Most of us will experience a long term injury or persistent pain in our lifetime, usually at a time that we feel is not terribly convenient. “I have too many things to do!” I often hear from patients. “I don’t have time for this!” What sort of strategies can you use to overcome the injury?
Clearly if you have a more serious injury, say a broken leg or a disc tear/bulge, it is going to take some time to repair and recover…. Whether you like it or not. I guess our bodies just don’t know how important we are… Getting angry or frustrated clearly isn’t helpful. An important thing to remember in these situations is that you can’t speed the healing rate up (human physiology only works so fast)…. But you make it take far longer than necessary if you don’t make the right decisions.
The first step I recommend to patients when overcoming a long term problem is to get your mind moving in the right direction, because then your body will follow. What I mean by this is that if you start thinking the right way, you will take the right actions and avoid the mistakes that will slow your progress. As an example, this week a patient of mine came in for a high grade calf tear involving the tendon which occurred when working out 2 weeks earlier. This injury is significant and takes months to heal before activities like running can even be considered. He was angry with himself for having “allowed” the injury to happen, and despite having crutches and a compression sock he started trying to get moving on his badly torn leg way too quickly in the first week. Not surprisingly this caused a lot more pain and inflammation which delayed his progress by at least another week. Only once he decided to stop being angry and accepted the injury for what it was, his mind was able to calm down and make the more sensible decision to stop pushing his body so hard when rest was the only “magic” elixir required at that stage.
The second concept that really helps is to ask yourself each day “what can I do today that will help and not harm my progress”. When I broke half the bones on one side of my body, there wasn’t a lot I could physically do lying in a hospital bed for 10 days. But I repeated this to myself and sometimes the answer was as simple as breathe, wiggle my feet to prevent blood clots, and tense (perform an isometric contraction) of those muscles which I could that wouldn’t cause my 6 broken ribs to scream at me in protest. It helps to think of the bell curve shown below: doing nothing isn’t going to make my injury get any better, and doing too much will likely cause overload and further aggravation. There is a “window” in the middle that is just right (the shaded blue area in the graph). This is the “goldilocks zone” where you are doing just enough to stimulate improvement but not so much as to cause harm. Your “job” as a patient is to do enough of the right things each day to stimulate improvement in those factors that are relevant to your condition. This is what your Physiotherapist will guide you with – specifically what you need to do at this point in time to optimise your recovery.
The next concept worthy of consideration is adequate rehab that is specific to your needs. Each time you get hurt the body inhibits (shuts down) some muscles around the injured area for protection. This can result in long term weakness and a predisposition to re-injury. Think of a hamstring tear and how often you’ve heard the phrase “he’s done his hammy – AGAIN!” Recurrence is the hallmark of inadequate rehab and poor decisions about resuming physical loading. In his autobiography, Australian cricket fast bowler Mitchell Johnson notes that in the first 6 years of his career he had recurrent lower back stress fractures. He admits that he did the minimum amount of rehab to get back on the field but developed a recurring pattern of injury such that every time he made it back to the highest levels of cricket and finally returned to maximum load levels he broke down. It was only when he did his rehab properly and thoroughly that he was able to bowl season in, season out at the highest level without injuring his lower back. More than ever I notice a tendency for patients to do the bare minimum to get out of pain only to have the injury recur a few months down the track. This isn’t necessarily a hallmark of the injury but one of inadequate rehab and a minimalist attitude. I think it’s possible that people confuse “no pain” with “I’m at full strength and ready to handle any and all loads again”. The finish point of rehab after a long term injury is when you are at full strength and function, not simply when the pain stops. The pain usually stops long before you are at full strength and fitness.
There are no shortcuts.
Just consistent work every day in your “goldilocks zone”.
Specificity is important. Sometimes the entire body needs rehab if, like me, you injured a lot of stuff or had a prolonged convalescence perhaps after being hopitalised. Other times your needs might be very specific, such as a weak set of muscles like the lateral gluteals or deep abdominals. The skill in clinical practice for your Physiotherapist is matching the degree of difficulty or load to the exact level of strength the patient has. If the load is too great then the target muscle shuts off and other muscles compensate, resulting not only in no improvement but a gradual worsening of the imbalance as the strong muscles get even stronger. If the load is too light then you are not optimising the use of your time. Again we’re back at the “goldilocks” concept.
There is no internet program or Dr Google who can work out specifically what YOU need at a given time point. You need a skilled clinician to do this. I can’t assess myself properly and neither can you. So listen to the advice given, stay in your “goldilocks zone” each day doing something positive to help your recovery (not too much, not too little… “just right”), and follow through with your rehab completely rather than being half-baked in your approach. You will also achieve excellent results. Lastly, stop looking for short cuts – there are none! You will get out of your rehab what you put in.