433- The Psychology of Sports Rehab Chiropractic

Welcome to the Evidence Based Chiropractor where each week we deliver the latest chiropractic research and marketing strategies all in the time it takes to get to your office. Now here's your host, Dr. Jeff Langmaid.

Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. On today's episode, we're talking all about sports chiropractic. It is a new study and it is a good one. It is all about chiropractic attitudes, beliefs and application of sports psychology in the injury rehab process. So if you consider yourself a sports chiropractor or take care of athletes professional or or weekend warriors, this is a great study and it even applies to people that aren't quote, unquote, athletes as well because there is a psychological component to people dealing with pain and looking for rehab. And this study is a good one that dives into that and much more. Now, before we get started, I want to say a few words about neck care. Neckcare.com check it out. Objective assessments of the cervical spine. These are objective, reliable assessments and, and exercises for neuromusculoskeletal control, proprioception, range of motion and sensory motor integration. I had Orey, the CEO of Neck Care over. We actually produced a interview as a podcast a few weeks ago. We have videos coming out. This is a piece of technology, if you fancy yourself a doc who likes to have objective data, who likes technology and likes to have the real deal. And this, the software and hardware looks awesome, works seamlessly and I cannot recommend it enough. I am looking at a unit about five feet away from me right now. Check it out neckcare.com and connect with their team if you have questions or are curious about how you can bring neckcare into your practice. Now, as I said at the top, today's episode, we're talking all about rehab, sports and psychology. How do these things intersect and how can you have knowledge about that intersection so that you can improve the clinical results that you get in your practice and just better guide people towards overall better health? That's what this study looked at. I'm going to drop a link down in the show notes of course, so you can check out the study yourself. But here is setting the stage. Now this study did take place in Canada and and they kind of start out by saying, hey, over a couple year period, 2009 to 2010, an estimated four and a quarter million Canadians aged 12 and older suffered an injury that limited their normal activities. And over 35% of these were related to a Sport or physical activity. So millions of people, I set the stage here. Millions of people in Canada, probably tens of millions of people in the United States, hundreds of thousands, if not millions of your fellow people, depending upon where you're tuning in from, have an injury that's limited their activity. And over a quarter, over A third, over 35% were related to sport or physical activity. So it's a big deal. And that is why, as you probably have heard me say in previous episodes, like almost every chiropractor at this point is a sports chiropractor. It doesn't mean that all you take care of is athletes. But for many people that see chiropractors tend to be on average a little healthier, a little more active, a little bit more interested, at least in proactive health. So they're, they tend to have higher activity levels. So no surprise that a good chunk of them suffer an injury as a result of that. They also highlight some of the previous research, such as Engels research from 1980, which was all around the biopsychosocial model. And they say since that time there's just been a big shift in healthcare away from biomedical towards a more comprehensive approach of biopsychosocial. And obviously the psychological component is where we're diving in on this study today. And they've also highlighted the fact that psychological interventions can have a real big, a significant impact on the sports injury rehab process. Now, as we'll dive deep in here, we are rehab based, movement based healthcare providers. We're not expected to be psychologists, we're not expected to be psychiatrists, obviously. So that's a distinction. However, we also know that us as movement based healthcare professionals, and in many cases the doctors that these patients are seeing primarily to rehab their injuries, that we're incredibly well positioned to influence the psychological aspects of the rehabilitation process. Why? Few distinct reasons, some obvious, some less obvious one is that usually we're the initial point of contact when an injury happens and we have regular contact with that injury throughout the entire process. We're assessing things, monitoring things, we're providing treatments and care for these patients and that time spent together matters. We also know, of course, that the physical and psychological components are not mutually exclusive and there's often a relation between one and the other. So our position as physicians, clinicians are really important from an emotional support perspective during the recovery process. And you can probably, as I'm saying this, you're probably thinking of patients literally right now in your practice. Like, yep, we tend to have a pretty deep discussion every visit Every second visit around getting back to that level of activity that they are hopeful for and accustomed to. Additionally, we're just hands on and that matters. When there's physical touch during manual therapy, during manipulation, during adjustments, it's just a different level and there's an impact there that is different than non physical touch, than non manual techniques. So there's often a level of comfort there with the patient to provider that stimulates additional conversation