03 Nov Prevention: Is it a Mindset or an Afterthought?
Written by: Karolina Shander, PhD
This is not your average gripe about insurance, or care, or lack of information and clarity. This is an expression of incredulousness at our society’s focus on rehabilitation, or “rehab,” instead of “prehab”—prevention and preparation. In the medical field, athletics, motherhood, and even everyday life, the idea “don’t fix it if it isn’t broken” runs rampant and fuels how we make decisions, and underlies an ignorance of the importance of therapy (behavioral and psychological), or, more simply, just a comprehensive self-awareness, before we need to “fix anything.” An example from the athletic world is the seeking of psychological/performance treatment once someone is no longer “doing their job”—i.e., making plays to make other people more money. The reality is that currently, most providers, including hospitals and physicians, are paid to treat rather than to prevent (Levine et al., 2019). What if this wasn’t the case? What if the focus was on prevention and preparation? What if our capacity to allow ourselves to grow in awareness of “who we are and how we are” could then arm and equip our special people, students, friends, family, children, etc. with information and tools to handle future experiences and obstacles that have previously been distressing and caused negative results. What if…?
Now, for those of you who do not know me, I am a counseling psychologist who specializes in sport and performance. Typically, what gives me energy and excitement is investment in and discussion about optimal performance, systems work in teams, preperformance routines, relaxation techniques, optimizing a holistic human identity, and managing retirement from sport while understanding the underpinnings of a human from a psychological and betterment standpoint. But, due to changes in my life, including identity shifts and adjustments from my athlete identity into motherhood, I have recently become more aware of a preposterous lack of emphasis on prevention and preparation. More accurately, there is a focus on fixing what is broken after the fact. As I have sat with most of my individual clients in my office, I have been overcome by the reality that 95 percent of the people in my office have entered the room because of a problem or real symptom that is causing issues in their life, with the hope of understanding it and making it “go away.” Although that is often a purpose of therapy, we need to start putting the emphasis on getting people the support, knowledge, and care BEFORE chaos ensues.
Medical Treatment
Within the medical system, we see an emphasis on physical therapy, occupational therapy, etc., but often a referral is made after an accident or incident, in order to manage an injury or adverse health outcome. Preventative services are BARELY covered in insurance programs. After sustaining an injury, an athlete might be told to download an app with some general information or stretches to do, or tips on implementing better nutrition in daily life. This is better than nothing but IS NOT ENOUGH. We often spend hours after the injury or medical incident trying to identify what is even covered in our rehabilitation…and how much access we have to those services before they are no longer deemed “necessary.” Sheesh. We are supposed to somehow prevent injuries while also quickly healing too, with no real resources. Despite the fact that articles have been written about the benefits of prevention and the increase in positive outcomes post-injury or surgery with the implementation of prehabilitation services (such as increased self-esteem and motivation with those undergoing ACL repairs [Fruin et al., 2024]), there appears to not be enough information to induce change within the medical system.
What if we had resources and information to prevent issues related to back or neck pain from sitting in a chair 9–10 hours a day? Or were provided real information or directions on how to understand our body, gut, and nervous system before issues develop with our weight, heart, or digestive tract? Or physical therapy programs that encouraged movement and body work to prevent our bones from deteriorating and promote long-term health and wellness, and not just managing knee pain after a replacement?
Sport
Unless you are in an athletic department or on a team that focuses on prevention and rehab, you typically do not have much access or knowledge of what can actually help you prevent injuries, or prevent burnout or well-being breakdown. Or, if you do have access to people or resources, it is muddled with the narrative of “push yourself to the brink” or “fake it til you make it.” Gosh, what a difficult system to thrive in. The dialogue is typically that mental health services are only necessary if “someone has a problem” or is in “dire circumstances.” Discussion about retirement from sport is only entertained for seniors, and unpacking the meaning of injuries and their impact are only touched with a 10-foot pole when a star athlete is undergoing rehabilitation from an injury in the moment. Injury and burnout prevention are typically ignored, as they are directly antithetical to being excellent and hardcore, despite the fact that most athletes burn out physically before they burn out mentally.
This is even more unfortunate when we have seniors/long-term athletes ending their seasons with an injury and then being left to find their own support network after graduation. We are leaving our high-drive athletes to flounder if we do not equip them with tools to manage these changes or difficulties and provide them with the information they need to be even better off in the long run.
