When I met Susan*, she had been managing her pain (not very well) for nearly 4 years.
She had an accident at work while she was performing a routine (manual) task, in a job she had kept for the past 8 years after immigrating to Australia. Her English was very poor and by most definitions her limited skillset and painful injury had made her a poor candidate for work.
Despite frequently referring to herself as "a disabled person", Susan wanted to work. At that stage, she was spending several hours laying down during the day as this was the only position that relieved her pain. Susan was very focused on minimising her sensations of pain and despite making significant progress in an exercise program, these gains rarely translated to increased function or activity outside of the gym.
As you can see, there was a huge disconnect here.
How Doctors Can Bridge the Gap
This disconnect became even more apparent when Susan and I went to visit her doctor. Susan's doctor was also of the opinion that despite her improvements in function, her reported pain levels were enough to classify her as completely "unfit for work".
If you've worked in vocational rehabilitation for any amount of time, you're aware that an "unfit" certification from the doctor is a huge hurdle to overcome. This is because:
- The opinions of Doctors and medical professionals often represent the "final say". Their judgements have immense power to dictate our path of action, progress and our client's recovery, function and outcomes.
- People's opinions of themselves, their capacity and their options are influenced heavily by their doctor's perspective.
- When a client and their doctor is of the opinion that the client is too sick, too unwell, or in too much pain... well, it's like slamming a brake on progress.
Work as a Threat
I think much of the Doctor's reluctance to explore working again as an option for Susan came down to the perception of work as a threat. After all, it's how Susan got hurt in the first place.
The argument about how we can converse with Doctors about the benefits of good work, and it's crucial role in recovery, is a post for a different day. If you're looking for some advice on how to speak with Doctors, Specialised Health has an excellent article on this topic.
I completely agree that Susan was not ready for work, mentally, emotionally or physically. But that didn't have to mean that Susan wasn't ready for activity outside of work. Both Susan and her Doctor had fallen into the trap of waiting for her symptoms to abate until exploring opportunities to "do more".
Susan herself had told me that she wanted to do more but didn't know where to start. In many ways she was waiting until she felt better to start living her life again.
It's not much fun living in limbo.
The reality is, Susan had been undergoing various treatments for years. It was unlikely that she was ever going to be completely rid of pain.
What Might We Try Instead?
Susan had already successfully integrated weekly workouts into her routine. She even reported feeling healthier after a workout. So, there was an opportunity here to increase her engagement in structured activities to help her build up her tolerance (and critically, her confidence) even further, as a path to one day working again.
If you have a client like Susan, he or she is probably very doubtful of her abilities and tolerances. Without work as an option (for now), people like Susan need an opportunity to gradually re-introduce structured activity back into their life, and to test different approaches to see how pain management can actually go hand in hand with (strategically) doing more.
What could your client try doing for X amount of time, even just once a week to begin with? Is it a 10 minute walk? Could she volunteer for 2 hours a week? What sort of structured activity did she used to enjoy?
Better yet - what is she already doing that we could help her amplify, just a little?
More importantly, how can you help her plan to incorporate these activities back into her life? What tools can we help her develop to cope on more painful days, and to not go "all-out" on good days that leave her feeling totally wrecked for the rest of the week?
Activity - especially smart, planned, gradual activity - does not have to wait until recovery. In fact, it's often part of the answer.
What's your approach in working with clients who have been told they are "unfit"?
*This is the first post in a series of case studies about the countless lessons I have learned from my clients. In order to protect their anonymity, I may change demographic information such as their age, details of their injury/illness, occupation or gender, and of course, their name. Sometimes, the case study is a combination of several people that share a common theme in their path to recovery. Sometimes, the case study is completely fictional.