that may not take place in a setting where there's not manual therapy. And I'll go one step farther with that in terms of just time as well. Not only are we often the first line of defense and the primary treating physicians or clinicians, but additionally it's just a lot of time spent right? You're sitting knee to knee, heart to heart with an individual, or they're on their rehab exercise equipment and you're spending time, you're assessing whether it's a movement assessment at the beginning, whether it's a movement assessment at the end, whatever it might be, it really just matters when you look towards, hey, how am I interacting with this individual throughout this process. And as we see patients, I always like to take this step back and say we see patients all day, every day. And sometimes things can become kind of old hat. We see people in extreme back pain, we're empathetic, but we've seen it so many times, it's a different story for the other side of that coin. That person, especially if they've never dealt with an injury before, it's like catastrophically life changing. So in many people, you have to think about this as well. Think about how nervous you would be if you had an injury and how apprehensive and how many questions you might have. And that's with the knowledge level that you already have. Most people coming into your practice, they know little to nothing about their physiology. Biomechanics, they know nothing at all. And that's most people. Most people aren't doctors, right? They just don't know. So it can be super, super scary. And as an athlete, whether you're a young athlete trying to perform on a team, a college athlete maybe trying to go to the next level, a professional or semi professional, now your livelihood's involved. These can become really big issues really, really quickly. And that is where the psychological component is so, so important. Now what they did in this study is they interviewed a whole bunch of chiropractors and basically got feedback. So the first thing they said is, well, how are we characterizing a sports injury? And they have a Couple different ways that they did. One, an injury that occurred while training or competing in a sport. Pretty obvious. Two, is medical attention was sought for that injury. So these are cascading. And then three, at least some time was lost from training or competition due to that injury. So that's how they qualified it as a sports injury. All three had to be hit. So what were some of the findings? Let's dive in. 62% of sports chiropractors surveyed believed that athletes are affected psychologically by an injury 100% of the time. So let me backtrack because that's like two separate stats and the same thing. Over 60% of the chiropractors said 100% of my athletes are affected psychologically. 15% of chiropractors said that the athletes were affected 75% of the time. 20% believe athletes are affected psychologically 50% of the time. So pretty much everybody was over 50% with meaning an athlete would be affected psychologically over 50% of the time. Pretty much everybody agreed to that. And over 60% said this is every single time. Right. And you know, whether that parses out one way or the other, it's just interesting. It highlights the fact that regardless of where that falls on the spectrum, it's a big deal. Additionally, we saw 75% of these sports chiropractors have referred an athlete to counseling, which is interesting. 61% refer directly to a specific mental health or performance coach with the clinical focus of the sport. That's interesting. And 23% use a specific written procedure when referring athletes for counseling services. So that's higher than I would have expected. And it might be higher. Even you might be saying, oh my gosh, I don't refer that often. And maybe I have never referred a patient directly to a sport specific mental health provider, but that's what this study showed, which is really, really interesting. Additionally, now we start to get clinical. So the most used psychological technique that the sports chiropractors reported using was creating variety in rehab exercises. And the least used technique was reducing depression. That's a little vague and that doesn't surprise me. So variety of rehab exercises was one way, I'm going to say, to overcome psychological hurdles. And this just makes sense. When people have fear, avoidance behavior potential over the course of a long treatment plan, boredom is a real thing. Additionally, just being able to vary things to feel as though you're progressing the variety that you can provide in the rehab exercises that you perform or prescribe for your patients can give them the indication. Hopefully, you know, and obviously you want to be the correct indication that they're improving along this path. And that's a really, really important psychological technique, is highlighting improvement, right? So a couple other stats here. Nearly 70% of the sports chiropractors suggested that it was very important to address the psycholog aspects of a sports injury, with none reporting that it was not important. So it, you know, I guess the easier way to reverse that, say it is important, and there's no question about that. And the sports chiropractor surveyed also said the most important skills that a sports chiropractor could learn are, and these three are really good, setting realistic goals, really, really important. You have to have people meeting and exceeding their goals, even if the goals are real. Really baseline to start being able to see that improvement and progress. So critically important to overcome the psychological hurdles. Two, understanding individual motivation. Of course, super critical, as we like to say, you know, your, your progress in our practice