Written by Stephanie Lievense, PT, DPT, OCS

I have been a competitive athlete for twenty years – much longer than I’ve been a physical therapist! Growing up, I participated in softball, volleyball, basketball, tennis, golf, dance, and gymnastics. I did some swimming, biking, and running if I had any sort of off season but was never serious about it. When I started college and no longer had team sports to keep me in shape, I regularly started swimming, biking, running, lifting weights, and doing yoga and Pilates. By the time I graduated college, I started playing with the idea of triathlons. Right before I started my first year of physical therapy school, I competed in my first triathlon – The Athleta Iron Girl sprint triathlon – and even won my age group! That was it. I was hooked. 

From there, I signed up for my first half marathon near the end of my first year in physical therapy school. I continued to sign up for short distance triathlons and more half marathons during lighter school semesters. When I graduated from physical therapy school, I needed something to work for that would keep me sane while studying for my board exam. I set my sights on my first Half Iron distance triathlon, and completed it (don’t worry, I also passed my boards). When I started my first job as a physical therapist along with an orthopedic residency, I dropped back down to short distance triathlons for time’s sake. Once I got the hang of “adulting” and completed my residency, I went right back up to full marathons and half Iron distance triathlons. I even did my first full Iron Man!

This all sounds and looks pretty glamorous on paper. I fell in love with endurance sports and somewhat excelled at them while working full time as a physical therapist and earning my specialty in orthopedics. However, those are the highlight reels. For as long as I can remember, until about two years ago, I struggled with body image issues as well as poor relationships with food and exercise. Over the years, I alternated between binging and purging or restrictive eating, depending on my current triggers. Just like recovering from an injury with physical therapy, recovering from this was not easy.

Several years, an amazing fiance, a brave best friend, two counselors, a psychologist, and a sports dietitian later, I was finally past all of this. In 2018 I completed my first full Iron Man twenty pounds heavier but faster, stronger, more powerful, and healthier (mentally and physically) than I had ever been. At this point you’re probably wondering what all this actually has to do with physical therapy. When treating anyone who is even remotely active, it has more to do with physical therapy and the rehabilitation process than you think. 

As physical therapists, we treat the whole person. When you walk into our clinic with a knee injury, you are not just a knee – you are a human. Other parts of your body can affect your knee. Your activities and motor patterns affect your knee and the rest of your body. Your past experiences with pain (both physical and mental) affect the way you move and the way your nervous system processes certain stimuli. Your diet, sleeping habits, coping mechanisms, and hydration affect your risk of injury and your recovery from an injury. 

Obviously we are not dietitians, psychologists, or medical doctors, but we have to keep all of these factors on our radars when treating our patients and be able to refer to the appropriate provider if necessary. If your body is not properly fueled, hydrated, and/or rested, it cannot withstand stress as well or as long, putting you at a higher risk for injury during exercise. This can also slow down the recovery process if you are already injured. During my restrictive eating period in physical therapy school, I actually couldn’t run for six months due to repeated calf strains. Had I rested and fueled my body, this could have easily been under control, but instead I kept trying to push any kind of exercise I could get and even restricted my caloric intake below 1,500 because I couldn’t run.

For those of you who have been to psychotherapy consistently, you probably know that recovery is not a nice, linear progression. Some days are good – you have a productive session with your therapist, you effectively recognize triggers and apply what you’ve learned, and you feel a sense of accomplishment and wellbeing. You think to yourself, “I’m getting better! I can do this!” But then there are the bad days. The bad days seem to come out of nowhere sometimes. You cry the entire therapy session and instead of covering ground, you work on damage control. Everything triggers you and your emotions go haywire. You feel like you’ve gone backwards and will never be that best version of yourself that you’ve been working toward.

For those of you who have been to physical therapy consistently…does this sound familiar? That’s because it’s the same concept – it’s a rollercoaster. Some days you complete your home exercise program perfectly, you can unload the dishwasher, and you can get through your activity of choice with minimal to no pain. You enter the clinic and tell your physical therapist, “It’s working! I’m better!” Then, there are days when you just wake up with pain. It’s there and you have no idea why. It could’ve been that awesome pain-free run that you did two days ago, but that doesn’t make sense – it didn’t hurt while you were running! You enter the clinic and tell your physical therapist, “I’m never going to get better! I’m going to need surgery!”

Patients come to me and want to be 100% by tomorrow, and I have to deliver the bad news that this is not a realistic expectation. There is no magic pill – we can help you feel better quite quickly, but 100% is going to take some time. When I finally got serious about psychotherapy in 2015, I expected to be “normal” in a few weeks, tops. I was very wrong – you can’t undo years of mental and emotional tangles in a few weeks. You also may not meet the provider who is going to get you better on your first try. I tried two counselors before finding the psychologist that I truly meshed with, and she and I worked together for three years before I felt like my best self. The same goes for physical therapy – most likely, you have compensated with the same faulty motor pattern for months or even years, and we can’t undo it in one session. 

Whether you’re reading this as an athlete, a patient, a healthcare provider, or a parent: I hope this post has spoken to you on some level. Just like rehabilitation for mental and emotional pain, rehabilitation for physical pain is grueling. It requires hard work and patience every single day. It requires awareness of physical and emotional triggers, bad habits, and your overall health. You may have to make some changes with which you initially do not agree but will help you recover in the long run. You have to celebrate the little victories, even when they don’t seem like much. Your physical therapist will be a sounding board on your bad days, a cheerleader on your good days, and an advocate for your health and wellbeing every day.