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Coming back from injury

Summary: 

In this special edition of The Confident Body, Michael Dermansky is joined by senior physiotherapist Will Ryan and special guest Natalie Hall who shares a patient’s perspective of coming back from injury. (And if you listen closely, you’ll hear our extra-special guest for the episode: Natalie’s dog!)

Natalie, who has a dance background, is a long-term client of MD Health who had a healthy and active life interrupted by injury. After enduring chronic pain for many years, with multiple surgeries as well as secondary pain from using crutches for a long time, she turned to MD Health to reclaim her active lifestyle. 

Michael and Will explore Natalie’s journey to recovery, and provide a clinician perspective on the challenges and successes they have seen with patients coming back from injury. 

CLICK HERE to read the full transcript from episode 7 of The Confident Body Show

Topics discussed in this episode: 

  • The importance of a positive mindset – not just the patient, but the practitioner. (4:40)
  • Why an assessment is the first step in overcoming an injury. (6:00)
  • Why recovery all starts with working the midsection of the body – the core, the back, the hips, the pelvis, the glutes. (14:00)
  • The importance of trusting your practitioner (16:00)

Key takeaways

    • While you have to be realistic, it’s important for the practitioner to have a positive ‘never say never’ attitude. Given Nat’s age and her overall health, getting back to what she loves doing was very achievable. (4:40)
    • The first step to overcoming an injury is an assessment. Here, we determine your previous levels of activity and identify where you are in terms of strength and movement and function. From there we determine what we need to work on specifically in order to get you back to doing the things you love. Finally, we set short, medium and long term goals to keep you on track. (6:00)
    • It’s important that patients find practitioners that will listen to your needs and continue to motivate you to push through. In this way you can become re-attuned with your body regarding what’s normal pain and what’s not normal, and not letting it restrict you moving forward. (7:30)
    • Once you’ve overcome your injury, you can then focus on going to the next level: getting fitter and stronger through strength and conditioning work so you are resilient to future injury. (10:30)
    • Working the midsection of the body – the core, the back, the hips, the pelvis, the bottom muscles – gives you a really stable base to be able to safely work on achieving other goals. When the core and pelvis area is strong and stable and resilient, your lower back, hips and knees are going to be better for it as well. It all starts in the mid-section. (14:00)
    • It’s vital to have trust in the professionals that you’re working with. Find someone that will listen and support you in the right way. Don’t be afraid to ask questions about what’s normal pain and what is pain that you need to stop. (16:00)

For practical articles to help you build a confident body, go to mdhealth.com.au/articles.

Do you have any questions?

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Our clinical staff would be happy to have chat if you have any questions.

 

Click on the Dash icon below to see the entire show transcript

Episode 7: Full Transcript

Voiceover: 

Welcome to The Confident Body, where experienced health professionals discuss how to get the most out of your body for the lifestyle you choose. We believe everyone can exercise and get the most out of life, regardless of your injuries or health issues. Now here’s your host, senior physiotherapist Michael Dermansky.

Michael Dermansky:

Hi everyone, and welcome to the show that helps you become more confident in your body so you can keep doing the things that you love. Today we’ve got a special episode; the topic is: what’s it like coming back from injury from a client’s perspective and also from a therapist’s perspective, and the different stages. 

We actually have three presenters today: myself, senior physiotherapist, Michael Dermansky; Will Ryan, branch manager and senior physiotherapist at MD Health in Paddington; and we’ve got a special guest today, Natalie Hall. She’s one of our customers, but I’ve also brought her onboard to talk about coming back from injury. 

I’ll get you to introduce yourself and who you are, what you do, how old you are, so the listeners know exactly who they’re listening to.

Natalie Hall:

Okay. My name’s Natalie, I have a dance background, but I’m currently in teaching, so a highly sort of energetic industry. I injured myself many years ago which led me to be on crutches for quite some time. I also had a bit of chronic pain as well, and being on crutches for so long also led into secondary pain into my back because of uneven walking as well.

