#132 - When Performance Becomes Personal: Mental Health, Identity, and the Injured Athlete with Dr. Karolina Shander, Part 2

Performance. Tech is everywhere, but here's the uncomfortable truth. Most clinics don't have a tech problem. They have a decision making problem. Welcome to the Factor podcast, where we talk about the stuff they didn't teach you in school, how to grow your practice, refine your clinical skills. And get better results for your patients. We're here to help you navigate the real world challenges of being a healthcare provider, from delivering top notch patient care to running a business that doesn't run you into the ground. Whether you're fresh out of school or scaling your practice, we're diving into effective, cutting edge treatments to get patients better, faster. We'll also talk about business strategies and tactics to help you work smarter and not harder, and the mindset shifts required to thrive as a top performer in your field so you can build a career you love without burning out. If you're ready to learn what works and what doesn't from leading experts in industry, innovators and respected clinicians across a wide range of specialties, you are in the right place, my friend. Let's dive in. That wraps up part two of our conversation with doctor Carolina Shander. In this episode, Doctor Shander gave us practical ways to think about communication, patient agency, burnout, referral conversations, and the emotional realities that can show up during recovery. One of the biggest takeaways is that providers do not have to have all the answers, and they don't have to become mental health professionals to support the whole person in front of them, but they can get curious, they get asked better questions, they can listen for the way patients talk about pain, identity, fear worth, and recovery, and they can build relationships with trusted mental health professionals so that when a patient does need additional support, there's already a pathway available. We also talked about something that matters deeply for clinicians themselves, and that's the need to create small, consistent moments of recovery, not just big vacations or dramatic resets, but the daily practices that help providers stay grounded, emotionally available, and able to continue doing meaningful work without burning out. Doctor Shander also reminded us that words matter the way we deliver difficult news, describe pain, discuss progress, and frame a patient's future can either increase fear or help create a sense of agency and possibility. A big thank you to doctor Carolina Shander for sharing such a thoughtful and practical perspective on the connection between mental health, performance, recovery, and clinical care. As always, thanks for listening to the Factor podcast. If this conversation was helpful, be sure to share it with a colleague, coach, or provider who works with athletes, high or any patients that are navigating pain and recovery. Be sure to check out the show notes for additional resources that we discussed today, as well as to access any special promotions from our sponsors or partners. Until next time, keep learning, keep refining your systems, and keep raising the standard of care. We'll see you then. Well. And I've heard time and time again from providers, especially those that are a little bit more seasoned in practice, that sometimes even a patient you've been seeing for a while, you have to ask questions multiple ways sometimes to get the true answer. And it's so funny because even being a patient myself, I realize that sometimes it's hard for me to articulate, well it hurts, he like, but it's like, where does that really hurt? Or where's that coming from? Or sometimes I know, especially for chiropractors, for pts, for people who are treating kind of the whole person from a physical standpoint, people forget to tell them things. Oh yeah, I forgot to. Tell you I've had this car accident two weeks ago, or I broke this thing in the past and it's bothered me ever since then. So I think there is a lot to be said, as you mentioned, for kind of like being very observant and kind of picking up on cues and picking up little subtleties that sometimes are not things that are at the forefront of people's mind when they're speaking to you about their pain, but certainly are things that if you have an awareness of what to look for, you certainly can see differently when it comes to being in the office with that patient having that visit. Let's say I'm a provider and I've noticed some things that you've mentioned are kind of those not necessarily red flo to where I think they need immediate help, but those kind of yellow flag things to where it's like, this person could really benefit from speaking to someone. How do I broach that topic without number one making them think that I'm doing that because I don't feel like I can help them, and then I potentially set them up to lose trust in me and my ability to treat them. And or how do I broach that topic in a way that doesn't offend them or have them think, oh, you think it's just all in my head. It's such a delicate dance, right, especially with those physical symptoms. No, it's it definitely is a delicate dance. And I even find myself a delicate conversation too, whether it's with coaches or even parents that are sending their kids into my office. But a big part of what you just said right before this is like how do we get curious