You should never run again. You should never ski again. You need to be careful. You are broken. You will continue to break down. Just don’t do that anymore then (insert the thing you love most).
Stop, please. Can we just stop this dialogue. Humans are resilient. We are strong, we adapt, we overcome. We are not frail. We are not fragile. We can rebuild. We can be better than we currently are.
People do this to each other, healthcare providers do this unintentionally all of the time with the words we speak. We instill fear of moving, thinking about being “careful” and drawing a picture that the body is fragile. Stop, please, stop.
Is there a time to set some guidelines (e.g. you fractured your bone, you need to be in a cast for 6 weeks without weight on it to heal)- of course!!! But when it comes to issues such as arthritis, chronic low back pain and return from injury (amongst others) we need to be SMART and SYSTEMATIC, but rarely do we need to be careful, cautious, concerned. We need to give guidelines - some pain that happens that stops when you stop the activity - and is no worse that night, the next morning - Is completely acceptable. If pain is above a threshold (say 5/10) or continues to hurt after an activity - that means the body was not ready for the activity (NOT that it was harmful).
More and more research is showing that imaging (x-ray / MRI) findings of more “chronic conditions” does not always line up with symptoms someone feels, but yet we often paint a picture from imaging of “degeneration”, “fraying”, “partial-thickness tears” - that 1) are often NORMAL findings on images and 2) may not even be clinically relevant. Once we have these pictures - it begins: the worry, the fear of making it works, the concern of “tearing” something further. Digging out of this trench mentally can be hard.
The last thing I will tell an athlete when they are returning to sport is to “be careful” - if you are “careful” on the field you are setting yourself up to get hurt again - if you are returning to sport at a high level - thinking about your injury when you are on the court/field is detrimental and you’ll be a step behind (which can lead to injury).
The number one factor associated with someone who had a total joint (knee/hip) returning to running is… if they want to run. If someone is gung-ho about running following a surgery - regardless of what anyone says - one day they will run again. And the individual- not their friends, not their providers - should not be the one making this decision based on how their body feels.
Overcoming fear of movement, fear of injury, fear of a little pain when moving is very hard when a picture is painted that you will worsen something. Pain is a vital sign - it does MEAN something - but it often does NOT mean tissue damage - it is asking you to change something (movement? Diet? Stress levels?).
Pain is a POOR predictor of tissue health or damage. There are times it lines up with tissue damage, no doubt. But for pains that have gradually started, without a mechanism of injury, without signs of acute damage (swelling, bruising, etc) - it comes down to the body wanting a break - to change activities, change movement patterns, improve strength, reduced work load on a tissue. If we can identify these areas, we can help to restore a well supported environment for the effected areas - and show people they are RESILIENT.
Try saying these to your friends or family (or patients) when they are hurt
Instead of “be careful” - say “be smart”
Instead of “you can’t do that” - say “Let’s help you work up to that”
Instead of you “can never” do that - say “that’s a great goal, Rome wasn’t built in a day - so let’s get you moving in the right direction” and give small achievable goals to work towards to big one!
Instead of saying “ you just have to live with it” - say “improving factors such as nutrition, increased physical activities, etc can help your body heal”
Let’s focus on what we CAN do vs what we CANNOT. Remember the body is resilient AF.