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Challenges of Rehab: Scaffold Building

Rehabilitation is hard for everyone. It’s being reminded everyday that you are not where you were before or where you want to be. You might find yourself checking in everyday to see if you are improving and often the gauge that stands out the most is pain.

Pain is an alarm in our nervous system to help us to pay attention to something, but persistent pain doesn’t have that same function anymore. It becomes more of a defensive response to any threat you perceive. It becomes a finicky alarm that sets off at any possible threat, whether it will cause actual damage or not. So often the challenge is having to navigate the experience pain during your rehabilitation process.

Rehabilitation is working on setting up scaffolding to support with rebuilding your life that is meaningful for you. As clinicians we help provide the tools and information to create a scaffold which includes sharing knowledge, coping strategies, guidance with building capacity and building confidence. However, the pathway through rehab is not smooth and often has bumps, ups and downs, and fraught with threats that appear to be dangerous but are actually normal experience.

To help you on your journey through rehab, these are the common experiences that many people have:

  1. Waiting for things to go back to “normal”: most people find themselves checking in everyday and waiting for things to go back to normal. Comparing themselves with how they were before the injury or to other people around them that may have gone through a different experience. But having expectations that you should be further along or you shouldn’t be having pain can trigger stress and frustration.

  2. Pain is not an indicator of outcome: pain itself is not enough of an indicator of outcomes with your rehab, particularly with persistent pain. It’s shifting the expectation that having no pain means you are getting “better”. Outcomes to watch out for are whether your ability to do things increase and your world gets a bit bigger. It may be that you can sit for longer spending time with your friend, go for a longer walk with your dog, go to the shops and come back without paying for it for the next day, or be able to drive that extra 15 minutes to visit your family.

  3. As your world gets bigger you are challenging your thresholds of tolerance: As you improve on your capacity despite pain, you start opening up more activities including, meeting more people, going to new environments which challenges your mental, psychological, physical and social limits. When you’ve have persistent pain and have been rehabbing at home, your world is much smaller. You create a safe bubble with contact with your people, in your space, doing things that you are comfortable with. Making your world bigger can be exhausting and a part of rehab is building up your tolerance across all your limits. Often this will challenge your pain threshold, which is part of moving it further to allow you to engage with more in your life.

  4. Moving back to life including work/school/activities can be daunting: It can challenge your perspective of how you feel about yourself and trigger memories about your injury, particularly if you’ve hurt yourself at work. Sometimes it’s going through the questions people have about your rehab and not feeling validated with your experience as often people won’t understand what you’ve been through. These are common experiences and it’s reminding yourself that it’s challenging in the beginning and overtime you will adapt and become accustomed to your new routine.

  5. Pain can be present through this whole rehab: You are constantly moving the goal post during rehab and you might not realise that when you’re in it. Moving a goal post means you will always challenge your tolerances and it’s a part of building capacity. So feeling similar pain in the beginning and further down does not mean you have not improved. It’s the outcome of your movement that shows you’ve grown and closer to how you want to live your life.

So having realistic expectations with your pain can help you manage dealing with pain, as you work with building your capacity. Working with your pain physio can help with understanding how to work through your pain as you work towards meaningful goals. As you understand your pain better, you’ll have the confidence to manage and eventually be able to remove the scaffold of rehab and live your most meaningful life.

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