Michael Dermansky:

Let’s go into that a bit more detail, Nat. Tell us about your injury. What actually happened? I know it was quite a few years ago, but what happened in more detail?

Natalie Hall:

Excuse me. I had some something embedded in my foot which they couldn’t find, and it was there for quite some time. It sort of hit a bit of a nerve in the foot which caused some problems, so I ended up having two operations. Yeah, which is why I was on crutches for so long. So, yeah.

Michael Dermansky:

What happened from those operations? What effect did it have in your life?

Natalie Hall:

Well, I couldn’t get my heel to the ground. They originally said to me, “Don’t expect to get your foot right to the ground.” Again, uneven walking, and I’m not used to being less mobile, I’m very physical. It does take an emotional toll on you thinking that you’re not going to be able to do those things that you love anymore, but was very important not to listen to that and just keep going.

Michael Dermansky:

Did you have any pain or any other issues around it too?

Natalie Hall:

Discoloration in the leg, pain in my back, pain in my foot and leg, lack of sleep as well because of pain. Pain usually pops up mostly at nighttime when you’re trying to get a nice restful sleep.

Michael Dermansky:

What did your life look like then? I mean, when you had this injury, you had something embedded in your foot, you had two operations, you were on crutches, what did your life look like compared to what it used to be like prior to that?

Natalie Hall:

Prior injury, I used to like to go to exercise classes. I used to walk long distances, dance a lot, go out with friends, those sorts of things, gardening, all those sorts of things. I was always on the go. I’m not used to not being able to do those kinds of things.

Michael Dermansky:

Okay. And tell the listeners a bit more about how did your life change after that too? How was it different?

Natalie Hall:

I was quite depressed actually because not being able to do those things that I loved. So it did lead into a bit of being down for a little bit, but again, it was more about not listening to people that tell you can’t do something, and continuing to push through that, and not putting too much pressure on yourself that those expectations as well. It was really baby steps. If you’re happy to sort of be okay with those baby steps, I think that helps because sometimes I feel people put too higher expectations on when they should be improving, or they get into that mindset that people can’t help them so they just sort of stay in the same cycle.

Michael Dermansky:

Right. And from your perspective, if you heard that story that Natalie said that she had something embedded in her foot, she had two operations, she was told she wouldn’t be able to put her foot back down again, she was very active before that too, and now she’s no longer that way too, she’s on crutches, has a very different life, what would you do? What would you think when someone like Natalie walked through your doors?

Will Ryan:

Well, I wouldn’t be as negative as what maybe some other people said in the fact that you can never do things again. I like to say to people never say never. Obviously, you have to be realistic, but I feel like given Nat’s age and things like that, getting back to all those things she loves doing is all really doable. The first thing I would do if Nat and I sat down and had a chat if she came to see me in clinic would be to really establish what her previous sort of levels of activity were, then sort of what her goals are in both the short term, medium term, and the long term,, and how we can sort of work together to get back to doing things she loves again.

Michael Dermansky:

Right. And where would that take you? I mean, if you find out what you want, what her medium, short term, long term goals are, what direction would that take you after that?

Will Ryan:

Well, the next step for me would to be looking at sort of what Nat’s level is now compared to sort of, I don’t like to say this, but compared to, I guess, the normal. If I got a good idea of where Natalie was at, obviously she had that injured foot, so I imagine that whole side would be quite weak as opposed to the other side that was taking weight even when she was on the crutches, but I imagine both sides would be a little bit weaker than normal. The assessment stage next would be the next important part in figuring out where Natalie was at generally with everything in terms of her strength and movement and function, and then sort of working with her from there to figure out what things we need to work on specifically in order to get her again back to doing those things that she loves.

Michael Dermansky:

Great. Nat, what about from your perspective? You had these injuries, you were told that you had to have surgery, you were told you couldn’t do these things. I mean, what does your life look like? We’ll go to the after now, then we’ll go to what led from A to B. What does your life look like now? Is it still restricted? Are you still on crutches? Do you still have all the restrictions you had when you had this operation? What’s it like now?