Maternal
Now do not even get me started on prepartum or peripartum care. You typically do not see a provider until eight to nine weeks of pregnancy, when there are a ton of questions about safety, feelings, and nutrition. Where do you turn to understand how to modify nutrition to fuel your body when wanting to hurl at the smell of anything, including paper? Where do you turn to understand how to modify movements in the gym? How do you know what symptoms to attend to with the hormonal changes you may be experiencing…the anxiety, nerves, feelings of being stuck? Where are the services for learning pelvic floor work to STRENGTHEN BEFORE YOU GET PREGNANT? Yikes, the answer is nowhere. You have to search for it yourself, and even then, none of it is typically covered, or there aren’t clear directions on what to follow. So, again, there is just a blatant void in peripartum and prepartum care. And for postpartum, if you are lucky, your provider may share a recommendation for pelvic floor therapy to be able to strengthen your muscles postchildbirth, therapy services to receive mental health support, and a number to call for lactation services. But by the time you are six weeks postpartum, you should be good to go, right? Wrong. That is when some of the feelings of sadness, intense anxiety, fear, difficulty with nutrition, physical weakness, identity crises, and other challenges may ramp up due to no one checking in on the mamas and their process. I truly wonder what it could look like if we talked to mamas about the transition of identity in becoming a mother before they actually deliver the baby, or strengthen pelvic floor muscles during pregnancy. I wonder how much mothers could feel seen and more confident bringing a child into the world if they knew how their bodies might change and respond internally, learn tools to maintain strength and well-being throughout their pregnancy and beyond, and feel ready to juggle the various bodily morphing—from shifting of internal organs to “mom strength.”
Psychological
Ha. Where do I even begin here? Preventative therapy? Never heard of her. Therapeutic emphasis on well-being before symptoms begin? Never approved. I mean, if you are not “mentally ill enough,” your insurance can dictate how many sessions you receive and what diagnosis you actually need to determine whether your mental illness is severe enough. And, if there is trauma, you have to justify how difficult a time you are having to get a medical diagnosis. What if well-being were included in our health care and an annual wellness check, just like a yearly physical? An annual wellness check could help keep track of our process and challenges of life, and how our mind is changing and adapting as we age. It could also help detect those mental health symptoms that may not be blatantly problematic. This could prevent future suicides and harm. People could feel cared for and heard, and at least noticed, and even more equipped to attend to their own symptoms throughout the year before problems arise. I would easily state that if most of us could utilize mental health services to become more self-aware of what we are experiencing based on who we are and our internal world, relationships and overall society could feel safer, more secure, and actually allow people to flourish.
In conclusion, the systems in which we live and work do not particularly support the lens of prevention and preparation. Also, those with privilege, including myself, have more access and means to take care of their mind, body, and soul before there is desperation and a need for help in our various life circumstances. Rehab is the norm, and fixing it when it’s broken still remains pervasive in many contexts. Until our systems see the value in human experience and the utility of prevention, maybe we can internally, within our own family and social systems, act on some behavior changes or mindset shifts to help balance within our own lives until our medical/social/psychological/political systems catch up to our needs.
So, Can We Do Anything About This?
To be frank, writing this all out actually induced a bout of hopelessness. Where do we go from here? Shoot, we may have to uproot the deeply entrenched systems of our health-care systems and rewire the cognitive thought processes we have operated within FOR DECADES. And the only way I believe we can do that is by speaking out and advocating for this need. I vow to continue sharing my belief in prevention, growing in self-awareness, and equipping those in and out of my office with resources to take care of themselves when they need to most. Those with power in the medical systems must advocate for services and wellness focused on health before there’s a bigger problem to solve. Powerful and influential sponsors and stakeholders in sport must embrace the need to highlight prevention of injuries—mental and physical equally. We MUST spread the wealth of knowledge on how a preventative mindset can equip our people to be the best version of themselves AND prevent many mental health and other obstacles. Think about how prevention could decrease potential medical/psychological/emotional challenges and increase how much we can gain as individuals, systems, and finally, as a world. I invite you to have this conversation often and share with those around you, and maybe if we turn up the volume on the conversation, we will be able to see the change happen for us and for our children.