Active Recovery After An Injury
We have all heard that after suffering an injury “rest is best for a speedy recovery”. But what does that mean? Many visitors to my clinic, having suffered an injury and rested up for weeks, complain that their pain just won’t go away. When I ask them what exactly they’ve been doing in those weeks, their answer usually is: “Nothing. I was told to rest!” To be fair, rest is defined as “cessation of work or movement in order to relax, sleep or recover strength”. Injury rest, on the other hand, actually involves movement— but not the kind that increases pain or aggravates symptoms. Rest is then followed by a graduated return to activity, commonly known as rehabilitation.
No matter whether it is a sprained ligament, torn muscle or a broken bone, the body goes through the same process, although recovery times may differ. Factors that affect the rate of recovery are severity of injury, general health, age, cause of injury, location and type of tissue. The greater the blood supply, the faster the healing time. Muscles will heal quicker than tendons, and tendons quicker than ligaments.
In some cases, early exercise can be beneficial. For example, tendons do not have a rich blood supply and the contraction and stretch can stimulate an increased blood flow and better healing. Muscles, on the other hand, need scar tissue to repair, and early activity may be detrimental although some movement is needed to ensure that new fibres are arranged in the right direction. Disorganised muscle fibres can result in muscle weakness.
Acute Inflammatory phase that lasts between 1-7 days. Although we know inflammation can be problematic, it is an essential part of the healing process. Whether you have sprained your ankle, torn a muscle or a broken bone, this stage of healing brings nutrients to start the healing sequence and it is also responsible for clearing the area of dead tissue and blood. Unfortunately, the increased pressure associated with inflammation can cause pain and discomfort; this is why ice can be very effective during this stage: it slows down the inflammation, reducing the pain and swelling. But remember, it’s important to not stop this process completely as it leads us into the next stage
Sub Acute Cell Repair phase can begin from day four and last up to six
weeks. During this phase fibres (scar tissue) are laid down; the more severe the injury, the more scar tissue will be produced. Pain usually subsides and this is the time when lots of re-injuries occur, as people take the reduction of pain as a sign the injury has healed. Remember, scar tissue is still forming and is disorganised, making it weaker than regular tissue. So, although you are advised to start moving to help reorganise the fibres, increase range and build strength, it should be a gradual process with a slow return to full activity.
The Remodelling phase begins by week three and can last from a few months to several years. It is a stage that is often overlooked but it is during this period that the scar tissue is reformed and takes on the same properties and strength as normal tissue.
Another consideration for healing and return to function is altered movement. As well as the normal healing reaction, our primary survival instinct is to avoid movements that are painful. Each of our 650 muscles has a role when we move, and any changes to our movement can alter our biomechanics. Imagine a train running slightly off track. It will move, but not smoothly, and damage will eventually show. The altered reaction of our muscles and changes in movement can cause tissue and joint irritation which can prolong the inflammatory response and slow down our healing and further affect normal movement; this can start a cycle of pain and re-injury. This is when physiotherapy can help. Physiotherapists can assist with pain relief and all stages of the healing process; giving advice on stretching and strengthening exercises, getting back to activity quicker and reducing the recurrence of injury.
Depending on the type of injury, both rest and exercise are important for recovery.
Kim Jackson is a UK-trained physiotherapist with over 20 years’ experience. She specialises in musculoskeletal pain and dysfunction including back pain and sciatica, stroke and other neuro conditions plus sports physiotherapy, having worked with local, regional and international athletes and teams treating injuries and analysing biomechanics to improve function and performance. She is registered with the Allied Health Council and is a member of PASL. She currently works at Bayside Therapy Services in Rodney Bay, O: 458 4409 or C: 284 5443; www.baysidetherapyservices.com