What your rehabilitation is missing..

Over my time as a physiotherapist, I have discovered one principle that will help with nearly all injuries. Now as I’m making this claim, you may be thinking an extraordinary technique to help with your pain, or maybe an exercise that fixes everything. Realistically, I have found that life is hard and any progress requires work. The principle I have discovered and what most rehabilitation is lacking is this;

“nearly every injury will respond well when you learn how to load it well.”

What do I mean by this? Keep reading and I will elaborate.

We have all been taught for years to rest, ice, compress and elevate an acute injury. Unfortunately, this education has not included what we should do after the initial inflammatory period. Some of us might try to get straight back into what we were doing, others may be scared and rest for far too long. The key behind managing load well is to listen to your body, and to understand how your body reacts when it’s injured.

Overuse or Acute?

Firstly, you need to recognise if this injury was caused by training too much (overuse injury), or if it was an acute injury like a twisted ankle. For this you may need some help – that’s where Click Physiotherapy can assist you via online consultation (click here to book now). It’s important to recognise the difference as overuse injuries may not require as much rest as an acute injury.

If you’re anything like me, you may have been training with this injury for some time before you decide to do anything about it. Regardless of how acute the injury is, you can always adjust your load to accommodate this.

The optimal load

There will always be an optimal load for your body – whether you train or not. Injury will occur when your normal activity exceeds your bodies capacity to bear the load. As you can see on the graph below, after an injury, the amount of optimal loading is decreased because your tolerance levels change. The key to managing injury is to find this optimal loading zone and then slowly increase as your body heals.

The next question you may ask is, how can I tell if I’m loading my tissues too much, or not enough? This is a great question, and even the shoes you wear can impact the load through tendons. It does take some practise, but the best place to start is to look at your pre-injury activity. If you walked 5km daily, after the injury you may find you can only manage 500m at first. Regardless of how much you need to decrease your load:

“Find a level of loading that doesn’t increase your pain”

Even acute injuries should not result in complete bed-rest! I do need to caveat that if you have sustained an injury because of trauma – like a fall, please get this checked medically as something could be broken.

What does this look like in practice?

What you will find is that when your injury is loaded well, your tissue tolerance will increase. This means you can gradually increase your loading to normal again. Let’s give you an example of what this might look like in practise:

John rolled his ankle in the morning whilst going on his morning jog. He applies the principles of RICE for 24 hours and his swelling settles slightly. The next day he still walks with a limp, so he doesn’t jog, but walks as much as possible through the day. Two days later he is walking normally and decides to try jogging. He tries for 100m and then his foot begins to hurt, so he stops. Slowly over the next 3 weeks he builds his running up every day and returns to his 4km a day baseline.

The bottom line…

Now I know the above example is very idealistic, but you can apply the same principles to your injury. Don’t completely rest, just do what you can and listen to your body. If it hurts, then do a little less next time. Sometimes injury will need further advice so don’t delay in getting things seen if you can’t manage them yourself!

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