I’m super excited about today’s post. It was written by a good friend and mentor of mine, Aline Thompson. Aline was one of the most influential therapists I’ve had the opportunity to work with and she’s largely responsible for the way I practice today. Make sure you check out her website and social media (links at the bottom of the post). Secondly, she’s writing about my former boss and old team mate back when I competed in Crossfit and worked at Crossfit Verve. Enjoy:
In the back of our minds we usually have multiple voices talking as we go about perceiving the world. One voice might swear at you like a sailor, while the other encourages you like a parent. Heck, maybe you’ve got a cursing parent voice talking to you. As a friend once told me:
“Sometimes you need to consult an expert.”
As a physical therapist, I am reminded daily that success in rehab (and in life) exists on a continuum. There are multiple factors at work as we strive toward goals and retrospectively attempt to correlate these factors to our wins and setbacks.
One of the factors I find especially compelling is mindset. Carol Dweck popularized this term with her book ‘Mindset: The New Psychology for Success’. She describes a ‘growth mindset’ as a belief that one is adaptable, a work in progress. It’s basically our self-narrative, what we tell ourselves about ourselves.
This is a story about a client of mine who exemplifies the critical role mindset can play, particularly in tough circumstances. My patient, Courtney, has employed a growth mindset and a self-identity focused on strength and health, both of which primed her for success in rehab following a substantial injury.
“The first thing I did was scream,” Courtney recalled. It happened, as accidents do, so quickly.
Courtney went to open a sliding garage door at her gym early one morning. The door rocketed open, yanking her arm brutally upward. She screamed, dropped to her knees, and immediately started crying. “I don’t know why I was crying” she recalled, as she registered not pain, but a complete loss of sensation. The same arm she had successfully rehabbed back from a rotator cuff repair a few years earlier was entirely numb.
Challenges in the physical health realm were not new to Courtney. While a senior on the swim and dive team in high school, Courtney experienced unexplained and persistent swelling in her right knee. Eventually she was diagnosed with Rheumatoid Arthritis (RA), an autoimmune disease that causes inflammation in joints, resulting in pain and stiffness.
Doctors prescribed cortisone, a knee brace, and also advised she stop participating in athletics. Following the “experts” instructions, Courtney reluctantly accepted these new limitations. In her early twenties, she become a paramedic, a chaotic job that led to disordered sleeping, unhealthy eating and minimal physical activity. Though medications had controlled Courtney’s RA symptoms, at the age of 25 she experienced a recurrence. Sore, stiff hands confirmed the flare-up, and she was put on three medications (pain meds, prednisone and methotrexate).
A referral to a rheumatologist resulted in a prescription for Enbrel, a medication commonly prescribed to RA patients. Managing her symptoms primarily with drugs, Courtney continued her work as a paramedic, eventually landing a position with the fire department. While there, she was introduced to Crossfit.
Though her doctors had advised against participating in this level of physical activity, Courtney dove into the workouts: physically, for the first time in a long while, she felt strong and empowered.
During a Crossfit Level 1 course, Courtney learned about nutrition and the healing effect of certain food groups. She employed a change in diet that further improved her physical well-being. Strikingly, the changes weren’t only subjective: her bloodwork and imaging results also demonstrated improvements in her RA markers.
In a final bold move, Courtney opted not to refill her prescription for her RA medication. Months went by and she continued to feel strong. Diet and exercise became the sole means by which she managed her RA. This was a pivotal point in her life. Courtney’s experience created a deep passion for healthy living. She became a Crossfit coach and gym owner and eventually one of the instructors on staff with Crossfit HQ to teach all over the world.
Fast forward to late 2017 and the garage door incident, which had caused a massive rotator cuff and labral tear. When I first met Courtney, I asked her what she thought upon learning she needed extensive surgery and concomitant rehab, and she was frank:
“I was pissed and frustrated.”
She knew it would be a long road and a major setback to her personal fitness goals. That stated, Courtney had a growth mindset, which she defined with a “YOU’VE GOT THIS” mantra.
In employing her ‘You’ve Got This’ mantra, Courtney held fast to three facts:
She went into action mode, teaming up with her nutritionist to develop a diet and supplement program to facilitate healing. She created a plan to continue working out within the constraints of her recovery. Pull-ups and presses were temporarily out, but there was a lot she could still do.
With approval from her doctor, she manufactured a waterproof brace so she could swim. Being in recovery didn’t affect her self-identity. She was still an active athlete. From a healing standpoint, movement and exercise is beneficial physiologically and psychologically. The following video was taken two weeks after surgery.
Courtney’s story is unique and inspirational. She came to me with a hearty, hard won, growth mindset. She spent years crafting an identity of strength and resilience by taking charge of her health.
I’ve written before about how I see my role as largely a “perception transformer”. Movement is a powerful gateway to enhancing self-identity: whether it’s a reconnection or revamp. I strive to help my patients feel like their best self: stronger, fitter, more flexible, adaptable, more resilient.
Beau Lotto states, “Our sense of self, our most essential way of understanding experience, begins and ends with perception.” How do you perceive yourself?
Self, health, and resilience: these are attributes we can cultivate. Perhaps you’ve developed these before getting injured or maybe an injury is your opportunity to create a growth mindset. In medicine we talk about neuroplasticity and bioplasticity; self-identity is plastic too.
By the way, Courtney is back to pull-ups, pressing, handstands and more.
Check her out at Instagram @foshosheps or @crossfitverve
Me, Aline and Zach Harmon recently at Zach’s Wedding
Courtney (top right), myself (center bottom) and the rest of Crossfit Verve’s Regional Team circa 2014
Read “Mindset” if you haven’t already, and thanks Aline and Courtney!
Dan Pope DPT OCS CSCS
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Keys to Fix and Prevent Shoulder Pain
Shoulder Impingement Part 7: Stages of Rehabilitation
How to Work Pain Science Into Treatment for Athletes
What You Need to Know About Pain to Get Out of Pain and Back to Training
How Much Pain Can We Push Through During Rehabilitation?
Should You Push Your Patients Into Pain During Physical Therapy Exercises?