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A 12 year old female is in her 3rd month of physical therapy for knee pain. She is 95% as strong as her unaffected side, is running, and able to cut and jump without pain. Her season is starting in 3 weeks and she is almost ready to return to sport testing.
You notice she has been struggling with her exercises and is not sweating or pushing herself like she did the first 2.5 months of care. She has also cancelled twice and is not wearing her warm up and school colors as she did before.
How would you approach this declining participation with the patient? Who would you include in the conversation?
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Great case Laura
Think of yourself in high school and college. What would you think of if a teammate did this?
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The first thought that comes to my mind with this case and this particular population is the strong influence that societal and environmental factors can have on their health condition, emotions, and motivation.
I feel my first plan of action in this case would be to simply talk with the patient about what I’m seeing. Hopefully at this point, I have established a good rapport with her and she feels comfortable sharing what she’s feeling and why she is losing motivation. I also feel it would be important to involve the patient’s parents and even coach(es) to discuss the sudden change in her participation and overall motivation with rehabilitation in order to establish an open line of communication and determine if they are seeing the same changes.
I know from my own personal experience with sports in high school, there’s a lot of overwhelming pressure to perform well and I can only imagine how much more pressure and anxiety I would’ve felt if returning to sport after a significant injury.
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Great points Ian
Adding family is key….. its also important how you do it. You want to have the athlete open up, not close up more.
Think about your strategy. what would the conversation look like?Another question:
Would you approach this differently from a 24 year old patient?-
In response to Kyle’s post. I would approach this differently for a 24 year-old. I think that potential stressors and effects of mental health are a lot different at this age; likely including work/school, finances, relationships – all of which could be impacting the pt’s performance. That being said, this may not be something the pt wants to discuss with their PT and I could offer counseling services or other specialists if it seemed appropriate.
I would also most likely only talk to the 24 year old themself and try to understand what they are going through rather than speak to a family member or coach; unless the behavior seemed severe or destructive.
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Agreed!
24 is a whole other ballgame
We want to open discussion and explain how this conversation can help the rehab process and outcomes.
We also need to provide stronger resource options for them! -
Agreed!
24 is a whole other ballgame
We want to open discussion and explain how this conversation can help the rehab process and outcomes.
We also need to provide stronger resource options for them! -
Agreed!
24 is a whole other ballgame
We want to open discussion and explain how this conversation can help the rehab process and outcomes.
We also need to provide stronger resource options for them! -
Agreed!
24 is a whole other ballgame
We want to open discussion and explain how this conversation can help the rehab process and outcomes.
We also need to provide stronger resource options for them! -
Agreed!
24 is a whole other ballgame
We want to open discussion and explain how this conversation can help the rehab process and outcomes.
We also need to provide stronger resource options for them! -
Agreed!
24 is a whole other ballgame
We want to open discussion and explain how this conversation can help the rehab process and outcomes.
We also need to provide stronger resource options for them! -
Agreed!
24 is a whole other ballgame
We want to open discussion and explain how this conversation can help the rehab process and outcomes.
We also need to provide stronger resource options for them! -
Agreed!
24 is a whole other ballgame
We want to open discussion and explain how this conversation can help the rehab process and outcomes.
We also need to provide stronger resource options for them! -
Agreed!
24 is a whole other ballgame
We want to open discussion and explain how this conversation can help the rehab process and outcomes.
We also need to provide stronger resource options for them! -
Agreed!
24 is a whole other ballgame
We want to open discussion and explain how this conversation can help the rehab process and outcomes.
We also need to provide stronger resource options for them! -
Agreed!
24 is a whole other ballgame
We want to open discussion and explain how this conversation can help the rehab process and outcomes.
We also need to provide stronger resource options for them! -
Agreed!
24 is a whole other ballgame
We want to open discussion and explain how this conversation can help the rehab process and outcomes.
We also need to provide stronger resource options for them! -
Agreed!
24 is a whole other ballgame
We want to open discussion and explain how this conversation can help the rehab process and outcomes.
We also need to provide stronger resource options for them!
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I apologize for the delayed response. Going off of what Ian and Kyle said, I would want to schedule time and sit down with just the athlete to talk to them about their change in participation. I think it is good to talk with the parents as well, but also have that time with just the athlete since sometimes they may not want to disclose things in front of their parents. I’ve seen it with some parents in clinic who are eager to get their kids back to playing and have high expectations of them which may cause them to close up if they are present during the discussion as Kyle mentioned.
As Ian mentioned and the articles discussed this as well, establishing rapport with patient from the start will hopefully allow them to open up. I would definitely start with an open ended question with the patient asking them what’s going on since their are so many factors that could be involved with this.
Similar to what Ian said, I know there are a lot of pressures and mental challenges that come with playing sports. Coming back from an injury is hard, especially if you feel like you are not where you’re supposed to be prior to playing. I think it’s important to be able to have these conversations with whoever the patient is working with, whether that’s their PT or AT. Also being clear and communicating with the patient about their progress. Maybe the patient did not know how well she has progressed and where her strength was. I know after injuries it’s a mental game and you’re always second guessing.
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In regard to the initial question and like Ian and Emily said, I would try talking to this pt one and one first. Hopefully with enough rapport established and with some open-ended/non-confrontational questioning the pt would open up to me. I think that if I had a successful conversation with the pt herself and depending on the parents amount of involvement, I may keep the conversation between myself and the pt for a session of 2 to determine any change in behavior and then involve the parents if the behavior continued or seemed to become destructive.
Growing up, sports were very competitive for me and I was in PT for injuries as early as 10 years old. Thinking back to my experiences in PT, especially with my ACL recovery at 15 years old, I did not have a very substantial relationship with any of my PTs. I think in practice now, I try my best to build rapport with pt’s because of these experiences.
Even though sports were competative for me back then, the intensity of kids sports has only increased. This pt may be experiences external pressures or possibly not feel like she is back to where she should be with her progress even if she tests strongly. This was one situation I experienced in which my PT and coaches allowed me to return to sport; however it took much longer actually playing the sport to feel 100% again and this took a heavy mental toll of not feeling good enough/being pressured by coaches to improve faster. If this situation was occurring – it may make more sense to get the coaches/parents involved to explain progressions/return to sport strategies.
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Agreed everyone!
I think you have great experience as a past athlete and PT patient. Back in the day patient rappor wasn’t as important and you saw it personally. We do better jobs and hopefully that opens the door for communication
Let’s always try to put ourselves in our patients shoes so we can help ourselves grow
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Agreed everyone!
I think you have great experience as a past athlete and PT patient. Back in the day patient rappor wasn’t as important and you saw it personally. We do better jobs and hopefully that opens the door for communication
Let’s always try to put ourselves in our patients shoes so we can help ourselves grow
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