Injuries are frustrating in lots of different ways. Even more frustrating is when they don't get better.
Let's be honest here- physio, rehab, health care, exercise, fitness, health etc. is not simple, and actually it is a lot more trial and error than you think, and more than most people are willing to admit! Really what we are doing is making educated guesses for treatment based on some science, our education and experience, and the person in front of us, then we see how you respond and do it again or change it! Sorry, but that is the truth!
Not everyone responds the same, not everyone has the same injury, and certainly not everyone is of the same health! All of this matters.
Some people respond very quickly regardless of the injury, and some people don't respond much at all. There are some theories on this based on a persons individual make up/genetics, but I don't know them very well and it would take a lot of deep diving into some heavy books and research to get a good grasp.
However, I do think that physio is awesome :), and most people do very well and will get better and reach all of their goals. I also think that there are some people who CAN respond well to treatment, but don't for various reasons that are changeable!
So here they are, and if you are reading this because you feel your injury or issue is not improving, see if one or more of these resonate with you, and make some changes.
In no particular order:
1. You are doing too much
This means a couple of things.
a. you are doing too much and not giving your body a chance to deal with the injury and settle down. Complete rest is rarely needed and there is nearly always a modification or change that can be made, but sometimes your injury is like a bruise- stop poking it (metaphor- it is probably not actually a bruise). Often you will hear clinicians say- if your eye is sore because it got poked, would you keep poking it?!
b. you are doing too much trying to "fix" the issue. Are you that person who is hopping from chiro, to physio, to acupuncturist, to RMT, to osteopath, to reiki instructor trying to get yourself fixed. Quit it- you are probably getting too many conflicting strategies and mixed messages, and probably don't have an actual plan in place. Choose one course of treatment, let them do their thing, and if they suggest bringing someone else on board to complement their treatment then that is great.
2. You are not doing enough
Again, I see this meaning a couple of things.
a. are you sticking to the treatment plan. As a practitioner it is frustrating when a client is irregular with appointments. What is frustrating is not how often we see you, but that it makes it difficult to come up with a plan. I am not advocating WEEKLY treatments until you are better (or even more if you are into the 3x a week model of care), but I am advocating communication with the therapist so that a plan is in place. I get it, getting in for treatment takes time, people are busy, and it costs money. So lets work with a plan. Tell me at the start if you can't come again for 3 weeks because your work schedule is crazy and you are on vacation, or whatever the process is. This is workable, if we know it is happening then I can give you things to do for 3 weeks, I can talk you through scenarios of progression and regression based on your response. This can work well if it is communicated. What doesn't work well is having 1 weeks worth of treatment, and then as you are running out the door telling me you won't be back for 1 month... that maths doesn't add up!
b. you are not pushing yourself enough. It is hard to implement change on the body. Take strength, it takes load and time. Example- doing overhead press with a yellow theraband 10x is not going to prep your shoulders for throwing your 15lb baby in the air- that just doesn't add up. If part of the process is getting stronger (and it should be) you need to follow parameters to actually get stronger.
3. You are being too specific
The body works as a system and needs to be trained as a system. If you have knee pain when running and you are only focusing on knee specific exercises, what about the rest of the moving parts when you run (ie everything)! What about your technique, what about your running volume, what about your hip strength, and calf strength, and all of these other factors which will contribute to how your body feels when you run.
If you are being specific to a tissue or joint, and it is not getting better, look broader. Look at how you can be healthier or fitter in general. Can you be better conditioned for the task you are trying to do and having difficulty with?
4. You are being too generalized
General health and functional movements are extremely important to consider and include in your treatment plan. But don't ignore the issue and don't be afraid to put some load and work on the local area. This might not be the first thing you do in treatment, but at some stage you definitely should train the injured area!
Take knee osteoarthritis for example- pacing, planning, and general exercise is all super important and has been shown to improve symptoms. But you need to rehab the knee, and specifically the quads.
5. Their are other related issues not being addressed
Pain is extremely complex and multimodal. Check out Greg Lehmanns cup analogy here. It is a great analogy and something I use all the time in sessions with my clients to help them understand the pain process.
If you feel that you are struggling to get better, you need to consider
General health- sleep, weight, diet, activity levels
Other injuries and painful areas. Yes your stiff neck is probably related to your shoulder pain in some way.
General life- stress, work, hobbies, family life etc.
6. Your expectations are too high
As practitioners we have all had the client who has experienced 10+ years of low back pain, but is frustrated that it is not better in 2 weeks, or 4 weeks, or even 6 weeks. To be honest with you, if you really thought it could get better in 4 weeks, you wouldn't have waited 10 years to see someone about it. Let us help you get a better understanding of the process of change, and what you are experiencing and going through.
Social media and the internet is a bit of a problem for this. There are too many 'quick fixes' and '1 treatment results' videos out there that everyone thinks their issue is a simple fix.
7. Your expectations are too low
This happens- more than you may think. You come in to treatment expecting that physio won't work, because it didn't work on your (insert body part here) last time. You are only here because your wife told you to do something about it, or your doctor suggested it. But actually you don't think it will help.
There is nothing magical about physio, it is a process and you need to work at it.
It has been shown that
More positive expectations = More positive outcomes.
Hopefully with some discussion around your issue and the plan, we can improve these expectations and get you on the road to recovery. But if you are against the result, it will be hard to get there!
8. You are not giving it enough time
Simply put, people give up before they have a chance to see change.
It is hard to implement change in the body, it needs consistency and it needs time to adapt. Think about how much time it takes to lose weight, build muscle, run further, get fitter! None of this is an overnight process and it takes time. That is the same when recovering from injury, so give it a chance and stick with it!
All of that being said, it is the role of your physiotherapist or health professional to manage all of these points with you.
If you are concerned with your progress, chat to the health professional about changes that could be made to the plan.
But most of all, stick with it, trust the process, and you will see the results!
Good luck and keep at it :)