Got a knee problem that just won’t knuckle under? A groin pull that just won’t go? A rotator cuff tear you can’t relinquish? Okay, enough silly alliteration: this short article will help you troubleshoot by introducing an underappreciated perspective on injury rehabilitation.
“The importance of injury prevention” is one of those concepts we can all get behind without any fuss, like the importance of vitamins or the importance of saving for retirement. But this article is not just about preventing injuries that happen again or injuries that happen because of another injury. Those are underestimated hazards, but they are related to an even lesser known concept in injury rehabilitation: minor re-injury can stop healing in its tracks.
This is the really important injury rehabilitation concept I want to get across in this article. We’re not just talking about the risk of a second “oh @#$!&” moment, dramatically re-injuring your injury, although that can certainly happen: re-injury routinely occurs in small, sneakier ways. And every minor re-injury retards recovery. Minor re-injuries can be so subtle that you aren’t even really aware that it’s happening — all you know is, you aren’t getting better fast enough.Every minor re-injury prevents recovery.
Good physical therapists are always considering the “aggravating factors” of their patients’ pain problems. What factors in our patients’ lives are making the problem worse? What keeps people from healing? What adds insult to injury? In a sense, almost every “aggravating factor” is a kind a re-injury. You could call them “micro” re-injuries. Here’s a great example:
I had a client with an exasperatingly tricky knee problem, a case of patellofemoral syndrome, a notoriously vague diagnosis that basically mean “hurtin’ kneecap.” It was an overuse injury originally. Over the course of a long walk, her kneecap just started to hurt … and months later it was still hurting. What was keeping it going? I got nowhere with this client for several appointments, until one day when I was digging deeper into her story and learned that she had a habit of sitting at work with her knees bent sharply, her feet tucked well underneath her, a position that puts enormous pressure on the underside of the patella. Bingo — there was our “aggravating factor”! She was re-injuring herself all day long, every day!
When you are trying to figure out why your injury isn’t healing, do not neglect this important perspective: could you be slightly re-injuring yourself regularly? Have you actually removed from the equation any forces that might be, even just slightly, hurting you again … and again … and again …?
Obviously, injured parts are vulnerable. A classic example of re-injury is the ankle sprain. The anterior talofibular ligament in the ankle is the most commonly injured structure in the body — and probably the most commonly re-injured structure in the body. Once it is damaged, it is never the same again. The chances of having a second ankle sprain are way higher than the chances of having the first.
People also often continue doing the very same activity that injured them in the first place. Like me, for instance: for years, I had almost annual compression sprains of my thumb joint — a “thumb jam,” well known to rugby players — from playing ultimate (a Frisbee sport with soccer-like intensity). I was at great risk for re-injury because I kept exposing myself to the same dangers, and the thumb was so damaged that virtually any impact constituted a real hazard, flaring it up again for weeks.
Obviously, you have to consider the risk of re-injury when you are trying to heal.
Consider another story:
One of my clients, before we met, had a shoulder injury — an ordinary thing, no big deal, just a little rotator cuff lesion, a tear in the muscles around the shoulder socket. Unfortunately, it impaired her ability to catch herself when she tripped and fell. It is amazing — shocking, really — just how hard you fall when you aren’t able to catch yourself. She fell face first onto a curb, and fractured her jaw and facial bones severely … a much more grievous injury than the original shoulder injury.
This kind of thing is surprisingly common. Patients with injuries need to be wide-awake alert to the fact that you are more vulnerable when you’ve been injured!It is amazing — shocking, really — just how hard you fall when you aren’t able to catch yourself.
Being injured is an unfamiliar state, and it’s the “weirdness” of that state — the new sensations, and limitations — that gets people into trouble. Just like a child needs to be warned to look both ways before crossing the street, injured people — especially if they’ve never been injured seriously before — need to be warned to be much more alert to potential dangers.
The risk of re-injury and collateral injury is not just underestimated, but a significant factor in many cases of chronic pain. “Prevention” is therefore not just a way of keeping yourself from getting injured in the first place, but directly relevant to recovery from injury. Double or triple your alertness and caution when limited by an injury, and bear in the mind the risk of minor re-injury turning an injury into a chronic pain problem.