updated 12/30/06
Injury and Pain Rehabilitation Tips
Thumbnail sketches of evidence-based rehabilitation and self-treatment strategies that I prescribe to my clients … and some I tell them to avoid
by Paul Ingraham, Vancouver, Canada MOREclose
Credentials and qualifications
I am a writer and retired Registered Massage Therapist (unusually well-trained for a massage therapist, a 3000-hour program). I’m almost done with a Bachelor of Health Sciences degree. I am a peer reviewer for The Natural Standard, and a copyeditor for Science-Based Medicine. My most important qualification is more than a decade of workaholic post-graduate study, clinical experience, and constant conversations with readers from around the world, including many experts who have provided countless suggestions and criticisms.
For more information, see: Who Am I to Say? More information about my qualifications, credentials and professional experiences for my readers and customers.
Credentials and qualifications
I am a writer and retired Registered Massage Therapist (unusually well-trained for a massage therapist, a 3000-hour program). I’m almost done with a Bachelor of Health Sciences degree. I am a peer reviewer for The Natural Standard, and a copyeditor for Science-Based Medicine. My most important qualification is more than a decade of workaholic post-graduate study, clinical experience, and constant conversations with readers from around the world, including many experts who have provided countless suggestions and criticisms.
For more information, see: Who Am I to Say? More information about my qualifications, credentials and professional experiences for my readers and customers.
This is an overview of essentially all of the practical self-treatment techniques that I most often recommend or teach to my clients — and a few popular ones that I tell them to avoid — with lots of links to more detailed information. Use it to brainstorm your approach to most healing and rehabilitation challenges, especially athletic injuries, overuse syndromes, muscular pain, joint pain, and chronic pain syndromes.
And of course sometimes there is only so much you can do for yourself directly. If you need professional assistance, it’s generally a good idea to Choose the Therapist, Not the Therapy, you may also really appreciate having some guidance in choosing an appropriate therapy. So Therapeutic Options for Pain Problems is a useful sister article.
Where’s the evidence?
There are no references in this article, but virtually all of the recommendations made here include links to more detailed articles which do discuss the scientific evidence and/or rationale for the advice given.
I do not make recommendations that are not clearly supported in some way by a credible rationale, or (preferably) references to peer-reviewed scientific research. No, science doesn’t have all the anwers — but it’s a start. For more, see Extraordinary Claims.
Table of Contents
- Icing exception: (almost) never ice low back pain
- Prevention: important even after you’ve been hurt
- Microbreaking: mobilizations at work
- Endurance training: under-rated but vital therapeutic exercise
- Strength training: pump you up!
- Stretching? Not so much, actually …
- Heating: the most basic comfort
- Raw icing: powerful therapy for tendinitises
- Contrasting: a simple but potent tonic therapy
- Epsom salt baths: don’t bother
- Extra water intake? Don’t worry about it
- Get more sleep: if you’ve got insomnia, start looking for solutions
- Rest and relative rest: the art of taking it easy
- Nutritition for healing: make sure that you are getting enough iron and B vitamins
- Postural correction: difficult and probably not important, but still …
- Ergonomics: not just about your keyboard height
- Sit on a wobble cushion: wobble your way back to health
- If you sit a lot ... get an Aeron
- Self-adjust your spine: crunch …
- Educate yourself: understanding actually reduces pain
- Orthotics: slip into something more comfortable
- Antidepressants: consider weaning yourself off them
- Therapy for the soul: personal growth is necessary for many healing challenges
- Breathe “bioenergetically”: an unusual and powerful tool for letting off some steam
- General activity increase: do something, anything at all
- Blow off steam: breathe and shake stress away
- Exercise classes: yoga, Pilates, aerobics, taiqi, bootcamp, etc …
- Progressive training: break up the challenge into baby steps
- Trigger point massage: usings tools, your own hands, or someone else’s
- Friction massage: for tendinitis only
- PF-ROM exercises: use it or lose it
- Mobilizations: massaging with movement
#1 Icing exception: (almost) never ice low back pain
Back pain is rarely an injury — that is, the pain is rarely caused by inflammation which might be helped by ice. Even in cases where inflammation is present, it is usually deep in the back under a thick layer of insulating muscle and the ice cannot “reach” it. However, back pain almost always involves muscular trigger points (muscle knots), which are more likely to be aggravated by ice and helped by heat! For this reason, the majority of people with back pain prefer heat, and a few have negative reactions to ice. For similar reasons, neck pain usually should also not be iced. Although experiments have shown that both ice and heat are modestly helpful for low back and neck pain, there are good reasons to err on the side of heat. Ice should only be used on the back by patients who clearly prefer it (for whatever reason), or when there is definitely a fresh injury.
