Injuries are a frustrating, and even more so when the same injury seems to keep coming back multiple times. Over time I have seen many patients re-injure themselves which is frustrating for them, but even more so for me as in most cases I can see how these injuries could have been prevented. Reflecting on these cases here are the 3 biggest reasons why I think injuries keep recurring.
There are 2 important questions I like to ask everyone in their initial appointment. The first being “how long do you think it will take for your injury to heal?” and the second being “what type of treatment do you think you will need to get better”. There can be some interesting answers to these questions, but I find they generally seem to follow 2 trends. The first being that people often underestimate how long it takes for tissues to heal. Determining exactly how long it takes for a tissue to heal is always a difficult question to answer as it depends on many factors. However, two of the most important factors to consider are what tissue is injured and what is the severity of the injury. Different tissues heal at different rates which is largely dependent on the tissues blood supply. Tissues with a good blood supply (e.g. muscles, bones and ligaments) take up to 6 weeks for full healing to occur (but will vary depending on the severity of the injury). However, tissues with a poorer blood supply (e.g. tendons, cartilage and nerves) tend to take longer up to 12 weeks. I often find people are surprised when I tell them these timeframes, so I think this is good discussion to have early on.
The second trend is that people tend to expect more passive treatments (e.g. massage, joint mobilization, dry needling etc.) over active treatments (e.g. exercise/rehabilitation). The problem with passive treatments is that the effects have only been shown to be short lasting and don’t directly change tissue structure such as muscle strength or length. If you have ever had a massage you probably felt better for a few days but no doubt after this time the effects wore off. Strength training however has been proven beyond any doubt to provide long term changes in muscle strength and length also improving someone’s capacity to reduce the risk of future injuries. The bottom line here is that if someone is coming to physio for a significant injury or a long standing issue and they expect that 1-2 sessions of massage is going to fix the problem, then this is an unrealistic expectation and before any results can be achieved this persons mindset will need to change.
The number one reason as to why people stop treatment too early is because their pain has settled down and they are feeling better. Because of this most people mistakenly believe that the problem has been fixed. This is almost never true as pain itself is never actually a problem but rather a symptom of a specific underlying cause. There can be many things that can cause pain such as muscle weakness, joint stiffness or poor biomechanics. The specific causes will be different for everyone and there is often a combination of factors at play. Whatever the underlying cause is, it is unlikely that it just appeared one day but more likely has been slowly building up for a while until the final straw was dealt leading to the onset of pain. Likewise, pain is often the first symptom to go away. This means that just because you have become pain free it does not mean you are fixed. As an example, let’s say we have a runner with a hamstring strain. In the first few days this person’s pain levels will be high, and they will likely have increased pain with any hamstring contraction. If we fast forward 3 weeks the pain levels should have settled down by this point. However, if we remember from the first point that muscle injuries can take up to 6 weeks to fully heal. At this point in time the hamstring is unlikely to be fully healed despite the pain being settled. If this runner was to resume running at this point the chance of re-injury is quite high. On top of this, rehab should extend beyond the period of time it takes for tissues to heal due to the reduction in strength that happens due to periods of inactivity, which brings us to the third point.
Whenever I ask patients how often they have been doing their exercises the most common response I get is “probably not as much as I should”. I understand that sometimes life gets in the way and you can’t fit in as much as you like, however it is important to set aside some time each week for your rehab. Exactly how often and how long you need to train for each week will vary depending on the type of activity you have been prescribed and what stage of the rehab process you are in. However, as a general guide 3 days per week is the minimum you want to be doing something. Anything less than this is simply not going to be enough for long term adaptations to occur, and a lack of consistency will only prolong the recovery process. I recently saw a quote from world renowned strength and conditioning coach Bret Contreras which summed up this issue perfectly.
“Regardless of how busy you are, it’s important to set aside a few hours for exercise. If you don’t give yourself that luxury, you will fall into the trap of being too tired to work out. This lack of energy is actually caused by lack of exercise. It’s a perpetual cycle that many people fall into, but the only way to get out of it is to start moving.”
As frustrating as injuries may be it is important to stay consistent and don’t rush the process. The best advice I can give anyone recovering from an injury is to accept from the beginning that recovery will likely take longer than you think it will and be harder than you think it will. Keep the end goal in sight and celebrate the small wins along the way. It may be tough now, but the end results will be worth it.
References:
Cuthbert M, Ripley N, McMahon JJ, Evans M, Haff GG, Comfort P. “The effect of Nordic hamstring exercise intervention on eccentric strength and muscle architecture adaptations: A systematic review and Meta-analyses. 2020. 50(1), 83-89.
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