Have you seen the animation movie ‘The Croods’? I’ve partially seen it (while the kids were watching it) and it made me think of my work with people with chronic pain.
For those who have not seen the movie, here’s an introduction from Wikipedia:
"Eep is a girl in a family of cavemen living and hunting in pre-historic times. Her family is one of the few to survive, mainly due to the strict rules of her overprotective father, Grug. In their cave home, Grug tells a story […] of a character that mirrors Eep’s curious nature to warn the family that exploration and ‘new things’ pose a threat to their survival, and says to never not be afraid.
This irritates the bored and adventurous Eep, and after the family falls asleep, she leaves the cave, against her father’s advice, when she sees a light moving outside. Seeking the light’s source, she meets Guy, a clever and inventive caveboy. She at first attacks him but then becomes fascinated with the fire he creates and is eager to learn more. He tells her about his theory that the world is reaching its ‘end’ and asks her to join him…”
And then they have this grand adventure, but I’ll stop here, I don’t want to spoil it by telling you more. You can also watch the trailer if you like.
The main characters are:
Grug Crood, a caveman who is the well-meaning but overprotective and old-fashioned patriarch of the Croods family.
Eep Crood, a rebellious teenage cavegirl who is Grug eldest daughter and is filled with curiosity and a desire for adventure. And, by the way, she moves like the best traceur you can find!
Guy, a nomadic caveboy who is not as strong as the Croods, but prefers using his brain and comes up with various ideas and inventions.
Although every person is unique, we all share some universal human capacities. And, metaphorically speaking, we all have different parts of the Crood family in our head. The overprotective father and the adventurous teenager represent two extremes of the continuum that we all have in us: the need for security and the need for novelty, experiment, and play.
Persons with pain often are like the Croods in the beginning of the movie: they are in a survival mode, but they are not what you’d call happy. They are told to “never be not afraid.” Grug, the protector is in control.
People with (chronic) pain often show signs of behavioural rigidity, their inner Grug is ruling. And this both in biomechanical behaviour as in general behaviour (is there any difference?). These patients show strong signs of protective behaviour. This protection is very strong and protects the persons with pain very well, but it seriously impacts their quality of life.
This behaviour is called maladaptive, and it often is, but I’d like to remind the reader that whether behaviour is adaptive or maladaptive is a judgement that is hard to make (as a therapist). What is adaptive and health-promoting in an acute situation becomes maladaptive after a while. If you just sprained your ankle, limping is normal and even good for you, but is it still healthy if you limp three months later?
Now, don’t get me wrong, Grug is not the bad guy! He’s probably the reason why the family is alive. We absolutely need mental and physiological protection strategies for when we are in distress, when our physical integrity is at stake or harmed. We need Grug, but Grug needs to know when to step aside.
Luckily, the Eep meets this guy called Guy, who is handsome, smart, ingenious, adventurous and very cool. Guy is the one who takes the family out of the overprotective state. Now that would be me.
😉
Actually, that should be me, that task is what physical therapist should do. But it is easier said than done. Like in the movie, it is a journey with ups and downs, and the path is not clear from the start. A journey we (the patient and the therapist) take step by step. A real adventure that can be scary and exciting at the same time. For people with chronic pain seemingly minor steps in that journey can be distressing. Remember, their system tells them to “never be not afraid.” So the physical therapist is a kind of guide, not the guide that leads and shows the one and only way, but the guide that facilitates the person to chose his/her own path to better ways.
In the end, “Grug becomes less protective, letting the family be more adventurous and risk-taking, thus bringing happiness to them all.” Now, that’s a happy ending.
Thanks for reading,
Pieter
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