Please see (Almost) Never Use Ice on Low Back Pain! for more information.
#2 Prevention: important even after you’ve been hurt
A major part of healing is prevention: that is, the prevention of re-injury, and so “prevention” is actually relevant even after you’ve already gotten into trouble. Also, injury and pain problems tend to make people accident prone. When one ankle is sprained, it’s easier to trip and sprain the other one. This is called “collateral injury,” and is amazingly common. Some collateral injuries are far worse than the original injury. Consider the case of a young woman who tripped and could not catch herself properly because of a shoulder injury, resulting in quite serious damage to her head and face. So, when you are hurting, it pays to make caution and prevention a higher priority than usual. Many of the strategies described below constitute prevention.
See Five Ways To Prevent Sports Injuries and Collateral and Re-Injury Prevention.
#3 Microbreaking: mobilizations at work
Microbreaking is the art of taking small breaks from work and moving around to prevent muscles from developing painful trigger points. It is a survival skill for every chair-bound office worker, student, computer user, or anyone at all whose work (or play) generally requires long hours of being sedentary. But taking a break isn’t enough: walking to the water cooler and back does not constitute actual stimulation for back muscles that are screaming with stiffness. It is necessary to actually do something therapeutic with microbreaks, and the best choice is usually mobilizations.
For a brief overview of microbreaking alone, see Microbreaking: Prevent low back pain and neck cricks with lots of little breaks. For a complete survival guide for sedentary work, see Back Pain and Other Hazards of Sitting In Chairs (Way) Too Much.
#4 Endurance training: under-rated but vital therapeutic exercise
Endurance training is a weight-lifting workout that uses large numbers of “reps” and lighter loads: i.e. lifting a light barbell thirty times, instead of lifting a heavy barbell eight times. It is the sensible default style for most women at the gym. Really, endurance training is just an intense kind of mobilization exercise (see above). Mobilizations are basically very easy endurance training, and endurance training is just mobilizations with some light weights. It is a terrific way to get some exercise without aggravating myofascial trigger points (muscle knots) — indeed, if done in moderation, without excessively exhausting yourself, it is trigger point therapy. It is a much more effective self-treatment for muscle stiffness and pain than, say, stretching. I routinely prescribe endurance training exercises to clients who aren’t sure what they should be doing at the gym while injured, if anything.
See Endurance Training for Injury Rehabilitation for more information.
#5 Strength training: pump you up!
Strength training usually refers to “high load, low rep” load-bearing exercises at the gym — you know, the kind of training that guys like to do, which usually involves a lot of grunting. Generally speaking, there is good evidence that some strength training is helpful in creating metabolic changes that lead to weight loss, which of course can have many benefits. And there are many specific therapeutic uses for strength training exercises, and physiotherapists are especially fond of prescribing them. For instance, strengthening the arch-supporting muscles in the foot relieves the strain on the plantar fascia, which is often irritated. But I am not a huge fan of strength training for specific self-treatment, however, for several reasons. As with stretching, I am writing about it here only because it is so popular that it needs to be addressed, not because I actually recommend it. There are a few “gotchas” with strength training, but the big one is that most people who have a pain problem have significant myofascial trigger points (muscle knots), and muscles with muscle knots in them do not respond well to strength training. Therapeutically speaking, you have to take the edge of your bad trigger points before you start doing strength-building exercises.
See Strength Training and Injury Rehabilitation.
#6 Stretching? Not so much, actually …
Stretching without clearer goals than “injury prevention” or “flexibility” is usually a waste of time that could be better spent on more effective healing strategies. Many recent studies have clearly shown that conventional stretching isn’t good for much, possibly nothing at all, but people tend to ignore the evidence even when they are aware of it. To be deprogrammed, see Quite a Stretch. Well-planned and specific therapeutic stretching is helpful for some injuries — evidence strongly supports the use of stretching for plantar fasciitis, for instance — but I usually do not recommend stretching as self-treatment, because its applications are too few and too specific. The most useful thing you can do with your stretching routine is to stop bothering.