about the person that's on our table or in their office? And so I use that kind of same lens of if you know, the person sitting on your table is prone to maybe feeling helpless, or maybe is prone to feeling like they're a problem, right, Like suggesting seeing an additional practitioner may feel really difficult and may feel really scary and unwelcomed. And so I think what I recommend to practitioners is to first get their understanding of, like what do they think about mental health or a sport performance person, have they ever had experience with anybody? What do they know about it? And then offer your own kind of understanding of like, hey, like I've been talking about this, or I've been reading about this, or I know this person that kind of offers this kind of support. Do you know anybody who's done that before? Or even talk about other athletes that are really in the news space that I have talked about it frequently. There's a lot of women's soccer players currently talking about their mental health and the challenges that they went through throughout their years of performing and playing, or people who have come back from injury and have utilized those kinds of resources being able to just showcase like, hey, that might be something that would be worthwhile, but no worries if not, just want to put that out there that can be an additional person on your team to help support you. I'm definitely not going to be the catch all, be all, the savior in any way of shape or form. But can I be a part of the team that can help support that athlete or that person on that table. Most people are a lot more willing to hear that somebody is going to be just another part of the system. Versus being somebody that's going to either fix it all or do it all, or be the thing that's going to change everything, because we may not be offering that as maybe a potential option. And then another kind of aspect or component for me at least, is this kind of like backdoor approach of like, hey, have you ever thought about incorporating something else into your practice or into your sport to amplify your performance, because a lot of the times we get people coming in here and saying like, oh, I want to be a better free throw shooter, or I want to be a better quarterback, I want to have better focus, and then we end up also being able to build up with their confidence and their worth and how they see themselves in relationships. And so sometimes that approach also works too to give them, hey, you might learn something about this, that or the other, and once they get into our office we realize maybe it's a little bit more than that. Absolutely well, and I can only imagine too, when you have an athlete who has had an injury, maybe one that is a career ending or a sport ending injury, and as you mentioned earlier, like so much of an athlete's identity can be wrapped up in being this thing. We as humans. Always tend to label ourselves in one way or another because there's their safety and there's comfort in that, especially if that's something that has been your identity for so long. And I would imagine that when an athlete is at that place where they've had a catastrophic so to speak, injury, that it's like, Okay, I'm not going to be able to be this thing anymore. How do you, as a mental health professional kind of help guide them through figuring out who they. Are after that? Like, maybe you're not this anymore, but that doesn't mean that you can't become something different or that there's so much more to you than just this one thing. You asked. One of my favorite things, I think because a big part of also my research in school was about transition out of sport and athletes who are experiencing a career ending injury. I mean, it's devastating. First of all, there's a ton of shock and then grief, So we typically work with that first and be able to process, understand, and make meaning out of what's happening. That's one of the most important parts about transitioning out of sport or injury in that kind of career ending way is to make meaning from it and understand it a little bit more and conceptualize it, because once we're able to experience it and make meaning from it, then we can actually make choices and do something with it. The other part that you talked about of identity, I mean athletes typically also foreclose on a lot of other parts of their identity because they're so committed to this sport or their craft. And so it's about building those other pieces up too, while managing the grief about letting go of the primary one or moving the primary identity to a different spot. And I like to talk about it that way of you will always be an athlete, or you will always be a performer. It's just that performer may change shape and look different. Like, for example, the way that I see performing and being an athlete is I technically have to be an athlete with my ten month old and my two and a half year old every day. I have to figure out how to have my energy in a certain place, how to show up as my best self despite many circumstances. That may not mean I'm sprinting and going off the blocks and swimming as fast as I can, but I'm utilizing those same skills, and so how do we see the transfer of those skills in a way that actually builds confidence and worth versus just being like, oh, yeah, you can do other things too, or like you don't have to be an athlete. Because the reality is most of the humans