How long is this gonna take…?

How long is this gonna take…? by The Sports Physio We live in a fast moving world. Where speed and efficiency are highly regarded and often used as a measure of success. Where time saving devices and innovations are all around us. If we do have to wait for something we quickly tend look for quicker alternatives. If we have to wait more than a few moments for a web page to download, we look to upgrade our laptop, tablet or broadband supplier. If we have to wait for service in a restaurant, or a store, we tend to complain or not to go back there again. If we have to wait more than a day or two for a delivery, we are usually displeased. As a rule most of us are not patient. We all want things done quickly and efficiently, its human nature, and waiting for anything can be, and usually is frustrating. This is never more true than when we are injured or in pain. In my experience, all patients will always ask me, without fail, some time related question such as... How long is this going to hurt for? How long will it take to heal? When I can run / play football / leap over badgers again? These questions, even the odd badger leaping one, tend to be the most important to patients. They want them answered clearly, accurately and honestly. This its perfectly understandable. Pain is an unpleasant sensation, having an idea of when things are going to feel better and life can return to normal is... Well just normal. But it can be extremely hard for healthcare professionals to answer these questions. There are many variables that effect recovery and healing times, so it is usual practice to give estimations. However in my opinion many tend to grossly under estimate the time it takes. This often leads healthcare professionals to recommend further unnecessary investigations, interventions or second opinions. I regularly get patients sent to me for second opinion, and when I start to take their history and do my assessment it becomes clearly obvious that they are progressing just fine, its simply a poor understanding or awareness of healing rates and how long things take to recover that has placed them in front of me. Not only does this poor explanation of how long things take to heal and recover waste time and resources for patients and other professionals, it more importantly, causes unnecessary distress, angst and frustration for the patient, they can become worried and stressed that perhaps they are having complications, when usually things are just fine, they have just been poorly informed at the out set. So to prevent these issues healthcare professionals need a good understanding of the normal biological healing processes and time frames. A good place to start is with the initial inflammatory processes after any injury. Knowing what is happening from the first few minutes, hours and days after an injury, through the following weeks, months and even years is essential. Here are some good resources on this here and here. Next, healthcare professionals need to be aware of the different classifications of bone,ligament, tendon, muscle and nerve injury. This further helps estimate the expected timeframes dependant on the mechanisim, type and severity of injury. Also having a good knowledge on the current research on 'return to play' times after injury helps answer questions on when a patient can return to doing what they love doing, such as badger leaping. Although this is a massive topic and there are hundreds if not thousands of different injuries there is some more info here here here and here Finally, lets not forget experience. The more a healthcare professional see's a type of injury, the better they will be at knowing the time it takes to recover. However.... There's always a however, even with all this information there are still many, many other variables that can effect healing and recovery times, both physical and psychological. Having an understanding of as many of these, such as medications, other medical conditions, emotional stresses, maladaptive beliefs and past experiences are again important. For example consider the effects of age, psychological state and previous activity level will have on neuromuscular deconditioning, also consider that deconditioning occurs much faster than conditioning, that neural connections are established quickly and can't be simply un-connected. Its not a simple one to one time ratio, eg one day out injured is not simply reversed by one day not injured. Giving accurate and reliable timeframes to patients is easier said than done, it is tricky at the best of times with many variables to consider, and it can be very tempting to simply guess or give extremely wide estimates. However, don't, this is not good practice, managing patients expectations is a key priority in all aspects of healthcare, and answering questions honestly and to the best of our knowledge is vital in this process. This may at times mean saying "I/we don't know" and there is nothing wrong with this. It is far better to say this than guess and risk giving erroneous and incorrect times. It can be extremely hard to regain a patients trust and respect when they have been given incorrect information. For example, I see a lot of patients soon after surgery and unfortunately still today many get wrong or misleading information or misunderstand how long things are going to take. A classic example of this is when well meaning surgeons or nurses telling patients "you will be back at it in a few days" or "you will be up and about in no time" These ambiguous sentences although appearing to be helpful, reassuring and benign, can be just the opposite. I often find myself having to carefully correct these mis-understandings when patients get concerned that things are not progressing as they expected, and it often causes them confusion and frustration, with them being not sure who to believe or trust anymore. I also often find myself having to correct a patients understanding of how long it will take due to other sources of mis information, such as from the internet, press, or even friends and family. Sometimes they listen sometimes they don't, occasionally my experienced professional advice just can't stand up against "Dave down the pub said..." So in summary it can be a complex and tricky minefield to give accurate recovery time frames, with many variables that can effect them. However all healthcare professionals need to be as well informed as they can on this subject, and consider that in this day and age of speed and quickness how long it takes the body to heal is often not as fast as we or our patients expect. So think twice before giving a patient a time frame, think more than twice before referring them on if you or the patient think things aren't progressing as quick as it should. Sometimes all you need to do is hold your nerve and trust your knowledge and experience. I will leave you with some wise words from @TheGrumpyPhysio below, who although at times can be a little close to the risque side, I think his (or her) heart is in the right place and often talks a lot of sense and can be hilarious although a little sweary at times! As always thanks for reading Cheers Adam