I prefer to prescribe yoga or pilates (which are much more than just stretching), Mobilizing! and Basic Self-Massage Tips for Myofascial Trigger Points. See also: Stretching for Trigger Points.
#7 Heating: the most basic comfort
For relaxation and moderate relief from aching muscle pain in a specific location, use heat in the form of heated gel packs, heating pads, Thermophores (a special heating pad), towels saturated in hot water and so on. Full-body heating in hot tubs, showers, saunas and steam rooms is also helpful, especially in conditions where emotional stress and/or knots in your muscles are the cause of your troubles, or a significant complicating factor. See A Better Hot Bath for tips on getting the most out of your bathtub or Jacuzzi. Generally speaking, do not heat recently damaged tissue such as ankle sprains or muscle tears. Both ice and heat may help neck and back pain, but you should usually choose heat: ice is more likely to aggravate cranky muscles, and usually can’t help because inflammation is either not present at all or simply too deep for the ice to affect. See (Almost) Never Use Ice on Low Back Pain! for details.
Please see Using Heat for Pain Problems for more information.
#8 Raw icing: powerful therapy for tendinitises
To reduce pain and swelling associated with any acute injury or tendinitis, always use ice, and also elevate the injury above the heart if you can so that it can “drain.” Beware of assuming that neck or back pain are “injuries” that needs icing — they usually aren’t (see (Almost) Never Use Ice on Low Back Pain!). Despite this, both ice and heat will usually help back and neck pain, and you should use whichever seems appealing to you.
Bags of frozen peas and even ice gel packs are not the best choice for icing; instead, use “raw” ice whenever possible. An ice cube held in a dish towel will do in a pinch, or make an “ice cup”: fill a Styrofoam cup with water, freeze it, cut the top inch off, and you have a large ice cube with an insulated handle. (Handy commercial “ice cup” products are now available as well.) Apply ice in slow circles to irritated tissues for two minutes or until you’re numb, whichever comes first. You can do this as often as you like — and many applications may be helpful — as long your tissues warm up between applications. Icing is most effective where damaged tissue is superficial.
Please see Icing for Injuries, Tendinitis and Inflammation for more detailed instructions.
#9 Contrasting: a simple but potent tonic therapy
Contrasting is a powerful, free, easy self-treatment for a wide variety of conditions that can benefit from an increase in circulation (i.e. practically anything except acute injuries). Gentle exercise and movement are excellent ways of increasing circulation as well, but it isn’t always an option to exercise a body part enough to increase circulation — contrasting is useful because it is powerfully stimulating to circulation without any significant risk of irritating tissue. (Please note again: it can’t be used on the freshest injuries, because acute inflammation is aggravated by heat.) Contrasting involves alternating between soaking in hot water and soaking in cold. Always finish with cold. Use a double-sink, a pair of buckets, a detachable shower head ... or whatever arrangement you can dream up.
Please see Contrast Hydrotherapy for more information.
#10 Epsom salt baths: don’t bother
It’s a popular idea, but there is no good reason to believe that bathing in dissolved Epsom salts will have the slightest effect on muscle soreness or injury recovery time. Although this folk wisdom may someday prove to have a sound rationale, clearly there is none that its advocates have thought of — or even tried to think of, it seems. Given the low stakes, I think this one is a no-brainer: the smart money is on not bothering.
For more detail, see Do Epsom Salts Work?.
#11 Extra water intake? Don’t worry about it
There is an epidemic of low-grade anxiety out there about whether or not we are drinking enough water, and I believe it’s all unnecessary. My clients regularly ask me about this, and assume that throwing back a couple extra litres of water a day is essential to virtually all rehabilitation, indeed to general health. The question would not exist if it weren’t for the scientifically questionable work of Dr. Batmanghelidtj, who invented the “threat” of “chronic dehydration” as a health hazard. It is probably not. There may be such a thing occasionally, but the weight of expert opinion is clear: if it exists at all, it is not serious, and easily cured in any event. The only thing at stake is a clear but minor general benefit to your health. In short, there are more important things to worry about. Drink when you’re thirsty, and ignore anyone who tries to get you to worried that it’s not enough. Drinking adequate water obviously matters. It just doesn’t matter much!
For the whole sordid story, see Water Fever and the Fear of Chronic Dehydration.
