Updated: Mar 18, 2019
Do you have a PLAN?
You, yeah you. Do you have a plan? I’m not talking about the generic kind you write up for the documentation most payers require if you are a clinician. I mean a plan that you discuss with your patient.
Or if you are a patient, does your rehab provider have a plan for you?
When starting a therapeutic relationship, I believe patients need to know you have a PLAN. Education is most effective when you meet the person where they are, when it is individualized.
After an injury not everyone wants to get back to the gym or back on the bike. Many hate lifting weights and even more despise running. Despite what my recommendations are to help develop my patients’ resilience I never lose sight of their goals.
Over the years so many of my patients have relayed that getting back to gardening – without pain, was their goal. Gardening IS A THING!
The hallmark of an enviable garden is beautiful, green grass. When you see a perfect lawn, it’s a head turner.
For the many gardeners a plan can be discussed by talking about their lawn.
This post was inspired by one from Jason Silvernail PT, DPT, DsC, FAAOMPT that is titled Watering the Grass.
Tending to a lawn is a great analogy for the process of returning to activity when your nervous system is a bit sensitive. Here is a condensed version.
The analogy of watering the grass (aka REHAB) is split into 3 stages.
Stage 1. DON’T WALK ON THE GRASS when you’re trying to get it to grow.
This stage is most often early in the rehab process but the intent is that you don’t stay here long. During this stage you walk, just not on the grass!
You don’t plant grass seed, to never set foot on your lawn all summer. But you do need to allow for an initial environment where you minimize stress that will impede healing. This could be avoiding certain positions, activities or loads. Once your pain starts to decrease you move on to….
Stage 2. TIME TO ALLOW THE GRASS TO GROW
This is the building phase and it requires focus and commitment. Getting your lawn to grow requires diligent watering. Your grass is nourished through water and sometimes fertilizer. Our bodies are nourished by many factors including sleep, a healthy diet and improved blood flow with movement. Remember, “motion is lotion.” You dose the watering of your lawn just as you grade your return to activity, a little at a time.
Stage 3. WORK TO GET THE BEST LAWN POSSIBLE
You don’t want a lawn that only looks good for a couple weeks, or even just a summer. You want a lawn that will come back strong. In that case you need to build a resilient lawn, one that will be able to withstand some stress. That takes some time.
You start by doing just a bit of walking on the grass but what you really want is a lawn that’d be ok with a mini pickup game of soccer, cleats and all.
In this phase of your rehab you are building up your tolerance to stress, whether it be load in the gym or mileage in your endurance sport, etc. If you are a gardener it’s often tolerance to a deep squat position. Getting there and getting back up!
Stage 3 leads out of rehab – back to doing what you love and hopefully with the tools and mindset to continue to become more resilient.
Having a plan does not mean you should expect a linear progression in rehab. Flare-ups and periods of minimal progress might happen. It’s kind of like spring snowstorms, droughts or your neighbor’s dog running around on your new grass seed. Shtuff happens and these are contingencies that you need to adapt to.
That is the overall essence of a rehab plan: STRESS, ADAPT & GROW…. Like your lawn.
“Our body is not a machine. It is a garden. We’re a single organism.” Dr. Lorimer Moseley, PhD
Photos by Sharon McCutcheon, Daniel Watson, Scott Webb, Ochir Erdene and Adam Frazier on Unsplash