Psychology during rehab

A recent twitter debate/argument prompted this blog. When I studied for my BSc in Sports Science and Physiology, I had modules from 4 broad areas. Physiology (obviously), Biomechanics, Motor Control and Psychology. At the time and ever since, I have had phases of interest in each area as I read and applied something new to my practice or my own training/sport. As a Strength and Conditioning coach, where a large part of my work is focused on rehabilitation in active sporting and general populations, I am never addressing one single area.

I know that by altering a sit to stand or squat pattern and perhaps adding load to that movement I alter the neural drive to different muscle groups. I change the kinematic and kinetic variables about different joints. I can, over time, alter the fat infiltration and cross sectional area of the muscle. I can increase someone’s confidence in their ability to complete the movement without causing damage.

So when we talk about using movement we can be certain that we are addressing some psychological aspects, alongside the physiological, motor and mechanical aspects. In a similar way, when we address the psychology, we can also impact the other areas. Reducing fear can alter how someone moves. Although I would suggest we limit some of the possible neural, mechanical and structural adaptations if we solely take this approach. One point I would contend however is that movement doesn’t work because the literature doesn’t say so. If you look at the majority of Low Back Pain strength interventions for example(speaking here as a strength and conditioning coach critiquing programme design) they are poorly designed and described and lack specificity in their aims.

It is our job to assess the person in front of us and, using our skill set, help the person to address the areas we think are going to help them improve. For me, my approach is based around the development of different biomechanical patterns to alter loading throughout the body and increase strength through those movements in order to affect changes to the physiology, psychology, motor control and biomechanics as I believe necessary. This is because I am a strength and conditioning coach and they are the tools available to me. To me, the suggestion that graded exposure to training is a purely a psychological intervention is false, unless it is the primary outcome of it’s use. Otherwise, you would have to describe all training as a psychological intervention, which is clearly wrong.

The important point is to be clear of the qualities that you are hoping to help someone change and intervene in a way that gives you the best chance of changing it. If that is addressing pain related behaviours, then choosing to use counselling in order to do so may be a good option. If you want to alter someone’s movement, removing any psychological barriers and showing the person an alternative movement strategy may be a good way to go. Very often debates over Twitter slingshot people to either end of a spectrum, probably because it’s a difficult platform to write a coherent argument that fully represents all of your view. Either way, it makes fun reading.

Neil Welch

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