sitting in my office want to continue to feel like an athlete. So how do we build that up and allow them to feel also this agency that they can choose how they use their athlete self and how they want to see it, and how they can transfer it in a way that actually feels real to them because they may not identify with the fact of using it as a mother. They might not they may identify it as like, oh, I might actually want to find a different craft that I do. Maybe it's I don't know, stock trading, maybe it's baking, maybe it's some kind of art. But being able to give them the opportunity to explore is also a massive part of the work once they get into my office. Something you said there I think is so important and I'm curious to hear your thoughts. You mentioned that them having the agency to make that choice and make that decision how important do you feel agency is to the healing process in general? It's like one of the most important parts, right, like feeling. And it's so hard because let's say you have you tear your acl right or something that you disc bulges in your back that never technically will go back to where it was before, because that's not how that works, right. But feeling like you have agency over what you're healing looks like and how much you get to incorporate the way that you utilize, whether it's the PT or whether it's like some of these other kind of medical interventions, is incredibly valuable, right, not just timing, but who they work with and how they work with them. Giving just somebody little pieces of choice allows them to feel like, Okay, I'm not just I don't have to just do this and manage it. But it allows them to feel like I get to I have the opportunity to. It's a little bit harder when you have like a career ending or like life changing injury where your life really does no longer look the same, not just about getting back to where you were, but more so adjusting to a new life completely. That's where it's a little bit harder. And then we try and figure out what kinds of places of agency they have in other spaces other than there may be physical health, but can they change maybe even where they work, or like what their schedule might be, or even things as simple as like when I get up in the morning or when I go to sleep, to be able to feel like, no, I don't just have to adjust because of my injury, but I'm going to adjust also corporate some healing when it comes to my injury, but then be able to feel like I have a life that I'm building, not just because of something that changed. Absolutely. And there's an old I don't know how old it is, but there's a common saying. You've probably heard it too, the physical therapy, physical medicine space, and the questions always posed, what's the best exercise to give a patient, to prescribe a patient, and it's the one they'll actually do. And I think that really speaks to what you were saying about agency, because so many providers are frustrated that they will prescribe home exercises, they'll prescribe home care to their patients, whether it's an athlete, whether it's just your normal. Everyday Joe. And then the patient comes back in and they're like, well, how did your exercise go? And they're like, I didn't have time, all right, I didn't figure it out or whatnot. What do you feel like are some fundamental aspects of and I know you already mentioned agency I think is a big thing. They have to buy in. They have to feel like this is something that is their choice to do and they're a partner in this. What are some ways that you would suggest for healthcare providers to get better buy in from their patients when it comes to their care plan. I mean from a factor stand point. A lot of our healthcare providers they're very performance minded, so they do take into consideration activities of daily living that the person already is doing, goals that they have. If they're an athlete, they certainly take into consideration the sport that they utilize. But when you're sitting. Down with a patient saying, okay, this is what I want you to do at home, what are those things that they should really have at the forefront of their mind to make sure that the patient actually follows through and takes responsibility for their care. It's a real question that every provider wants to get the answer on right, It's like, what is the one thing I can say or the few things I can say to really make them understand they have to participate in this. They're not just going to come here and get a magic wand that I can wave and make it all better. I think I'd come at a place with that from curiosity and transparency. I think the people that know me best is I'm pretty direct and so like similarly, like if I want somebody to practice imagery or some focus or some things that we practice in session, and I ask them pretty directly of like how willing are you at this point as much as you know from a conscious mind, how willing are you to practice this? How also likely are you to practice this? Because this is an additional task, right, And so I try to understand what it would look like and what kind of barriers they are going to be for them, whether it's yeah, they have kids or maybe they have a really tough schedule. So what are some places that I can have them do their skills or their kind of rehab, not in addition to but while they're doing something else. Right, So that may look like getting curious of like when do you have three