Natalie Hall:

No, pretty much no restrictions. I mean, they did do what they could, but with their methods, my heel only got so far. It was only sort of continuing with the reformer Pilates with you guys that I got it fully to the ground and got pretty much full range back. I can just do things normally now, wear whatever shoes I want to and not feel restricted.

Michael Dermansky:

Well, the important part, you can wear whatever shoes you want to now. That’s really, really important.

Natalie Hall:

Yes.

Michael Dermansky:

But talk about the story about what happened. What led from A to B? How did you get from there to where you are right now as well? How did you work through those different stages?

Natalie Hall:

Not giving up. Some people might say, “Well, there’s nothing more I can do for you.” It’s about finding the people that will continue to support you with your needs and listen, and also continue to motivate you as well to push through sorts of things and becoming more familiar, and re-attuned with your body pretty much of what’s normal pain, what’s not normal pain kind of thing, and not letting it sort of restrict you on moving forward.

Michael Dermansky:

Okay. What did you do? I mean, you didn’t just the Rs. What other things did you do to get you to a stage, and then what else did you do to get to the next stage after that too?

Natalie Hall:

Again, reformer Pilates basically helped me a great deal type thing, and just continuing to do the day to day things that I like to do, so might be going for a walk, but not as far as what I used to just until I gradually get better, hydrate therapy, relaxation, and positive mindset. Having that growth mindset’s really, really important, especially with people with pain because they tend to get in that stage of well, it’s never going to get better, I’m never going to not be in pain, those sorts of things. It’s getting up and getting motivated every day and not giving up.

Michael Dermansky:

And so, when you did do an activity and there was pain, how did you take that? What did you do to manage the situation to take yourself to the next level after that and the next level after that, next level after that? Because you’ve got a very fairly unrestricted life now, but that wasn’t always the case.

Natalie Hall:

Just rest it when needed, and yeah, just sort of take it easy. Yeah, just become, as I said, you need to really become familiar with your body of what’s enough and what’s too much, and you will get pain along the way, but it’s just resting it when you need to, those sorts of things.

Michael Dermansky:

Okay. And so, what does your exercise regime look now? What would you physically do these days as well in terms of exercise regime and in terms of the lifestyle you have right now?

Natalie Hall:

Lots of walking, I still sort of do my own little sort of dance exercising as well, and I just, I still do your programs at least a couple of times a week. So, yeah.

Michael Dermansky:

And do you still get pain now these days?

Natalie Hall:

Nope. Not really, no.

Michael Dermansky:

That’s fantastic. When you hear all that story again, Will, if Natalie walked through your door when she’s like now, I mean you’ve taken her a few times as well, where would you take her program to the next level as well? Where could she possibly go? And it always really depends on her goals, but what would your thinking be where she walks into your doors at this stage, as opposed to where she was previously?

Will Ryan:

Yeah, I guess at this stage now it would be instead of having those goals of getting back to full function and the things that she loves now that she’s doing that which is awesome, it would be all right, how can we take you to the very next level as well, how can we get you fitter, stronger, keep you as resilient to injury as possible as well. I’d start looking at doing things like adding in more strength and conditioning stuff on top of the reformer Pilates work as well, whether that’s using barbell weights or even just starting with something as low as maybe some high intensity training on the bike, just to add in that extra little bit of even harder stuff, just to continue to push a little bit, but again, we’d do it with Nat’s guidance too. It would be very much dependent on how she pulls up after those sessions and things like that onto how hard we push it. But it would just be those extra little things just to take it to the next step as well.

Michael Dermansky:

And if there was a next step, what would be the ideal for you, Nat, where you say, “This is the absolute ideal life I want.” What would that be?

Natalie Hall:

As in for exercise?

Michael Dermansky:

Yeah, physically. Yeah, not so much the exercise itself, the outcome of the exercise. This would be great, like, “I’d want to dance again or I want to do something else.” What would be your absolute ideal, the perfect physical state for you?

