Experiencing flow during physiotherapy…

Flow is a concept coined by Mihaly Csikszentmihalyi explained in detail in his book of the same name. Flow is the state of being which every professional athlete, dancer and musician wants to be in when executing an exquisite skill or art form. It is the state whereby the abilities and skills of an individual perfectly fits the task at hand. When this happens, the individual is totally present and immersed in the doing of the task, a sense of calm and being in full control without the presence of tension, doubt or anxiety. The individual in flow is fully committed to the process of the task without any expectation or concern for the results. It is in that moment when you feel that time stood still and yet ironically time flew past so quickly that hours felt like minutes. At the end of which you would probably feel that you just experienced heaven on earth.

The concept and best conditions to experience flow captivated my attention and interest since I read its book when it was first published more than 10 years ago. I found that the harder I try in wanting to experience it, the more elusive flow becomes. Flow is not something that happens with trying or pushing too hard, it requires one to be able to know when to push and when to pull back. This is probably similar to what the martial arts strive to achieve when executing precise and effortless forms and moves to defeat their opponent. The regular practice of skills with attentiveness is the key in preparation for the flow experience. However it cannot be forced or coerced, it happens when the individual is ready. Hence the experience of flow comes when ‘preparation meets opportunity’ (a phrase borrowed from Oprah Winfrey) and it happens when it happens, usually not when you want it to happen very badly.

In my work as a physiotherapist, I crave for flow. Simply because it makes everything better and of course, who doesn’t want to feel time fly past quickly at work. I see patients who come with their prime goal of getting rid of their pain, whether it’s a painful back, neck, shoulder, knee or ankle. As part of their experiencing pain, there is usually some level of anxiety and muscle tension that comes with it, there is an absence of calmness and in the patient feeling fully in control of the situation they are in.

The whole experience of being a patient and needing treatment sets the conditions for an experience which is just the opposite of a flow experience. If the pain condition has been recurring or long- term, it typically means the patient has used up all his coping strategies and is failing to adapt to or recover from his condition. Not a fun place to be in for anyone.

Creating an environment for patients to experience flow during their recovery is, I believe, a key strategy for successful rehabilitation. As the saying goes, ‘we teach what we need to learn the most’. So here I am teaching what I need to learn most: 3 points which in my humble experience I have found useful in creating flow for myself and my patients during a physiotherapy session.

1. Listen to the patient

I am guilty of forming my opinions, judgement and biases on my patients prior to truly listening and understanding their complaints. True listening takes time and skill, with intentional listening, patient’s anxiety level drops as the therapist is sufficiently attentive and empathetic. Attentive listening means not being distracted by your own thoughts, but allowing yourself to see things from the perspective of others, untainted by your own beliefs and opinions. Once a patient feels that their concerns are understood fully, they relax more and whatever you do for them hereafter becomes more effective. In this calm state of mind for both therapist and patient, both parties are more likely to experience flow .

2. Address any anxiety and fear

Really understanding a patient’s perspective on their pain and injury takes time. Any anxiety and fear linked to their pain needs to be addressed. Oftentimes a patient will not acknowledge that there is any fear or anxiety, especially with direct questioning. Most of the times, it has to be inferred from assessing them as they perform movement or their reaction to the elicitation of pain as the physiotherapy session progresses. As trust is established between therapist and patient, a patient is more willing to acknowledge that certain aspects of their pain creates stress and anxiety. It is important to address anxiety by equipping patients with strategies for success between treatment sessions. Strategies for patients to own their problem typically reduces anxiety about their pain and helps them overcome it more effectively.

In addition, as a therapist, we have our own relationship to physical pain due to our past injuries and pain experiences. It is also imperative that we address our own experiences with pain, including addressing any anxiety and fear we have with these experiences and use that as an opportunity to both be able to empathise as well as learn to overcome our own pain experience effectively. Our own relationship with pain affects our ability to affect our patients’ relationship with their pain, whether we like it or not. It is an opportunity for growth and learning, learning to overcome my own experiences of pain, helped me be a better therapist.

Hence addressing anxiety and fear linked to pain experiences for both yourself as the therapist and for the patient is paramount in allowing flow to happen.

3. Be a catalyst for their success

As much as we want to believe that our work is about us, it’s really about the person who is experiencing the pain i.e. the patients. As much as we want to feel successful and praised for our good work, it’s really more about patients’ feeling successful and being rewarded for the ‘work’ they are doing to get better. Creating flow for your patients means finding as many positive changes in the patients as you can and emphasise on those positive improvements as rehabilitation progress. Focusing on their progress and their active participation for the positive changes in their daily life. Equipping them with sufficient know-why and know-how helps in creating flow during their rehabilitation process. Create conditions whereby they experience success, this involves teaching exercises which they can perform well enough but still challenges them, never sending them home with exercises which they fail miserably or reproduce their pain when it’s not supposed to. Ideally they look forward to doing those exercises, as it relieves their pain or make them feel more in control of their situation. Matching the exercise difficulty to their ability and tweaking it to make it possible yet challenging for patients sets the stage for flow.

There are probably a lot more strategies to create flow during physiotherapy rehabilitation. Do you think flow is important as part of your rehabilitation plan? If so, what other strategies do you use? Do share your thoughts.

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