Avoid This Injury Rehab Trap

Many people mistakingly quit rehab too early. Most of the time when people do this, they either don’t feel pain anymore or they see that their injury is ‘healed’ on imaging. It should go without saying that these two scenarios in and of themselves are fantastic outcomes. However, this is normally not the best place to stop working with your rehab professional. Far too often, we see people that stop at this point flare things back up when they get back to their activity. Or they keep having the problem recur every so often. We’ll explain why this happens and what you can be working on to avoid this cycle and unnecessary prolonging of your injury and sitting on the sidelines.

Scenario 1: You’re no longer getting pain

Often times the first step in our plan with you is to calm things down, and this is an important step in the process. This can include strategies like modified activity or eliminating activity for the short term, teaching you about factors you can adjust to reduce loading on the painful area, exercises that help relieve pain, etc. Sometimes this calm down period is quite short (not always) and this is GREAT when it happens. The trouble is, pain and certain types of pain issues are related to things like activity levels and certain types of loading (eg., faster movements, stretch based movements etc).

If you look at the graph pictured here, this illustrates this quite well. A given body part for an individual will have a ‘load tolerance’ - simply the amount of loading that body part can handle. If this is exceeded for too long or too much all at once, this can sometimes cause pain. When we ‘calm things down’ this often feels better but upon returning to activity people will often go right back above this load tolerance and then are back to square one.

Our goal with continuing rehab is to guide you with slowly and methodically returning to your activity while ensuring this line isn’t being exceeded. Additionally, using what we know from the body part you’re dealing with and the demands of your activity, we can use exercise to improve this load tolerance. Combining these two things, we can improve how much that body can tolerate and theoretically we can reduce the risk of getting that same pain recurring as often.

Scenario 2: Your Injury is “Healed” on Imaging

We see the following scenario occur quite often: a client fractures a bone or has a surgery and goes in for their follow up appointment with their doc…they look at the scans, the injury is healed, and the conclusion is “you’re clear!”. The client leaves that appointment with the reasonable assumption (based on what they’ve been told) that they’re ready to return to activity. Most often, they quickly realize that they aren’t ready and are still dealing with pain and sometimes flare themselves up badly enough to set themselves back quite a bit. We’re not faulting the doctors for this, their job is to make sure the tissue is healed and that it’s technically safe to get back to things. However, the reality is that most injuries even when technically healed need time to be re-exposed gradually to activity. This is because tissue status doesn’t always (in fact it often doesn’t) relate 1:1 with how a tissue ‘feels’. How a tissue feel has a lot more to do with your body’s interpretation of danger.

Consider this analogy. Have you ever gotten in the car and accidentally left the volume on really high? Your body doesn’t react very well to that. However, if you wait you can usually turn up the volume to that same level gradually over time. This is a similar thing that’s going on in your tissues. You need to allow graded exposures to ‘convince’ your body that it’s safe to engage in that activity again, or else it might fight back.

Further, the tissue itself although ‘healed’ may not be remodelled enough to actually tolerate greater forces. The way a tissue gets remodelled is through gradual, progressive loading and time. In this way, you can actually tell your tissues what you want them to do and how you want them to grow. If you’re an active person, you want your tissues to be robust and prepared for a variety of types of movements and forces, not just ‘healed’.

In Conclusion

It’s a great thing that you aren’t feeling as much pain and/or that your injury is healing. However, this is often a very important stage to continue rehabbing your injury. You can work with your physiotherapist to continue building tolerance and returning to activity in a graded manner. Use your rehab to set you up for success!