When I asked my physical therapist what she feels are the most important elements in healing, she responded first that getting the swelling down was key in allowing a person’s body to heal and feel less pain. I had been wrestling with factors like age, level of physical fitness prior to diagnosis or surgery, amount of support, expertise and connection with the person’s medical team, attitude toward healing and experience with and toward pain.
Another physical therapist mentioned nutrition, age and shape of the tissue prior to surgery (how long from time of injury to date of repair). I wonder about sleep, and its healing power as well. And of course though neither of them mentioned it directly, how much a person follows up on the exercises prescribed by her therapist will also make a difference, as will attending the therapy sessions. Neither can replace the other.
My massage therapist answered immediately that it is a person’s mental attitude that most affects outcome. That and how fit someone is prior to surgery. If a person is expecting to do well, she finds that they do. If someone goes into surgery expecting it to be terrible, then they often experience it that way.
It is a complex matrix of all of these factors and I’m fascinated by the interplay and balance of them, as well as how to stack the deck toward greater healing.
I asked my regular PT whether the protocol following the repair of the massive tear in my rotator cuff was based on the injury itself, or some other factor. She confirmed that it is indeed based on the injury itself, so a 20 year old woman would take the same steps as a 70 year old man. The older person might need more time, but the 20 year old would not be allowed to move more quickly than protocol dictates.
I understand the necessity of standards of care and that the team has experience with many many people in treating this injury and how the safest, most efficient recovery can happen. My therapist is not willing to risk further injury or compromise the repair just because I am eager to move ahead and I feel ready. My subjective experience of readiness must be weighed and balanced with my therapist’s knowledge. It is a challenge for someone who is active and impatient. Who wouldn’t want to feel better NOW?
As I gradually use my arm more, I must be mindful of not pushing too far. Because I have no reference point other than my own, I must be content with moving along as I have. What facilitated my positive outcome, and how can people benefit from this?
The way someone experiences pain, and level of fear is also relevant. Fear can get in the way of willingness to try something new or push a threshold. This can be helped with information. The clearer I am about what to expect, the easier it is to try something and push myself. Knowing the difference between discomfort that is in the service of stretching and healing and pain that indicates something one shouldn’t be doing is important to distinguish. Muscles getting used to doing new things can feel good, even if a bit uncomfortable at first.
The more we know, though, the better position we are in to partner with our health care providers in moving through surgery and recovery as quickly as possible. It requires paying attention, being aware of our bodies, and noticing the differences day to day, the incremental gains as well as the warning signs to back off. The dynamic, ever changing miracle that is the human body has never benefitted more from the interventions that medicine and the multiple therapies have to offer.