Coping with the Emotional Impact of Orthopedic Surgery

Coping with the emotional impact of orthopedic surgery

By Kirsten Belzer, LCSW, Psychotherapist

Snap, snap, crackle, pop. That was the sound of my life changing in an instant during a summer stroll. I fell on slightly uneven pavement and broke three bones in my ankle and severely dislocated it, leading to a surgery and months of recovery.

An orthopedic injury is typically a traumatic event. The recovery can elicit many emotions. As a psychotherapist, I found that not much has been written on coping with the psychological impact of such an injury and the recovery that follows.

Other than a few research studies, much of what I found was contained in individual blogs. I was struck by how many bloggers noted this experience was the most difficult period of their lives. As a therapist who specializes in trauma and loss, I hope it will be helpful for patients to read about common emotional reactions to an orthopedic injury to normalize their experience and make it easier to cope.

By allowing emotions to arise without judgment, we allow them to move through us. We can also take committed action to make positive changes as a response to these reactions. The following list notes emotions and reactions that might be felt as part of an injury that requires many weeks to months of recovery. This list does not imply that every patient will experience all or even most of these, but many patients will feel at least several of the following:

· Trauma reactions: Trauma can be anything we experience or witness that threatens the life or well-being of ourselves or someone else. Depending on how the injury occurred, studies have shown that 20-50 percent of orthopedic injuries can lead to Post Traumatic Stress Disorder (PTSD). The risk increases with a violent nature of the cause of the injury and the older the patient. While most patients with an orthopedic injury won’t develop full PTSD, the physiological reactions immediately following the injury may include shaking, chills, nausea, insomnia, and lack of appetite. Such reactions may also happen once the cast is removed and the patient sees the limb or foot looking quite different from what it did before the injury. Trauma first produces physiological responses and then come the psychological reactions, such as flashbacks, fears and avoidance behaviors. Calm the nervous system with deep breathing through the nose. Bring yourself into the present moment by noticing five separate neutral things you can see, hear and touch in this moment. Listen to good quality guided imagery or meditation. An excellent source is the Headspace app. Also, ask your doctor or nurse what to expect before the cast is removed so you are at least somewhat prepared for what you’ll see.

· Fear and anxiety: Our fears can help keep us safe. Patients understandably fear re-injury. Our brains help us in this way by noticing actual dangers so we can avoid them. Sometimes, though, our brains work a little too well and create more anxiety than is helpful. Anxiety and fear can also apply to the distant future, as patients worry if they will ever again re-gain full or even close to full mobility. Talking with one’s doctor or physical therapist can help allay these fears.

· Self-blame: Many patients will replay the injury and blame themselves. When my doctor asked how my injury happened and I began with, “It was really stupid…”, he told me everyone says that. Ask yourself what was the original intention of whatever it is for which you are blaming yourself.

· Disappointment: You will probably miss enjoyable events or outings while recuperating, or at least not be able to participate how you would have planned or wanted to. Of course, this will be disappointing. Remind yourself this is a temporary state.

· Helplessness: While some helplessness is part of the process of recovery, remind yourself there are many things you are still able to do.

· Shame: Some people will feel ashamed of the less-than-able shape they are in as they heal. You can ask yourself, “Is this a helpful thought?”

· Frustration: Almost everyone might feel frustration to at least some degree. It’s not easy getting around on crutches or even the knee-roller, which to me had looked easy and like fun, until I actually had to use one. You may remind yourself that you are growing in ways and literally and figuratively using muscles you otherwise wouldn’t have.

· Anger: Some may turn toward others or oneself. Perhaps there is blame of someone you perceive caused the injury. Anger at oneself is also common (see Self-Blame). Anger is often either anxiety, fear or hurt in disguise. Ask yourself what’s beneath the anger.

· Loss/grief: Feelings of loss are real and understandable. With each loss, there are multiple losses. Some of the notable ones may include a loss of a sense of control or invulnerability; a loss of a certain body image; a loss of social connections; and a loss of financial stability, among others. Allow yourself to feel these feelings and grieve or cry if needed.

· Vulnerability/lack of control: We all need to believe in a sense or order and control in the world, otherwise we would have a hard time functioning. For example, if we didn’t trust that other cars would stop at a red light, we would be afraid to drive. Yet with a life-changing injury, those assumptions about ourselves and the world may be shaken. Remind yourself that whatever caused your injury is probably the exception to the rule and not a normal occurrence.

· Resentment: Some people may have resentment arise if they perceive others are not there to help or understand them in their time of need as they would have expected. Remind yourself that our expectations of today are our disappointments of tomorrow. No one is obliged to help us, even if we have helped them in the past. There may be reasons we don’t know or understand for why they can’t be there for us at our time of need.

· Sadness: Feelings of sadness may arise for a variety of reasons. Feel them, and allow them to flow. Have a good cry if you feel that arising. Share the feelings with a supportive person.

· Boredom: Not being able to move much for many weeks can be monotonous. Appreciate that at least we live in the best time in history to have such an injury with access to all media at our fingertips. Take the time the learn something new online. Write in a journal. Call friends you have been meaning to connect with but hadn’t had the time. Meditate.

· Lack of energy: Fatigue is common, as the body is taking energy and putting it toward the healing of bones and tissue. The body has wonderful ways of protecting us and fatigue can be a way of forcing ourselves to take it easy and cocoon as needed to protect ourselves. Low energy, however, can also be a symptom of depression and if you believe that’s what you may be experiencing, talk to your doctor or mental health professional about this.

The good news is positive change can come from moving through a life-changing injury. Post-traumatic growth is real. As we get through the recovery process we can find a sense of strength and resiliency we may have never realized we had.

Through the experience of having to slow down, we can take the time to figure out what’s important to us in life and what isn’t. We may set new priorities and clarify our values and goals. Some may even be able to take the time to begin to live those values and work toward the goals while healing.

With such an injury, one has a good excuse to retreat from the everyday stressors and obligations of the world. This gift of time can be used for reflection and turning inward in a growth-inducing way.

Some relationships may be strengthened, as we realize there are people around us able to provide care in ways we may not have imagined. While others may let us down, we can ask if those relationships really add to our lives or drain us.

The recovery period also allows us to take time to choose health. We are forced to take care of ourselves in ways we may not have considered before. We can also choose to think about ways of caring for our well-being in the future.

Although we wouldn’t have chosen such an injury to learn these lessons, reframing this period in as a gift and staying open to the lessons can be most helpful. Instead of telling ourselves, “This happened to me,” we can say, “This happened for me.”