Natalie Hall:

Yeah, pretty much working on that now is, a bit more flexibility back and the strength for general wellbeing, your body strength in general because the line of work in particular that I’m in, I don’t want to get injured, whether I’m at work or at home. So, just keeping that strength up, especially in the legs, the back, and the core is really important as well.

Michael Dermansky:

It seems like a very common theme we’ve had all through these last seven episodes where having the strength back to be able to round the hips, the pelvis, the core, this has been a very, very common theme, and you’ve talked about adding more in terms of barbell work as well, how important that’s been? How do you see that? Because we’re seeing a very common theme emerge over the last six, seven episodes as well.

Will Ryan:

Yeah, it’s exactly what Nat said. We just keep building on what’s there, but just by pushing things even harder in particular, those areas around that sort of, I guess, midsection of the body, the core, the back, the hips, the pelvis, the bottom muscles are a big part of that. All that gives you that really stable base to be able to start safely working on other things, whether that’s doing more dancing, training, going for longer walks at a higher intensity, or whatever it is.

Michael Dermansky:

Why is that so important to work on that core, the stability of the hips and pelvis? How do you see that, Will? Why is it so important?

Will Ryan:

Well, I guess that’s the base of where our arms and legs move off is that core, that pelvis area. When it’s nice and strong and stable and resilient, generally the stability, what we kind of say, it’s a bit of a lingo term, but down the chain or up the chain is a lot better as well. If you’re really stable around your midsection there, your core, your lower back, your hips, odds are your knees are going to be better for it as well, and from there your ankles too, from there your feet. It all sort of starts in the middle sometimes, but even if I did see someone with a specific ankle injury, I would still probably incorporate some of that mid-section type strengthening work as well because yeah, you got to look at it almost holistically, I guess.

Michael Dermansky:

Well, I mean, you’ve been taking a slightly different perspective and nothing to do with that Natalie here is if someone has a knee reconstruction as well, one of the major parts around that is controlling around the hips and pelvis. If your hip control isn’t well, you’re going to wobble all over the place, and it’s going to put that graft at risk, or it’s going to put you more at risk of re-injuring as well. It’s a massive part of the whole picture of what makes someone stable, and we know that even with knee problems, for example, about 50% of the control comes from the hips and 50% comes from the knees. If you don’t address both, you’re really missing the whole picture of the reason why someone has the ability to do different tasks and keep their body under control.

Will Ryan:

Yeah, and I think Natalie would probably attest to that. With the foot issue that we were working on, she would’ve done a lot of work around the hips as well. Is that right, Nat?

Natalie Hall:

Yeah, correct.

Will Ryan:

Yeah.

Natalie Hall:

Yeah/ and a good extension of what you do as well also helps improve general wellbeing. Fatigue, I have way less fatigue, not that I’ve been too fatigued, but it just helps with fatigue and general wellbeing, I think as well, and I think a big misconception can be is reformer Pilates exercise for people that do have injury, but not necessarily. It could just be to strengthen your body or general wellbeing or injury prevention like you mentioned before.

Michael Dermansky:

It’s an interesting you talk about injury prevention and for wellbeing, but let’s go back a little bit on the pain side, and your journey was interesting because the pain and the injury didn’t stop you seeking help. You still did something about it. We have a lot of clients, and Will’s been in the same position as well, where a lot of people fear doing things because there’s pain and I must have pain, I must have an injury, I can’t do it. Why was that different for you? Why did that paradigm not be a limiting factor for you? Because it shouldn’t be, but it is a lot of the case. I have pain, I have an injury, I can’t do it. How was that different for you, Nat?

Natalie Hall:

I think it’s the trust in the professionals that you’re working with. If you’re not getting the right outcomes from one person, you need to find someone that will listen and does support you in the right way. So, that positive vibe that you provide and also the encouragement as well and not being afraid to ask questions. A lot of people don’t understand what’s normal pain and what is pain that you need to be aware of and stop. So, not being afraid to ask about the types of pain that you’re getting, is it normal, those sorts of things.

