This post is a sort of intermediary between my last post, where I shared some of my discussion with Simon Roost Kirkegaard, a Danish physiotherapist and awesome human being, which led me to a new understanding of my pain and how my beliefs/fears/expectations about my hip were limiting me in ways I didn’t realize, and my next post, which will be about putting that new understanding into action.

But before I get there, I wanted to go over confidence because I’ve been thinking a lot about it since my chat with Simon. He had mentioned in our discussion that he finds most of his patients don’t have confidence in the injured or painful body part.

It struck me that our conversation was largely couched in the notion (though not overtly stated) that to reestablish confidence we must go through a process of identifying the beliefs, fears, and worries that contribute to the lack of confidence in order to challenge and change those beliefs.

That’s all well and good and I agree. But it’s not as black and white as that sentence sounds so I couldn’t just dive into the next post without touching upon my thoughts about what role confidence has played in my pain experience.

The nuances of confidence

My discussion with Simon led me to a few new realizations, the first in relation to confidence in my hip, and confidence in general after injury or pain. Confidence is not a black and white issue, there’s a whole lot of gray which may be easy to overlook in a treatment setting.

If you were to have asked me if I lacked confidence in my hip before this discussion with Simon, I would have said no. In fact, I had been telling myself the complete opposite, that I was pretty damn confident in my hip and I was quite proud of how far I’d come. I was hiking, snowboarding, jumping around on obstacle courses.

Hell, I had even started running. Running! If that ain’t confidence, I don’t know what is.

So I wasn’t afraid to put my hip through some stuff. I was confident and unafraid during those activities (though, admittedly, I do still worry sometimes. But I talk myself through it. I’m a worrier).

In those contexts I did not think my hip was weak or unstable. But as soon as lifting weights came up, Whoa! something changed. That I wasn’t so confident about. But I didn’t realize this because I was doing so well in all these other areas. The idea that my hip might be too weak or unstable wasn’t a universal thought, it was very specific to weight lifting.

I didn’t become aware of this lack of confidence in my hip until Simon forced me to look at it in a weight lifting context. (More truthful is probably that I was aware of it but didn’t want to deal with it.)

Performance in the clinic or gym may not be carrying over to real life

My point here is that looks can be deceiving. A person can be really active in some areas of their lives or be fit and in shape and knock it out of the park in PT or during workouts with their trainer but may still have these unfaced fears (mind you, when I say ‘fear’ it’s not an ‘oooohhhhh I’m scared’ type of fear, it’s more of a discomfort and sense of unease surrounding an activity or movement or sensation that is easier to sum up in the word ‘fear’) and unfounded beliefs in other areas of their lives.

And it’s not likely to be something at the forefront of their minds. If they’re anything like me, they’ve likely written off whatever it is so it’s become a non-issue because they believe(d) it was never going to happen for them again. They were told by someone or otherwise came to the conclusion that they’d never golf again, or run, or fish, or walk, or play basketball, or garden. Or lift weights.

It may take some digging to get down to it as it may have been buried for quite some time. It’s hard to face things we think we can’t do anymore, it’s painful. And emotional. It’s easier (or so we think) not to face it all.

So our confidence in some areas of our lives may not carry over to other, similar areas, though we may expect them to. Our thoughts about ourselves, our beliefs, our expectations, are all quite nuanced and can be markedly different in different (though similar) situations.

We’ve been here before, we’ll be here againConfidence after injury when there's persistent pain - is it universal, or situation specific?

This is important to recognize because we may have to go through this process of confronting fears (sense of uneasiness, discomfort, worry surrounding an activity), challenging and changing beliefs a few times – it might not be a one and done type deal. It wasn’t for me. It’s more likely to be an ongoing, lifelong process as we age, as our pain changes, as the world changes.

At one time all the other activities that I’m doing now, some of which I’ve been doing for a while, were also activities I never thought I’d do again. For each of them I had to go through a process of regaining confidence in my hip.

Confidence in one activity doesn’t mean confidence in another

But for some reason that confidence didn’t carry over from one activity to the other. My confidence snowboarding didn’t mean I was confident running. My confidence running didn’t mean I was confident to lift weights.

I don’t know why, you’d think it would be a bit more universal, that confidence in my hip in one activity would transfer over to confidence in other activities.

But it didn’t. Perhaps it’s because all this stuff is a lot handle and by chunking it up and dealing with smaller portions it’s easier to deal with. One thing at a time, sort of thing. And the longer we’re in pain, the more chunking we may have to do.

So now I’m here once again, going through it all again with weight lifting. And I’m sure I’ll have to do it again (and maybe again and again).

Just something to keep in mind.

Expectations matter. A lot.

This is my major AHA of the past week working through this stuff. What I realized was that throughout my progress over the past couple years (as well as my years of pain before that, when I was at a standstill) I had certain expectations about what my right hip would do during activities – from sitting to bending over to walking to doing therapeutic exercise to my more athletic pursuits of late.

