Lifestyle Behaviors on Rehab and Performance
When I was fresh out of physical therapy school, I honestly thought I could “fix” everyone’s musculoskeletal problems. It didn’t take me long to realize there are just some injuries that cannot be fixed with physical therapy. For example, physical therapy alone will not return an ACL-deficient infantryman back to heavy rucking on uneven terrain, kicking down doors, and clearing rooms in a combat situation. Additionally, through experience, I quickly learned about the impact psychosocial factors have on an individual’s rehab prognosis and athletic performance. In the Army these include, but certainly not limited to, combat related PTSD, general anxiety, and secondary gain (duty restrictions, disability income, etc.). These are lessons I learned fairly early in my career, and I was able to adjust my practice accordingly based on the patient’s history.
Unfortunately, what took me over five years to truly realize and appreciate was the influence a patient’s lifestyle choices has on their rehab potential and/or physical performance. It’s shocking to think it took me this long, but the choices a patient or client makes outside my walls can either hinder or completely prevent the beneficial effects of physical therapy and programming. Basically, I can give someone the best services available, but it won’t matter if they make overall poor lifestyle choices. Despite the huge impact these behaviors on physical rehabilitation and athletic potential, we oftentimes overlook them or completely avoid the conversation altogether. The goal of this post is to simply give the “For Dummies” overview of the impact of some key lifestyle choices. This is not meant to insult anyone’s intelligence as it seems commonsense. However, as I hinted at earlier, the physical therapy and coaching professions in general can do a better job at addressing these issues.
Here is my list of key lifestyle factors that can and should be discussed with patients or clients: general health, physical activity, mental health, stress management, sleep, diet, and tobacco use. As medical providers and coaches, we should have a general understanding and grasp on each of these topics. Below is how I explain the importance of these lifestyle choices on their physical rehabilitation and human performance.
In the strength and conditioning realm, it is much more challenging to have a new client who has multiple physical restrictions and comorbidities. The same is true with rehabbing injuries. The prognosis for a generally fit athlete after a meniscus repair is much better than an obese diabetic with a similar surgery. There are certainly several health issues we cannot control, such as cancer and many other conditions; however, there are multiple other health traits and characteristics we can positively manipulatewhich can ultimately reduce our risk for illness while improving our rehab prognosis and overall performance. The keys are to remain generally active and maintain a healthy weight.
For most injuries there are two “worst things” someone can do regarding physical activity:
1) become a couch potato, or 2) ignore the pain altogether. Becoming sedentary and avoiding physical activity may temporarily decrease pain symptoms but ultimately leads to deconditioning, stiffness, fear avoidance, and other physical impairments which complicate the rehab process. Basically, they are digging themselves into a bigger hole. If they ignore the pain and take a “pain is weakness leaving the body” mentality, he or she will further perpetuate the problem. This turns a smaller injury into a larger injury and delays the healing process, similarly to picking a scab trying to heal. In general, modified physical activity is great for injury recovery as it promotes blood flow, joint lubrication, and pain modulation. The amount of physical activity you can/should do varies based on the injury and individual. Your physical therapist or a good personal trainer can advise on what may be appropriate for you.
There is a tight relationship between how a person mentally or emotionally feels and how they physically perform and feel. Google “depression and chronic pain” and you will have plenty of scholarly readings to keep you occupied for days that support this statement. It’s a vicious cycle I see too often with our military population: the more depression/anxiety/anger a patient feels, the more pain and general musculoskeletal dysfunction they experience. It’s impossible (and unhealthy) to attempt to avoid all “negative” emotions that come with simply being human. The key is to acknowledge and know how to manage them when they are present. There are multiple different ways in addressing general emotional and mental distress including meditation, journaling, diaphragmic breathing, and many others. It’s important to know what works for you and your patients/clients while also knowing when to refer out to a specialist. And, as an individual going through an emotional and mental valley, it’s crucial to know when to push ego aside and seek help.
Humans have two parts to our nervous system: sympathetic and parasympathetic. The sympathetic nervous system is the “stress” system that is responsible for the fight-or-flight response. When it is active, adrenaline and cortisol levels spike to prep the body to handle short durations of stress (ex: run from a lion or fight the lion). To the body, stress is stress regardless if it is from a legit physical threat or from a looming deadline. Due to our high -tress lifestyles, our bodies are in this sympathetic state more often than intended which ultimately harms us. The goal is to spend more time using our parasympathetic nervous system which helps down regulate our bodies and allows for recovery. This is the active system when we are calm and relaxed. If you are stressed, finding ways to relax and appropriately handle your stress will be beneficial both physically and mentally.
Sleep is arguably the most vital component to injury recovery and pain management over all other lifestyle behaviors. While we sleep, we see a spike in hormones that aid in recovery (ex: growth hormone) while others that inhibit recovery drop (ex: cortisol). When we are awake we are constantly breaking down our bodies through activity and stress. With adequate and quality sleep, we are able to undo the harm and promote optimal healing. Without good sleep, we are perpetually breaking down our bodies. If a patient or client is not sleeping well, please discuss this with them or encourage them to see their healthcare provider. Treatment options vary greatly from simply changing nighttime routines (dimming lights, avoiding stimulants/alcohol, avoiding “screen time” before bed, etc.) to medications to sleep studies (to rule out sleep apnea).
What we eat is converted to the fuel and building blocks for our bodies, and the quality certainly correlates with the quality of our diets. Consequently, eating poorly will lead to poor performance and poor recovery. Our bodies need a good balance of HEALTHY carbohydrates (vegetables, fruits, whole grains), HEALTHY fats (olive oil, nuts, avocados, seeds), and protein. Carbohydrates serve primarily as fuel for our bodies, and eating unhealthy carbs is like putting diesel fuel in a jet engine…not ideal. Fats regulate hormones and serve as a secondary fuel source. Fats are not bad like most diets indicate and should be consumed in moderation (focus on unsaturated fats over saturated fats). Proteins are the building blocks for our bodies’ tissues. Without protein, we can never rebuild what has been broken down. If an athlete or patient needs additional help with their diet, consider referring to a registered dietitian for further assistance.
By now most of us should know that ALL tobacco products (cigarettes, cigars, dip/chew, electric cigarettes, etc.) are bad for overall lung and heart health. However, what many do not know is that tobacco products also significantly delay the body’s ability to heal and recover. Tobacco decreases general blood flow and oxygen delivery to the tissues and cells. Blood flow brings oxygen and nutrients to the cells while removing harmful cellular wastes and carbon dioxide. Without optimal blood flow, the body has a difficult time bringing in the “good stuff” and removing the “bad stuff”. Ultimately, tobacco use significantly delays the healing timeline or even prevents healing from occurring. There is a plethora of resources available to help individuals quit using tobacco products.
Bottom line, we as providers and coaches can provide the very best services to our patients and clients, but our efforts may be dwarfed by that individual’s personal lifestyle choices and behaviors. We can certainly overcome some obstacles and find workarounds, but eventually what he or she does the other 23 hours of the day are going to have a bigger impact than the one hour we get to work with them. The conversation may be difficult and/or awkward, but I challenge everyone in the medical and health settings to speak with patients and athletes about these behaviors, especially if progress is limited. This is common sense to most of us, but the Average Joe unlikely knows how his too regular late-night Call of Duty marathon accompanied by Bud Light and Pringles will negatively impact his ACL reconstruction rehabilitation.
As always, I appreciate you taking the time to read this. Hopefully you were able to pull a nugget or two from this to apply to you and those you serve.
1 Corinthians 3:17
If anyone destroys God’s temple, God will destroy him. For God’s temple is holy, and you are that temple.