Recently, I had the opportunity to work with a teenager who is an avid horseback rider. She was great to work with. It was evident that she took an active role in her rehabilitation. When I gave her something to work on, she would return for follow up demonstrating her proficiency and improved performance in what she had been shown. She simply is the type of person that a physical therapist loves to work with.
During her course of therapy she corrected the deficits she had demonstrated at her initial evaluation. With that, I encouraged her to resume activity as tolerated. Towards the end of her treatment she reported resuming horseback riding. So much so that the activity was limited more by the horse’s fatigue than her own! With that, I recommended to her physician a full return to horseback riding as tolerated, including participation in an upcoming horse show.
At the horse show, I spoke with one of her parents. At her physician’s visit concern was expressed regarding her return to horseback riding. As any PT would like to hear, the doctor said that since I said she was OK to ride, then he was in agreement.
I understand that a parent will be concerned regarding the possibility of reinjury. However, in this case I was far more concerned regarding the negative effects of keeping this young lady off the horse for too long a period of time. Being restrained from a normal activity, particularly one someone enjoys, is, well, bad. Not only does one suffer the physical effects of being inactive, but there are psychological effects as well. The loss of the joy the activity brings. The change in a person’s self image from being a capable performer to someone who is disabled. It can lead to (or aggravate underlying) depression.
When someone is injured or sick, they may take on a “sick role”. They learn new limitations, and their relationships with those around them change. Instead of contributing as much, they require more. The extent of the sick role can be influenced by those around. Someone who encourages an injured person to do less than what they are safely capable of doing can increase the “sick role” behaviors. Someone who encourages an injured person to do what they can may facilitate their recovery.
Of course, it is important to consider the “tools” an injured person has to work with. Generally speaking, a physical therapist will determine where someone is weak and help them to become strong; they will find where they are stiff and help them to become flexible, and they will find where they lack control of their body and empower them to take control in a positive way. When these deficits are corrected, it is time to move on. That is the time when not to hold back.
As it turns out, her horse fell not once but twice when they were jumping at the show that weekend. Each time, her immediate response was to bounce up and check that her horse was OK. Everyone turned out just fine, including her parents.