or four minutes between things that you can incorporate this that it's not an additional task but just something you do instead. Right, Like I might have some breathwork to do for public floor therapy, I can do that in my chair right between clients. And so if I were to say, like, oh, I have to go do this thing, I'm probably not likely to do it, but more so like, okay, every time I take my time and a break, I'm going to practice these lifts in my chair. So getting curious about like when are they actually able to maybe implement it without it being an additional task, and then being really curious of what do you think is gonna hold you back? Is it time? Is it willingness? Is it that you're afraid also that you're not gonna get better? Right? Like that's also maybe a barrier at times. And so I like to be pretty direct, and sometimes clients or patients are pretty forthcoming, and sometimes they're not, but at least it opens up the conversation and the door because maybe the first time they come back to you and say, yeah, I didn't do them or I forgot, and then you asked the question again, I'm like, yeah, we talked about this last time, and I'm curious, like, is there anything different, Like you said this was a barrier or this was gonna be something that was gonna be a challenge. Is that what happened? Because if so, then like let's get curious and invite them to also offer maybe is it a for an exercise that doesn't feel as vulnerable or as like shameful? Right like if I really struggle to do my heel lifts or something like that because I feel stupid at practice, is there something else that I can do that doesn't make me look as silly right in front of my teammates or in front of my coaches, or that makes me feel strong and capable. I know not all exercises make us feel strong and capable, but maybe there's another one that can make us feel capable that I might do before I do something that's really really vulnerable. And so those are the things that I would think about. The buy in, though, is for us to also remember that if somebody is not willing to maybe put in some of the work, all we can really do is get curious and understand them and offer them the fact that like that's okay, and also, you I want to do this for you at home, But how can we together craft a plan that you're going to be actually going to be following. And if they don't being okay with that, then maybe they're not in the place to implement this help just yet. I think that's one of my growth udges throughout the last decade has been that sometimes people aren't in the place that they're ready to change or to receive support and help, and that we can just continue to offer, continue to be there and remind them that I'm here even if even if they don't take a ton of action right now. The best clinicians aren't the ones who know the most techniques, they're the ones who can execute the right system consistently. The Factor Rehab system teaches made with wondercraft Start Creating Today at wondercraft dot Ai to guide patients beyond pain relief and into performance optimization. Attending a live, hands on Factor training allows you to walk away with a system you can run Monday morning. Made with wondercraft Start Creating Today at Wondercraft dot Ai Houston and Buffalo. Each is limited to only twenty seats and they're selling fast. Visit Factor education dot Com to learn more and sign up faktr education dot Com now made with Wondercraft. I think that's really important too, especially for new providers, because when you are the provider, when you are the product and the service so to speak, that someone is coming to that is spending their money, spending their time investing in Yeah, I'm sure there's a lot of feelings that you as an individual have when a patient goes to you when you felt like things were going great and then they just never came back. So I think that was huge in what you're saying about having those conversations. Would you recommend that it's better to ask questions early on about their availability in terms of time, their normal schedule likes, so that you can go ahead and be proactive about coming up with that treatment plan, keeping in mind well, they have multiple kids and they're often in the car running from place to place, so that you can incorporate a little bit of that into the plan from the start. Yeah, that's actually one of the things I love here. Doctor don and I have a little kind of like spreadsheet that's included in our intake paperwork of like their daily schedule and weekly kind of performance habits, because again, that may not give us the complete details, but gives us a better understanding of like, yeah, how often are you sitting? How long are you in the car? Do you have a ton of commuting time? Yeah? How long are your practices? Are you really active in them? And so to get some of that information upfront and then be able to elaborate in session of what does it really look like and what's feasible because again, like I can know a ton of stuff about imagery, and I can give them a ton of skills and tools to work on when it comes to confidence. But if they only really can focus for thirty minutes each day, okay, wow, then we're going to be kind of working uphill. And if I don't know that, I can tell them a ton of things and that's not going to be really all that useful to them. I think that's huge to get that information right from the get go with their intake