depends upon two things, right? Your goals or your treatment or care plan depends upon two things. What we find during our examination and what your goals are. Those two things combined really are what showcase what a treatment or care plan should be. So understanding that individual motivation is critically important. We highlighted this a little bit at the beginning. Is this individual just looking to stay active? Is this individual relying on this for their income? Right. And do they have insurance or not? Like, those are just real things? Are they motivated to get back to this because it's their livelihood, because it's fun, because of the social aspects of it, because it is a critical, foundational part of their life? All of those different things are important to understand because it can frame the conversations you have. And the third one is enhancing listening skills of the provider. So really listening, and not just, I'm going to say, passively listening, but really actively listening to the patient and understanding what they're dealing with. It's not just about being empathetic. It's really about that next level of active listening where you can understand, empathize, provide a summary or synopsis, and then provide action steps. And sometimes it can be just, just actively listening with purpose. But it's really, really important to have all three of those items. So the sports chiropractors in this study suggested that stress and anxiety was actually the most common reaction to sports injury, along with exercise addiction, fear, avoidance behavior, and treatment compliance issues at times of all things. So these findings are in line with previous studies. But it's important to really understand that when somebody has a sports injury, they're very likely going to have stress and anxiety. They might have exercise addiction where they've been exercising so aggressively so heavily for so long. That's a real thing. When then you can't do it, right? Fear, avoidance, of course, always an issue. Depression for a variety of social media and physical reasons, and treatment compliance issues. That's an interesting one based upon, you know, a lot of factors can go into that, right? Cost, location, desire. Depression plays a role in that as well. So all important things to keep in mind. So the sports stocks in this study really valued the sports education that they have, with two thirds indicating that they had had a postgraduate course and that it was important or very important. However, one of the things that they also mentioned was that they wanted more education both on the theory and the application of sports psychology specific to the rehab process, which I think was an interesting takeaway. Additionally, the docs in this study felt as though the training covered had a lot more to do with performance than injury rehab, which is obviously important from a holistic understanding of the recovery process. So a lot of really interesting takeaways. Just a really, really cool study. And I found this to be just great. I mean, it's just great information to know, to understand and to apply. And there were a couple of things that the docs also kind of highlighted as successful coping is a coping mechanisms, excuse me, one, positive attitude can't replace that. Compliance and commitment number two. So really, really big deals as far as that's concerned. And 75% of the docs in this study again had referred an athlete to counseling and this number was significantly higher than any other studies. So that could mean a couple different things. Maybe it was just the subset of docs that they found in this specific study. Maybe it was those specific patients were all part of a team and they had easy access. Could be a variety of things there. But I think the most important big takeaway from my perspective is, as I like to say, and we have this as a campaign within patient pilot by the smart chiropractor, the athlete in you. Right? Everybody out there is an athlete to a certain degree, at a certain level, in some way, shape or form. So understanding the differing levels they may be at, the motivations that they might have, and how you can guide their recovery process in the best and most meaningful way is one of the best skills we can have as providers. So I'll drop a link down to this study down in the show notes, of course. Also a big shout out to stop pain clinical. Their starter pack is awesome. If you have not checked it out, you gotta do. So head over to Stopa. That's kind of hard to say, but we'll drop a link down in the show notes. There's a special deal there just for listeners of this podcast. An awesome starter pack, super affordable if you have topical analgesics in your practice. Maybe you have in the past, maybe you're looking for a new one right now or you just want to have an awesome variety. Their products are awesome. I can't recommend them. They support the podcast. I recommend you support them. Stop Pain Clinical. I'll drop that link down in the show notes. And finally, if you're thinking about bringing Shockwave technology into your practice, I cannot recommend Stem Wave enough. It's what I use in the practice that I use that I own. Excuse me. Go stemwave.com the evidence basedchiropractor hook up with their team, have a conversation. They are as again, as a listener of this podcast, you are gonna have access, exclusive access to the best offer that they have to be able to bring Shockwave into your practice. Go stemwave.com I'll drop that link down in the show notes. Otherwise, thank you for being a chiropractor. Thank you for tuning in and listening to this podcast. I hope you have a fantastic week in practice and I will talk to you soon.

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