The Over-Rehab Syndrome

Dr David Colvin workers compensation

21/07/2018 Dr. David Colvin, trained in orthopaedic surgery in Perth. David's specialty is knee and shoulder surgery and sports injuries.

Some orthopaedic conditions are painful due to inflammation of the tissues or joint. This includes osteoarthritis of the knee, frozen shoulder, rotator cuff tendonitis and subacromial bursitis.

Successful recovery from orthopaedic surgery requires a structured progressive rehabilitation program. However, it is possible to have too much of a good thing. It certainly looks good on a progress report to have a graph showing that last week you lifted five kilograms, this week you are lifting ten kilograms, and next week we are going for fifteen. But an overly aggressive rehabilitation program can actually perpetuate symptoms from an inflammatory process. I see this particularly with gym based strengthening exercises for patients with osteoarthritis of the knee.

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When treating patients through their private health insurance, their fund normally covers approximately six sessions of physiotherapy. People often stop formal supervised physiotherapy once their fund contributions run out. I rarely see people having much therapy beyond the three month post-op mark, regardless of the operation.

Contrast this with the workers’ compensation environment where it is not uncommon for me to see people who are twelve months post surgery and still having some form of formal rehabilitation on a weekly basis.  This is not a good thing for you as the patient for several reasons.

over-rehab syndrome

  • “Over-rehabilitation” may be aggravating an inflammatory process and contributing to ongoing pain.
  • Frequent visits to the therapist serve as a never-ending reminder of your medical condition and limits your ability to live a normal life while your treatment is progressing.
  • This arrangement can lead to a dependency upon the therapist.  It is in your best interest to take “ownership” of your rehabilitation plan and to incorporate that plan into your daily life.  Do not become a prisoner of the workers’ compensation scheme, captive to an unending rehabilitation program.
  • Frequent appointments for rehabilitation impede your return to work and stop you from resuming your normal occupation.  Again it is standing in the way of normal life.
  • Failure to achieve unrealistic goals in the gym can give you a negative mindset.  You might feel that you are failing the rehabilitation, when in fact the rehabilitation is failing you.

My advice in this situation is to take a break.  A three month “holiday” from rehab can be a good thing if we are not seeing the improvements we expect.

I think it was Einstein that said the definition of insanity is to keep doing the same thing over and over and expect a different outcome.  If the rehabilitation is not working, change the plan. 

Surprisingly, many patients find it difficult to take this advice.  Be brave and make some changes.  Ask your therapist for a plan that you can undertake in your own time at home or download one of my rehab programs here.

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