Injury Recovery
Your Injured, Now what?
You were training for a trail race, or the ski season, or just enjoying your daily 3 mile walk, then you feel the pain. Your knee, your calf, your back or your whatever starts to protest against the only part of the day that you carved out for yourself. Your brain says go, but your body say no. Maybe it will go away, you hope. But it doesn’t. The pain persists, then gets worse. You take a day off, then a week or maybe more. The rest helped a bit, but it didn’t solve the problem. Are you to old to ski, run, bike? Did your doc tell you to just stop doing the activity that you love? How can you keep your sanity if you can’t go for that 5 mile run?
Slow down, take a seat and put some ice on it. This is the acute phase of your injury, the first 3-5 days. Ice is used extensively for injury recovery because it compels the body’s vasculature to constrict. This vasoconstriction slows down the delivery of all that fluid to the site of the injury, allowing your body to catch up and remove the byproducts of the healing process. It is true that you don’t want to completely limit the inflammatory properties of healing, but if you have swelling, your body is producing the inflammatory cells faster than it can clear them with your venous and lymphatic system. Ice gives you some control over the inflammatory process and provides a much needed relief from the pain. When applying ice, make sure there is something between your skin and the ice pack. Apply ice for a maximum for 10-15 minutes, then remove the ice for the balance of the hour. If you can no longer feel the pain from the injury or the skin under the ice pack is completely numb, it is time to remove the ice.
Take a deep breath, don’t despair, this is a temporary road block. The sub-acute phase of injury can last 4-8 weeks. Your physical pain can keep you in fight/or flight mode, disrupting your internal physiology. Layer on top of that, the negative thoughts of never running, biking, hiking or skiing again and you are not putting yourself into the best position to maximize your healing. Breathwork has been extensively studied and proven to be a potent tool in reducing physiologic and psychologic arousal.
When injured our body tends to stay up-regulated due to pain and/or the mental stress of altering one’s active lifestyle. You are stuck in a fight or flight state. Breathwork can shift you away from arousal, down regulating your acute response to the injury. Daily and intentional breathing, slow and deep through the nose helps shift the body to a parasympathetic state, think rest and digest, where it can more efficiently heal. A simple down regulation protocol is taking a 5 second nasal inhale, pausing briefly and then controlling a 5 second nasal exhale, again followed by a brief pause. Do this for 10 minutes daily. If your doing the math, your daily time commitment with ice and breathwork combined can be as little as 20-30 minutes per day.
Movement is medicine. The subacute phase is when you start to test the boundaries of how much your body wants to move. In the first part of this phase, explore the limits of your movement with pain as your guide. Start moving that elbow, or knee or back within a pain-free range of motion. Don’t move the joint or muscle into the pain. Carve out 10 minutes a couple times a day to move intentionally. This is your daily workout. Don’t skip it and don’t do it in while surfing social media or other in distracting environments. At this point you can phase out the ice, keeping your daily time commitment still at a half hour with breathwork and gentle movement.
The body giveth and the body take the away. As you progress through the sub-acute phase, your movement strategy should become a bit more nuanced and focused on activating or inhibiting particular muscles. Muscles tend to contract in response to an injury. Initially this reflexive contraction is beneficial because it helps stabilize and localize the injured tissue. However, a muscle that is constantly contracted will itself become irritable and painful over time. Additionally, muscles that are carrying too much tone tend to compel us to make compensatory adjustments in how we walk, sit, sleep, and carry things, etc. These compensations can have negative down-stream consequences. Foam rolling and/or stretching inhibits muscle tissue that is chronically contracted. To be clear, I am not suggesting foam rolling or stretching injured tissue. But using these modalities adjacent to injured tissue can help inhibit muscles that are carrying to much tension secondary to the injury. Dedicate 10 to 15 minutes daily to gently foam roll or stretch. Keep breathing, keep moving, now add in some stretching/foam rolling; Time commitment, 45 minutes daily.
Just as our body will chronically contract muscles in response to injury, it will also inhibit muscles in an effort immobilize your injury. Time to wake those muscles up. You can recognize inhibited muscles by how weak they are or even by their smaller appearance. Start with some gentle contractions of the muscle without moving the joint at all. After a few pain free days of gentle contractions, begin to gradually move the adjacent joint through its full range of motion. Once you have full, and pain-free motion, you can gradually start adding some resistance. You had already dedicated 10 to 15 minutes to focus on movement, we have just add scale and intensity to the movement. Your daily time commitment is still 45 minutes, with breathwork, movement and stretching/foam rolling.
In my experience, the overwhelming majority of minor injuries and aches/pains can be solved at home. If you approach your injury with a some focus, a strategy and a set time commitment you will not only return to your physical baseline, you will now posses the confidence and the tool kit to overcome future setbacks. However, if you are stuck and need advice or believe the injury is more than you can handle, please give my office a call for a phone consultation or in-person evaluation. For contact information: www.returntosportphysio.com.