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Recovery is not a straight line

“Sorry to disappoint you, but I am not doing so well past few days, seems like my back pain returned.”

These were the first words *Trina, a 22-year-old University undergraduate, said when she returned for her third physiotherapy session, after experiencing massive improvements in her first 2 sessions.

I found it intriguing that she thought I would be disappointed for not being able to maintain the improvements made. Without hesitation, I told her I was not disappointed and asked her if she was.

She was expectedly so and I went on to reassure her and said that, “This is not unexpected Trina, recovery is not a straight line and it is normal to experience ups and downs.”

I went on to enquire what has happened over the past few days. She shared that she did indeed felt so much better, she continued with the exercises, albeit did them a little less regularly and she was so caught up with her schoolwork that she sat 3-4 hours straight without getting up.

At this point, I reminded Trina that when she first saw me 2 weeks ago, she could only sit 30 minutes before she has to get up as her back would hurt, and how a week ago, on her 2nd session she reported being able to sit for one and a half hours. Hence by sitting 3 hours continuously, there is a 600% increase in her sitting in 2 weeks, probably an unrealistic increase in the duration on prolonged sitting.

I then reassured her that what she experienced is not unusual, many people would have done what she did and returned to old habits which contributed to the back pain.

“Trina, you did not disappoint me. And I hope by seeing that you have simply increased your prolonged sitting too quickly, a natural thing to do when you feel better, that you don’t feel disappointed as well.”

“Yah I feel so bad that I cannot sustained the improvement, I guess when I get caught up in my schoolwork it gets really hard to peel myself off my desk,” Trina said sheepishly.

“It is indeed hard when you have schoolwork to complete and have to pause and take a break. What do you think you can do to remind yourself to have standing breaks?”

We went on to discuss different strategies she could adopt to ensure she takes a short stretch and movement break every hourly.

“I will make it a point to get up hourly, even just to take a 2 min stretch break or a toilet break,” Trina said.

Trina was able to arrive at her own game plan to overcome this situation that she faces as a conscientious undergraduate. This further ensures that she is more likely to follow through on it than if the strategies came from me.

"Remember Trina, that it takes time for your body to adapt to sitting longer. By doing your exercises and being more active, in time you would be able to cope with sitting longer."

“I feel like I came for physiotherapy with counselling included,” Trina said, “you are working on my body and counselling me at the same time,” she added.

“Haha, well it is not exactly counselling, it is called pain coaching, by combining pain coaching with physiotherapy, we can work together for better progress and results,” I said. “Okay, now my work is done,” I jokingly said, “get up and show me the exercises we went through last week.”

*Name has been changed for patient confidentiality

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