By: Dale J. Buchberger, PT, DC, CSCS, DACBSP
It would be difficult to debate that today’s world has largely been groomed into an “instant gratification” society. Like it or not, if you watch television, use a cell phone or surf the Internet, you are being trained to live a life of instant gratification. This occurs in everything from your purchasing habits to relationships. Companies such as Apple and Samsung draw you in with the advertising strategy telling you why you need to wait in line to get the latest and greatest version of their products, even if you can’t afford it. Patients are now bringing this societal training into their healthcare. Many patients seem unrealistically disappointed if their condition is not cured in one visit or one treatment. Here is the bad news: unless Dr. McCoy from Star Trek arrives with his “Tricorder”, getting well will be one thing that maintains a focus on “delayed gratification”.
There are five main reasons why rehabilitative medicine, such as physical therapy, takes more than one visit. While some people may experience symptom relief in one visit, they certainly are not “fixed” in one visit. The simple answer is time. The human body takes time to heal, time to rehabilitate, and time to return to pre-injury levels of activity. How much time? It can take as long as a year to heal from any particular surgery or injury depending on the invasiveness and complexity of the surgery or injury. It can take a minimum of 4 weeks to begin to retrain your body to perform an activity such as walking or running. Most strength gains within the first 4 weeks of rehabilitation are not actually strength gains. It is your brain learning to perform the activity or exercise. You merely get better at performing the exercise. This is referred to as neurological training. It takes a minimum of 8 to 12 weeks to generate true muscle strength via muscle cell hypertrophy (enlargement of individual muscle cells) or hyperplasia (increase number of muscle cells). No one gets stronger or better at a task in one visit.
Once a plan of treatment and recovery is developed, it takes dedication from both the provider and the patient to follow through with the plan. There are usually moments along the way when the patient’s dedication will be tested. This is when the healthcare provider needs to assist the patient with either following through with the plan or recognizing a medical reason why the plan is not working and alter the plan to improve the rate of progress. Good communication between the provider and the patient can usually answer any questions as to why the plan is speeding up or slowing down. Sometimes patients that have had a complex surgery or injury can feel as though they are behind schedule when they are actually on schedule.
The plan requires that the patient take responsibility for following through on the various aspects of the plan. This is one of the more difficult aspects of a plan for rehabilitation of an injury or surgery. This means that the patient must keep their scheduled appointments, communicate with the treating provider, and follow through with the prescribed home exercise and treatment program. The patient may be asked to perform home exercises two times per day. Finding the two times can often be a challenge in a modern world. Therefore, performing a home rehabilitation program may require changes in the patient’s schedule of normal daily activities. It also requires cooperation and understanding from the patient’s family.
Behavior modification is the fourth and most difficult aspect. Changing the patient’s mindset from instant gratification to delayed gratification will make the process smoother and reduce frustration. Make your home exercise program a priority instead of watching television. Change your diet to allow healing. Reduce harmful activities. Be open minded to the rehabilitation process.
Finally, understand that the process of rehabilitation and healing is not linear, and that treatments and exercises are prescribed for specific reasons with specific goals in mind. Symptoms such as pain will change as the process goes on. As the rehabilitative process becomes more challenging, pain may temporarily increase. There may be increases in pain, early in the process during exercise because the healing tissue is being selectively worked. Specific stresses improve healing but it doesn’t mean it won’t hurt along the way.
If you are prescribed physical therapy treatment, be sure to communicate with your physical therapist. Supply clear and concise information about your injury or disorder. Always be ready to answer the question, “on a scale from 0 to 10 rate your pain, where 0 is no pain and 10 is the worst pain imaginable”. In the end, the provider’s plan is based on the information you give them. If you are not clear, then the plan may not be clear.