#12 Get more sleep: if you’ve got insomnia, start looking for solutions
Sleep deprivation may be an unsuspected aggravating factor in many cases of chronic pain or slow injury recovery. Indeed, you may be suffering some of the consequences of sleep deprivation even if you think that you are getting a “normal” amount of sleep with 6–7 hours per night. In his book his book Sleep Thieves, sleep scientist Stanely Coren of the University of British Columbia spells out just exactly how sleep deprived most people in our society probably are, and how much more significant the consequences may be than we realize. An increase in aches and pains, immune system suppression, and weight gain are three common side effects of relatively mild sleep deprivation. And if you are actually suffering from significant insomnia, it gets worse.
Of course, insomnia can be tough to beat, so see Save Yourself from Insomnia! for some of the best tips available (way beyond warm milk).
#13 Rest and relative rest: the art of taking it easy
Surprisingly, rest is often underestimated or simply ignored as a factor in healing, yet it is the most important method of reducing irritation to a healing injury, and of course it can also be psychologically important. Health care professionals distinguish between two different modes of resting: (1) total rest, and (2) “relative rest,” which involves resting from activities or avoiding movements that might irritate an injury but trying to be active in other ways.
For more about how and why you should rest, see The Art of Rest. For more about the crucial (but sometimes difficult) balance between irritation and stimulation, see The ‘Use It Or Lose It’ Principle.
#14 Nutritition for healing: make sure that you are getting enough iron and B vitamins
Obviously good nutrition is generally important to health, but the point of this recommendation is much more specific: there is good reason to believe that even relatively mild nutritional deficiencies may perpetuate or aggravate myofascial trigger points, thereby complicating virtually any musculoskeletal condition. Muscle energy metabolism may be compromised by low iron and B vitamins, especially B1, B12, and folic acid (see Simons). Therefore, a nutritional review is advised when troubleshooting any mysterious or stubborn pain problem. Simple supplementation may make a significant difference. I have seen at least one vivid case of this in my professional experience. Probably the benefit is present in many cases without being quite so obvious.
#15 Postural correction: difficult and probably not important, but still …
The evidence suggests that posture is not terribly important. Poor posture and structural problems like scoliosis (spinal curvature) definitely do not necessarily cause pain. Meanwhile, plenty of people with acceptable posture have terrible low back pain. Postural correction is also so challenging that it is probably rarely worth the trouble — I’ve never seen a dramatic case of improved posture. Nevertheless, I have never been able to dismiss the importance of it entirely, and there are some examples of specific postural habits with unfortunate consequences. Poor posture has got to be at least a contributing factor in some problems. Probably the most effective approach is to increase complex physical activity, especially doing tasks that require coordination. A technique called “taping,” and ergonomic design, may also be helpful.
For a selection of practical strategies, see Posture Exercises for Posture Correction. For a much more in-depth examination of the subject, see Stand Up Straight.
#16 Ergonomics: not just about your keyboard height
Ergonomic fine-tuning of your workstation and life is usually much less important than being generally active, and taking regular breaks from whatever you do, however you do it. However, there are some common ergonomic problems out there that need correcting. The ones that I see the most often are: high monitors and holding the phone to the ear which tends to cause headaches and neck cricks, and reaching high and far for keyboards and mice with often results in elbow and wrist pain.
For other ideas, see Unconventional Ergonomics and Back Pain and Other Hazards of Sitting In Chairs (Way) Too Much.
#17 Sit on a wobble cushion: wobble your way back to health
Sitting on a wobble cushion is like sitting on an exercise ball — it gives your postural musculature something to do, keeps your back “frisky” — only more practical and convenient. Sitting on exercise balls is a great idea, but they are bulky, you can’t sit on them all the time, and there is rarely room in anyone’s office for both a chair and and exercise ball. Enter the Disc ‘O’ Sit, Sissel Balance Fit, or Sissel Sit: compact enough to be convenient, wobbly enough to be therapeutic.
See Wobble Cushion Technique for more.
#18 If you sit a lot ... get an Aeron
Should you buy an expensive chair? Probably. Good chairs aren’t everything, but they do help. The best in my opinion is the Herman Miller “Aeron” ergonomic chair. (They do not pay me — I’ve just got one.) It’s like this: sitting on anything for ten hours is probably a more important factor in your health than what you are sitting on, but if you plan on logging about 40,000 hours in a chair over the next twenty years, you might as well make it a good one. My advice is to splurge a little and buy an Aeron for your office — at home or otherwise — and buy it now, not after another 6,000 hours of sitting have gone by. Unlike any other chair, they come in three sizes. They are extremely well-designed and highly adjustable. They have a twelve-year warranty, and are built in such a way that they will probably last much longer than that. And they are not that expensive, especially when you consider how long they last. End of sermon.