information. And I think too, as you mentioned earlier, having those conversations, being intentional with your communication and the way you speak to patients is so important. I know that, especially too when it comes to the physical medicine space words have an extreme amount of power over patients, and while as a profession healthcare providers I think are at least a little more aware now of the power of their words when it comes to catastrophizing pain or giving specific terminology or gnostic terms that patients can now go to. It used to be it was just go to Google and WebMD and freak themselves out. Now they can have a higher conversation with GPT or claude and get a full diagnosis for better or worse, and long term forecast of what their life could be like. What do you suggest healthcare providers should keep in mind when it comes to delivering difficult news or informing a patient about maybe something that's a little bit more disappointing than what they had hoped was going to be the prognosis or diagnosis. Yeah, can I ask you what is like one of the harder diagnoses do you feel like to deliver? Because I can think of maybe their progress as slower, so their return to play is slower, right, Like, Okay, I can respond to that, But what diagnoses do you feel like are the hardest to deliver? And again, as a non clinician, I can't speak from experience, but I can say, having had a front row seat for it. Sometimes I think some of the harder ones involve things like identity, as you mentioned saying we're going to have to refer you for surgery now, or if there's someone who post injury, post surgery and they're just never able to get quiet back to where they used to be, or a then for providers that treat a lot of weekend warriors and former athletes, like, hey, dude, you're seventy now, your seventy year old body is not going to work the same way that your twenty five year old body did. Things like that that can be really crushing when that is such a core part of their identity. Okay, what I was, That's what I was kind of hoping for, because the angle that I typically take right is, first of all, I take a step back and think, what is this going to mean for this person taking account into their identity? Right, So let's say this is a seven year old human takes a lot of pride in what they do and they love crushing it. But this is really starting to brittle their bones, right, or like this is really detrimental If I know this about them, I think about Okay, I have I want to share with you this information about how your behavior is impacting your health and kind of look at it from a this doesn't define you, right, these behaviors are challenging your health, and I know this means a lot to you. So let's get kind of curious and creative of what it would look like to still honor your identities and the things that matter the most to you, while also keeping in mind that we have to adjust right the words of like, there's a whole kind of phenomenon about the power of yet right and also the terminology or words about like we need to adjust, not fixed, not stop, not you're never going to be the same, but more so, we need to adjust to a new new normal. We need to identify what's going to be the best path moving forward given the changes you've experienced. And to have this kind of almost like openness and idea and almost again curiosity to what it could look like to change our behaviors or how we see ourselves despite this really challenging news. Right, Like, if I have an athlete coming in who's like they have some kind of injury and they're let's say it's a back injury and they're unable to return to the field as quickly as they would like to. I mean, first of all, it's honoring the fact that like this is really crappy, is not the news you want to receive, and honestly, it's not the news I want to give you either. And what we need to do is see it as just information and not something that's defining the next couple steps, because I think what's really common for high achieving humans and a lot of people in this planet as we see things as black or white, like I'm either healed or I'm not, or I'm cleared to play or I'm not, versus yeah, I still have these challenges and can I still move forward in some way, shape or form, even if it's not the way that I had envision to begin with, So offering opportunities of maybe healing or growth that's not maybe just yeah, you're cleared and you're fine, versus like, hey, you've gotten a lot stronger here and highlighting the growth that you've already seen while acknowledging the fact that they're not where they want to be. Yet absolutely well. And I think it's important to have they say to have and phrases instead of butt like instead of you so much have and like so that they can see that while you have this injury, you maybe have this long term thing that you may have to deal with moving forward, and you can also still be this thing. Yeah, it's not an either or there's not a choice to be made about one versus another. And I would imagine too that that's also one of the things you want to listen for when it comes to having conversations with patients throughout their care journey is, as you mentioned before, how are they speaking, What type of language are they using? Are they using a lot of negative self talk? Are they making comments that make you question what kind of support system they may have outside of your interactions with them in the