I expected my right hip to be different from the left to varying degrees, depending on the activity. I expected it to hitch, pop, hurt, catch, feel restricted, clunk or thunk, shift weird, not be as mobile, get sore sooner. I expected it wouldn’t be smooth, that it’d move differently, feel differently, BE different.

And it was.

Exploration instead of expectation

After my conversation with Simon, I worked hard at ditching the expectations and focused more on exploration. On letting movement happen and focusing on the movement goal, not overly controlling movement and focusing on the machinations of my hip. This will form a large part of the next post.

This shift from an internal focus to an external one was a big step. I hadn’t realized how intensely internally focused I had become and how this likely played a detrimental role as I try to get back to the activities I love doing. I was so focused on my hip because I didn’t really trust it.

But I felt ok exploring without expectation after chatting with Simon. And not just in weight lifting but in the other activities that I’ve been doing for some time, and there was a definite difference. My running game went up a notch and my basic movement patterns improved dramatically. Dramatically!

Even though I thought I had confidence in my hip during these activities, I doubted it, I expected it to be different. It wasn’t real confidence, real trust, it was conditional. And it took me exploring this other area of movement to discover that.

Learning what to do vs. being told what to do

Another thing I realized, exploring is tougher. It’s easier to just have someone tell you what to do (and what to expect). But even though I just want someone to tell me what to do (it’s so much easier, especially when it comes to pain stuff because pain stuff is hard), it’s definitely not what I need.

That’s hard to admit. It’s much easier to just have someone give me a workout so I don’t have to think about it, I just have to do it. And I’ll follow it to a tee, I’ll knock it out of the park. But when I’m just told what to do, I’m stuck. I have to keep going back for another workout (or another whatever). I have to keep being told what to do because I don’t know how to do for myself. This just keeps me dependent and disempowered.

And even though I know this isn’t a good thing, it’s easier, and thus easier for me to fall back on.

Confession: I will take the easy, passive route if given the opportunity.

Simon didn’t give me the opportunity. He didn’t let me just passively receive the information, go do, and report back. He made me work it out. He made me think. He made me understand. He empowered me.

As patients we need the pain science education but we can’t just be told it, we have to understand it and we have to come to that understanding on our own. We have to challenge some beliefs and confront some fears and come to an understanding of what it actually means to us, to our pain, to our lives. I think this is best done through gentle nudging and guided discovery. And I think not everyone will be open to it.

That’s the hard part. Not everyone will be open to it. But we do what we can to help get them there.

Permission matters

Permission is important, too. I am always seeking permission from a person of authority because I don’t have full confidence in what I know and what I think when it comes to this pain stuff. It’s hard to feel confident in your capabilities when all you get from healthcare providers and insurers is NOs and sets of limitations. When your constantly being told all things you can’t or shouldn’t do.Doubt, lack of confidence, negativity all hold us back when trying to change pain

NOs that make their way into your thoughts and beliefs about yourself.

When you live with the same NOs and limitations for YEARS, as I did while I was in the work comp system,  and when you’ll be denied care if you do one of the NOs, it’s hard not to let the NOs define you. My NOs included no lifting, no squatting, no climbing, no sitting for prolonged periods of time, no running. I felt like I was a frail, breakable being.

I’ve found that even in therapy settings where they’re doing things right there can be an underlying sense that we must be careful because we’re fragile. There’s lots of pink weights and stretchy bands but no squat racks. You know what I mean?

Those NOs, those limitations, that sense of fragility are insidious.

Even after I started getting hip to pain science, it was hard for me to apply what I learned to myself. I mean, who the heck was I? I’m no expert. I had (have) doubts and fears and worries.

Once I understood the pain science stuff, I still needed permission to put what I’d learned into action from a person of authority. I needed someone who’s an expert in pain to tell me: yes, you can do this, you’ve got everything you need.

Because pain is SCARY. Even when we know it’s an indicator of tissue damage, it’s hard not to worry about it. Even when we’re successfully getting on with life, pain still gnaws at the edges of our brain. It makes you doubt yourself, you lose confidence, you get tired.

It’s always going to be an area of concern because it’s PAIN. You know what I mean? So permission is important.

This stuff is important to recognize. I’m all for optimism but I’m for realism, too.

Ok. So I’m still working on the follow up to Part 1 of my talk with Simon and hope to have it out soon, but I felt I needed to go over these thoughts, and that they belonged in the middle, so you understand where I’m coming from and why what he and I talked about worked because just saying ‘I regained confidence in my hip’ didn’t seem sufficient.

It’s not so simple as ‘he said’, ‘I did’.

It’s the details that matter, the nuances, the little things that may seem insignificant but can be quite profound. Sure, the details, the nuances, the ‘what works’, will be different for each of us, but there will also be similarities.

And I’m sure there will almost always be that common theme of ‘this shit’s complicated’

So thank you for bearing with me for this post.  I’m still trying to figure out what is useful and what isn’t and welcome any feedback you may have.

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