Michael Dermansky:

I think that’s a really good segue for you to have a chat with your perspective, Will, because I mean, Nat’s pretty much nailed it on the head, but as a health professional, how does that pain injury cycle fit in with you? How do you understand it and see it for the patient’s perspective or client’s perspective?

Will Ryan:

Exactly what Nat said I think in terms of identifying what pain is real pain and what pain is okay to deal with in terms of exercise component. When you are injured, and I know this personally from being injured myself as well, but to get better, you actually need to move that injured body part in the best way that you can. It might not be if you’re not up to the capacity yet to run or jump or whatever it is, at least walking is still using that a little bit. It might still be being uncomfortable walking, but it doesn’t mean that it’s going to do any further damage or anything like that. I think that’s really important.

Will Ryan:

Quite often when we do, I guess, see people who have had that longer term injury history as well, they do find that they might be very scared of doing things, but then from my perspective, it’s like, all right, let’s say they’ve had a low back injury and they’re scared of bending over and picking something up off the floor. Well, if I can get them bending over and picking something up from like a chair height first, that’s a great starting point to getting to that full bending to pick something up off the floor. It’s about gradually exposing people to these things that they’re scared of doing because of injury, and then as their pain and injury improves, you can just build it up further and further and further in order to get to that full movement and get back to that full activity that they were doing before.

Michael Dermansky:

I mean, that’s it, it’s that borderline, I guess the balance of science and art, knowing where because you need to ask people to do a little bit more than they’re comfortable doing to be able to get a change, but not go over the top, and that really tight balancing act between what’s a good amount of level to make change and what’s too much that is causing damage as well. It’s a real fine balancing act, and I guess that’s the art of it just as much as the science of it too.

Will Ryan:

Yeah, a hundred percent. You’re always walking that little fine line between too much and not enough. I think once you get a really good understanding of the patient and they get a really good understanding of you, that’s when you can find that really happy medium, and that’s when you really start to see the results come to effect.

Michael Dermansky:

Yeah, okay. Nat, now that you are much more active as well, what’s on the horizon for you next? Any particular physical aspirations that you haven’t achieved yet that you want to do next?

Natalie Hall:

I think it’s like with anyone that as you’re getting older, you want to not lose the ability to be able to be as active as you were, I guess, when you were younger as well. So, keeping fit as well because when you’re fit also, it’ll help with other things. Just general wellbeing.

Michael Dermansky:

And I guess that’s a big thing I hear as well is that people want, I want to be just feeling well, I want to have a good general wellbeing, and having that good balance of strength, balances of control. Lifting weights to be strong enough is a massive step to have that sense of wellbeing when you do have an injury and when you don’t have an injury. Well, thank you very much, guys. I think that’s a great conversation of where someone’s taken their life when they have an injury. It hasn’t held you back, Nat. It’s been great and allows you to really have the life that you want to have. It’s great to hear that you’re not restricted now because you’ve had any previous injury, because you’ve had chronic pain, because you had a surgery. None of that’s really holding you back in your life.

Michael Dermansky:

That’s exactly why we want to see people’s lives. It’s not about them getting over an injury. It’s about them having the life that they deserve, and as you said at the very start and why we’re running this show, the reason why you want a confident body is to be able to do the things you love and enjoy your life which is why we want to live. Will, anything you want to finish off with, any summary that you want listeners to hear, Will, before we finish off about coming back from injury? any take-home messages?

Will Ryan:

I’d just like to really reiterate what Nat said about the positive mindset thing. I think having that positive mindset if you are injured and sort of having that outlook that I am going to get better, I am going to get back to doing these things, I feel like that shouldn’t be underestimated. That should really be everyone’s main mindset when they do have an injury.

Michael Dermansky:

Natalie, anything you want to add to the end of the show?

Natalie Hall:

No, I think I’ve pretty much covered it.

Michael Dermansky:

Right. Fantastic. Well, thank you very much guys for the interview. It was a great interview. Next time we delve into the next topic in a couple weeks, and thanks for your time. Thanks everyone.

Natalie Hall:

Thank you.

Will Ryan:

Thanks.

 

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