A regular discussion that occurs at the clinic includes the questions: What is the right thing to do after an injury? When should I start manual care? How long should I wait before I resume activity/sport? Am I good to go if I don’t have pain anymore? These are all valid questions and the answer to all of them unfortunately is: It depends.
For the purpose of this discussion I will only be focusing on injuries that do not require surgery. Post-operative care can also follow this sequence but the timing is usually longer.
Manual therapy of any kind CANNOT directly speed up the healing process. What it does do is the following: It helps point the tissue in the direction that it should heal, it helps release endorphins to make you feel better, and active/rehabilitative strategies help re-establish good motor control. Therefore, it would be in your best interest to initiate manual care as soon as you can. It will help guide your transition from stage to stage.
So, let’s get to it! Here are the FOUR stages that you should follow after an injury:
1) Relative Rest
2) Bracing
3) Getting outside of your comfort zone
4) LOAD, LOAD, LOAD
Relative Rest:
This part of an injury recovery plan is the easiest, mainly because you do not have to do very much. You let your body calm down after an acute injury. Having a chronic injury usually means you missed a step or skipped a step in the evolution of recovery. Now the length of time you rest depends on the type of injury you’ve sustained. If it is a 1st or even some 2nd degree sprains or strains, then resting four to seven days is usually good enough. In this stage, you will do light range of motion exercises with no loading, some light isometric contractions (tense your muscles but don’t move a joint), and either ice or heat depending on the timing of this type of intervention.
Bracing:
Bracing is important in the early stages of recovery because it’s what allows you to get through your day with little to no pain. And at this point, if you don’t brace, simple movements can lead to pain. Your main goal here is pain management. Bracing is also an isometric exercise, just as in the relative rest stage but with stronger contractions. Bracing thus helps create stability to minimize muscle strain or joint irritation.
This is the stage where many people falter. They end up finding a strategy to move with as little pain as possible, but pain and discomfort always reappear because they haven’t moved on to the next stage. They have essentially trained themselves into a state where the brain and tissue (muscle, tendons, ligaments, etc.) think anything outside the brace is dangerous. Bracing for too long can lead to tissue compliance or even capacity issues (see the next stage for an explanation of these concepts).
Getting outside your comfort zone:
This next step is the transition from rehab to training for preventative measures. At this point, it is important to understand the concepts of tissue compliance and tissue capacity.
Tissue compliance is the tissue’s ability to allow you to move through particular ranges of motion. Compliance issues are often reported as tension. This tension could be associated with the actual injured tissue or could very likely be felt in supportive tissue away from the injured site. The latter is most often the case and, likely, the reason you got injured in the first place. Poor tissue compliance in one region of the body puts undo stress on other regions, especially more mobile regions.
Tissue capacity is the ability of the body’s tissues to perform under a load, whether it be body weight or the addition of an external load. A nice little summary is:
Tissue capacity < load = injury
Tissue capacity ≥ load = Rehab
Tissue capacity >> load = Prevention
In order to be pain free, you need to move with control and, if you have control, then you automatically have good MOBILITY! An important point to remember, however, is that everyone has different degrees/amounts of mobility and we are not trying to fit everyone to a set of ideals. Focus on your current status and work on making small changes.
LOAD, LOAD, LOAD:
At this point in your recovery, you should be pain free but could still experience some discomfort that is alleviated with controlled movement prescriptions. Here, you should be doing traditional exercise routines that stress the body to respond to the forces applied to it. The work that you do here is preventative of future injuries.
So, if you happen to have injured yourself and want relief from the pain, book an appointment today and let's start your recovery process!
Dr. Mark Bird, BSc (Hon), MSc, Acu, DC
Chiropractor at The Coach House Therapeutic Centre
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