After the capitulation of the Australian cricket team in the second Test match against England on Sunday 21st July 2013 the commentators remarked that there would then be a 10-day break before the next Test, which Australia were sorely in need of. It is common parlance in cricketing circles to believe that this break will allow teams to return afresh, with new vigour, primed concentration and unshackled of any lingering doubts or fears from the previous encounter.
Although I hold no hope (nor desire) of seeing Australia beat England in the next Test, I do feel that this break will be beneficial to them – beyond giving their tired and aching muscles a rest. This may be intuition but there may well be (or not!) science to back this up.
So why may a break help and why should this be intuitive?
These questions were highlighted in a session the day after by a patient of mine. (She has complex regional pain syndrome and has suffered with pain for the last 6 years.)
“Can I take a holiday from my treatment plan over August?” she politely asked. (She diligently follows a daily self-management programme that is regularly tweaked.)
“Of course”, I said. “That’s a great idea!”
I find that people I treat with persistent and complex pain experiences such as long-standing complex regional pain syndrome need to see rehabilitation very much like a 9 to 5 job. This doesn’t mean they’re on the go all the time as much of the treatment may include relaxation techniques and settling exercises. However, they need the consistent and repetitive nature of this within their plan in order to make serious progress – it’s a bit like learning a new language.
She wanted a holiday to allow her to “just get on with a normal existence for a month” whilst visiting her Mum. We had already scheduled in regular breaks of a couple of days to allow her to refresh, stabilise, have downtime etc…but this was going to be significantly longer.
Having a break from this process seems sensible and possibly necessary. Perhaps a break will allow a shift of focus to a more ‘normal existence’. This may include making the most of what’s important to her – what she values in her life world, including family, environment or work. In some ways this is akin to following the concept of health promotion, such as is proposed by Antonovsky in his Salutogenic model (e.g. Antonovsky 1996) the essence of which is reflected in the psychoneuroimmunology literature (check out Esther Sternberg (2001) for a gentle introduction).
Maybe it will help to top her energy levels up. Giving her further strength to continue the long process of rehabilitation. Certainly a break from work makes many people feel this way. Maybe time out from the respective clinicians and hospital appointments would be enough to return to a treatment programme with renewed zeal! Inspection of the scant literature backs this view up. Holidays have been shown to have positive effects on health and wellbeing. Unfortunately these effects are lost soon after returning to work (de Bloom at al 2009).
We could be more reductionist, for instance looking at things from a systems or cellular level. The research from pharmacological management suggests that there will be a small population that maintain the gains that they have achieved during a treatment cycle during their treatment holiday (e.g. Tanaka 2012).
A month is a long time yet I feel confident that my patient has the knowledge and skills to help herself. In that case what is an appropriate amount of time to take as a holiday or a break in order to get maximum benefit whilst minimising the negative effects?
This brings me back to the Test cricket between England and Australia. They have 10 days between matches. It is a fairly historical custom, certainly one I’ve been familiar with since a child. I wonder whether they had weighed up some of these questions when deciding on the optimum amount of time between Tests?
So back to the question of whether a break will help the Australian cricket team…I guess we’ll know by this time next week. As for my patient, I’ll keep you posted…
– Tim Beames
A. Antonovsky 1996 The salutogenic model as a theory to guide health promotion. Health Promotion Intl. 11(1): 11-18
J. de Bloom, M. Kompier, S. Guerts et al. 2009 Do we recover from vacation? Meta-analysis of vacation effects on health and well-being. J Occup Health 51: 13-25
E.M. Sternberg 2001 The balance within: The science of connecting health and emotions. WH Freeman & Co, New York
Y. Tanaka 2012 Intensive treatment and treatment holiday of TNF-inhibitors in rheumatoid arthritis. Curr Opin Rheum. 24(3): 319-26
I have a similar CRPS patient of two years who feels wonderful every time she visits her grandchildren for a week out of town.
Through my own observations over the years I have witnessed variable degrees of benefit or not from holidays and I suppose that brings us back to the Psychosocial questions in relation to environment and context far more than the break in treatment itself.
Maybe the Australian cricket team are homesick?
I need to get in here quickly before day 2 of the test and Australia collapses . YES! It looks 10 days break gave us time for analysis, problem solving and a new direction. The Australian team even walk more jauntily!
Breathing a sigh of relief, I am pleased to share an update on the ‘break’.
Firstly, I am pleased to share some positive and perceptive feedback from my patient. She had recently picked up a new car with suitable adaptations. This has allowed her a new found freedom that coincided with her break/holiday from her treatment programme.
“Had to email you as I feel the happiest I’ve felt in 7 years!! The car is amazing giving me so much freedom, it feels incredible. I can drive with no pain and get out of the car and carry on. I’ve already been to loads of places and lots more trips planned! I feel totally different!”
Her reflection on the break after around 2 weeks off:
“In theory a month sounds a long time to put a rehab programme on hold, but in practice I’ve needed some time to adapt to a new regime/de-stress (its not easy stopping a strict daily programme, particularly when you’ve schooled yourself to thinking its essential to your recovery!). However, I’m pleased to have the opportunity to move the focus away from my foot, though in so doing I was then somewhat surprised to discover it still hurt!!”
And the cricket update is an interesting tale….
The 10-day break did wonders for the Australian cricket team (I believe Australian sales of Shiraz temporarily soared!!). They returned with renewed confidence and energy. Unfortunately, they were denied an impressive victory due to the rather predictable Lancashire weather (rain).
What is clear is that this Australian cricket team needs a refreshing break after each Test match. The following match that came only a few days after their impressive showing proved too much (and Shiraz sales in Australia saw another temporary peak…).
I think the australian team needs more than a break – we need someone who can bowl a leg break!.
I guess although we say the programme is on hold, it never really is – what was achieved before keeps reverberating in the brain.
A rest from a programme is really just a context change?.