Sometimes when I see patients who are likely to have a long recovery process I forget to mention the fact that the recovery is not smooth, that plateaus or dips are expected in the process. It is always a mistake when I forget to do that.
People who are recovering from a serious injury or surgery and who can expect the process to involve months rather than days or weeks can also expect that the recovery process will begin with a fast start, lots of improvement over the first few days or couple of weeks, then slow down. In nearly all cases, the process stalls after a few weeks and the patient then feels like nothing is happening and gets worried, or worse. In many cases the patient can even experience a setback in which case the result is the certainty that he or she is worse off then at the beginning. It is almost never true, but just feels that way because he or she does not feel as well as last week.
The reaction they have to the event most likely depend on whether or not I preset them with the information ahead of time. If I have preset the patient, then he or she comes in and informs me that recovery has slowed down, and that he or she may not too happy about it. If I neglected to mention it before, then there is considerable angst built up that has to be diffused before we can get on with that, and sometimes-future sessions. The basic facts are the same; the reaction varies in the extreme.
So, for you who have had a total joint replacement, particularly knees, who are recovering from an injured shoulder including a surgical repair, who are dealing with tennis elbow or some other repetitive strain injury or any of the other long recovery type problems, remember that getting better follows a graph incline that is much more like a stair step than a straight line. There are plateaus where the new status is consolidated, where the improvement is negligible for days or sometimes a couple of weeks, then it starts again. The recommendations I make for what to do next depends on what the status is at any particular time and whether more strenuous activity is warranted, safe or possible. If the patient anticipates plateaus along the way, then periods of mental stress over lack of improvement are more likely avoided and the whole recovery becomes easier, for both of us.
These comments are general in nature. Be sure to check with your physio or doctor if you are not sure whether they apply to your situation.
Dave Rohe is a recently retired physio having practiced in New Zealand since 2004. He originally qualified in the USA, subsequently practicing in Malawi, Egypt and Cambodia prior to emigrating to New Zealand in 2003. He has enjoyed management positions in pediatric and adult outpatient facilities as well as taught physiotherapy for 15 years at the University of Georgia. He is currently living in Parakai with his wife, Sharon Robinson, a local midwife, near his adult children who are working, and one of whom is studying to qualify as a physio through the programme at the University of Otago. His articles previously appeared in local newspapers in Taranaki and on the blog site sponsored by NZSPT.