et cetera. There's been a lot of focus in the corporate world lately about burnout and about the signs of burnout what to look for. I'd imagine that, much like burnout can happen with people who are high achievers from a mental and a productivity standpoint at work, you have the same thing when it comes to dealing with athletes. If I'm a provider who treats the gamut of different patient demographics, what are some signs of burnout that I should look for that can kind of tip me off to the fact that this may shift or change my care plan a little bit in terms of kind of the timing and the sequencing of things, versus really kind of forcing that patient to slow down a little bit in some aspect of their life. Yeah, it's a good question. I mean, burnout can look a little bit different for different kinds of humans. But the things that stick out to me is probably their drive is lower, but their excitement to improve is lower, so they're maybe not talking a lot about what they're doing additionally, or any of their practices, or kind of maybe there's somebody who watches a lot of tape or even other sports, you see kind of a decrease in that. You might see some really emotional dysregulation. May not just look like sadness or anger, but maybe some just like volatility and variability and how they're showing up in your office, if there's big shifts and changes like that's something to be paying attention to. Maybe also changes in how much if you ask, like how much they're sleeping, are they getting rest, are they feeling like rested? If that is also happening underneath the surface, you'll see some changes and how they're able to recover. Also, I mean any kinds of big shifts and changes in eating habits and so paying attention to big weight loss with weight gain, or even comments regarding nutrition and hydrating because that is typically falls by the wayside or is a big product of some of the burnout too. So I answer your question. Yeah, I know that these are all huge like things to look for because I think so many people, especially because a lot of the providers that we have in our network are themselves high achievers. They are giving of themselves every day. They all went into the profession to heal and to help people. I think burnout is one of those things that while sometimes you may think you know what it looks like and other people, sometimes it even sneaks up on you yourself. And because we do have so many in our network that are either students going through school and studying for boards and burning it at both ends there, or those that are in practice and trying to grow their business, I think, in my experience anyway, burnout is one of those things that is kind of sneaky because you don't see it, and usually by the time you realize that you're burned out, you're definitely there. Welcome back to the Factor podcast, where we bridge the gap between rehabilitation, performance and real world clinical practice. I'm your host, Jessica Riddle, and today we're continuing our conversation with doctor Carolina Shander, licensed psychologist and certified mental performance consultant who specializes in sports and performance psychology. In Part one, we talked about the whole human behind the athlete, how identity, mental health, relationships, rest, recovery, and performance are all deeply connected. We also discussed why trust matters when integrating mental health support into sports medicine and performance environments. In Part two, we'll move into the practical side of that conversation. Doctor Shander shares how health care providers can broach the topic of mental health support with patients without making them feel dismissed, judged, or like their symptoms are all in their head. We also talk about agency, patient buy in, injury recovery, career ending injuries, burnout, and how providers can use curiosity and better questions to understand what is really happening beneath the surface. This episode also includes an important conversation for health care providers themselves, especially those of you who are high achieving, deeply empathetic, and constantly giving of yourself. In practice, doctor Shander will offer practical insight into recognizing burnout, building small moments of recovery, and creating rituals that help providers reset their own nervous systems. Between patients and at the end of each day, Whether you work with athletes, active individuals, performers, or patients that are navigating pain, injury, stress, or identity shifts, this conversation is a reminder that healing is rarely just about the issue, It's about the person attached to it. Let's get into part two of my conversation with doctor Carolina Schander. Hey guys, if you like what you heard today, I encourage you to visit our website at Factor hyphenstore dot com that's spelled fak tr hyphenstore dot com to find out more information about all that we have to offer. We have a variety of online offerings as well as our hands on Factor Rehab System course scheduled in cities around the globe. Be sure to also check out our event calendar and bookmark any of these upcoming live webinar dates coming up in the near future so you can join us live and of course the biggest compliment we can receive is for you to help us spread the word to your our friends, colleagues and classmates. You'll find all the important links, as well as info about our sponsors in the show notes, so be sure to check those out,