being required to take time off from work to attend appointments.

Further to this, depending on the injury, the person and their role, an injury may have an impact on a person's productivity and cognitive function at work. This may come as a result of either a purely physical stand-point (ie: moving slower) and/or from pain stand-point, pain is very mentally draining and fatiguing

What Can You Do?

As with any treatment intervention or advice we provide, ensure that you are working within your scope of practice and scope of understanding. If a person (and their employer) require guidance, advice and recommendations relating how they can safely continue to engage in the workplace whilst recovering from an injury, but you feel this is beyond your scope of expertise or comfort, there are healthcare providers who deal extensively with occupational injuries who you can refer to.

Activities of Daily Living

It can't be understated how much an injury can impact our day-to-day lives. At home we may be slower doing tasks or may not be able to get things done at all, which is incredibly frustrating and upsetting, especially if a person doesn't have the social support networks around them.

From getting buying groceries, getting the kids to school, walking the dog, doing the laundry or even just time being on our feet preparing meals, all of these can be impacted. It is entirely within our scope to ask about and explore these elements with our clients, and we may be able to strategise with them on ways in which we can limit the disruptive element of the injury.

What Can You Do?

One important aspect is to be empathetic, supportive and continue to remind clients to be kind to themselves, especially if they are someone who is either highly independent (by choice) or they don't have the support networks around them.

If during a consultation you have discussed the above and the client has said they'll "be fine", but you do have concerns, I don't feel it is outside of our scope to check-in with them via phone and re-visit these questions. As sometimes the consultation itself can be overwhelming, there's often a lot of information they are processing. Not to mention, people (myself included) can underestimate how much of an impact the injury will have when they are going through the day-to-day motions of every day life.

Recreational Activities

Engaging in physical activity has numerous positive effects, physically, mentally and socially. For many, participating in physical activity serves as a primary outlet & method of coping with stressors from various aspects of their lives. Having this outlet impacted or removed, can be highly detrimental, with the effects coming into play rather quickly.

People will often experience a range of emotional responses & stress as a result of being injured. Emotional responses to injury include sadness, irritation, decreased motivation, frustration, anger, feelings of isolation and disengagement, in addition to alterations in sleep &/or appetite (AOSSM - Consensus Statement).

Having spent well over a decade working with individuals who have suffered a musculoskeletal injury &/or have been required to undergo surgery, it is never lost on me how important it is to encourage continuing to engage in physical activity, from both a mental health and physical health standpoint.

It is very easy (and lazy) for clinicians to simply advise a client to stop doing activity whilst they are recovering from an injury.

This advice can do more harm than good!

A great place to start when it comes to how we can approach our management of musculoskeletal injuries is with the editorial by Blaise Dubois & Jean-Francois Esculier Soft-tissue injuries simply need PEACE & LOVE, published by BJSM in 2019 (click here).

These recommendations are built on the strong evidence that exists for how integral these multiple facets are on the experience of those with musculoskeletal injuries, not to mention their recovery outcomes.

What Can You Do?

For more on the golden rules of loading click here

There are so many options that exist for us to help facilitate continued engagement in physical activities.

In my personal experience, it was this motivation for exploring options that actually lead me further and further down the path of musculoskeletal management more well over a decade ago. I'm sure many of you who work in regional settings can appreciate that oftentimes are are limited service availability, so can appreciate this anecdote...

I was working in a small town and managing a lot of musculoskeletal injuries for clients who were still wanting to attend the gym (a great referrer of injuries into my clinic). After a lot of frustration on my clients' behalf (and my own), as far as trying to get alternate strength programs devised that would facilitate the client being able to train around the injury. Which then lead me to obtaining my Cert IV in Fitness, purely so I had the knowledge (and insurance!) to write programs to allow gym goers to train around the injury. Having enjoyed that so much, lead to post-grad studies in rehabilitation and so on, now here we are...

This isn't to say that you as clinicians need to do this, but this is more so to empahsise that oftentimes people want to continue to be active and we have great scope to facilitate this, either personally or via our referral networks.

Treat the Person NOT the Pathology

In summary, it is important for us as clinicians to consider the person as a whole and not just the injury itself when it comes to how we approach our management.

By treating the person and not just the pathology, we can help ease the burden of injury for the individual and hopefully mitigate a number of the negative physical and psychological impacts the injury may have.

I hope this article has given you some insights into how we can better approach our management of musculoskeletal injuries with out clients.

If you're wanting to expand your knowledge, skills & confidence when it comes to rehabilitation lower limb musculoskeletal pathologies Exercise Therapies in Podiatric Practice will help you do just that.

Click here to find out more.