See HermanMiller.com. For other chair warrior survival tips, see Back Pain and Other Hazards of Sitting In Chairs (Way) Too Much.
#19 Self-adjust your spine: crunch …
First of all, stop worrying about cracking your joints: there is no compelling evidence that there is any significant risk in doing so. Second of all, make a point of cracking your spinal joints in order to facilitate recovery from pain and stiffness in the torso and neck. The chiropractic profession would have us believe that joint cracking is essential to general health, which may be asking us to believe too much, but scientific evidence has shown that it probably is helpful to stimulate joints with cracking and other “adjustment” for relief of ordinary musculoskeletal pain. Of course, don’t crack your joints if you hate the feeling. But if it feels relieving, by all means, do it without guilt or concern, in reasonable doses: like many physical therapies, it supplies a blast of fresh sensory input which has a cascade of minor benefits.
A full article on this subject has been in the works for a long time, but is not yet ready. Meanwhile, a lot of closely related information is available in my article Does Chiropractic Work?
#20 Educate yourself: understanding actually reduces pain
“Pain is an opinion on the organism’s state of health.” — V.S. Ramachandran. “Ramachandran” is not an eastern mystic, but a neurologist. His important idea is that the experience of pain is powerfully affected by our level of anxiety. Not only do the body’s nerves send messages about problems to the brain, but the brain tells the nerves how sensitive to be. Thus, we invariably hurt more when we are worried, less when we are calm. This concept is vital in pain management and recovery, and indicates a rational, urgent need for self-education (the most important part of) anxiety-reduction to be a part of every difficult healing process. This is why that I routinely lend good books to clients with severe chronic pain, and encourage them to do things like take workshops (as at Haven).
For more about this fascinating idea, see Pain Is an Opinion. But recovering from anxiety is easier said than done. For some practical ideas, see Help for Anxiety.
#21 Orthotics: slip into something more comfortable
Orthotics can be a good-bang-for-buck solution to a variety of otherwise untreatable postural problems and gait dysfunctions. On the one hand, I cannot emphasize strongly enough that things like leg length differences and are much less important than physical therapists generally make them out to be. However, they can be a factor. The closer a problem is to the feet, the more likely it is that the right orthotics will have a therapeutic effect. Be aware of the possibility that orthotics — good or bad — can be difficult to adjust to, disrupting fine-tuned postural adaptations and forcing awkward new ones. Some people find the cure to be worse than the disease.
It’s important to get orthotics from a reputable supplier, and certified pedorthists are by far the best choice. Some podiatrists may be appropriate. You should not purchase orthotics from physiotherapists or chiropractors under any circumstances. For more information about how to buy orthotics, see The Trouble with Orthotics.
#22 Antidepressants: consider weaning yourself off them
SSRI antidepressants are not medicine. The scientific rationale is tissue-paper thin, they have proven dangerous side effects, a proven lack of therapeutic effect on depression, the companies that make them have the largest snake oil profit motive in history, and they have been caught red-handed buying off American juries to block prosecution for their crimes. Their numerous side-effects and the atmosphere of doom and gloom that they tend to cast over a person’s life constitute a serious complicating factor for all injury healing, especially chronic pain patients. If you’re taking them, please seriously consider getting off them. (But don’t just stop. They are chemically addictive, and it is dangerous to stop taking them suddenly.)
If you have suspect that these dangerous drugs are a crock, please, don’t take my word for it: there is plenty of good reading to do. You can start here: SSRI Antidepressants Are Not Medicine.
#23 Therapy for the soul: personal growth is necessary for many healing challenges
As science advances and mind-body perspectives on health and healing become more sophisticated and practical, we understand that pain problems are powerfully mediated by stress, self-limiting behaviours, and “emotional constipation.” Professionally, I am in an ideal position to see how people’s quirks and habits cause, slow or prevent all kinds of healing. Particularly for clients struggling with a difficult and slow healing process, I recommend that they “get personal” with their problem. Sometimes it’s a matter of just learning new coping skills for a problem that is never going to go away. And sometimes people need to come to terms with the fact that years of self-sacrificial workaholism, for example, are actually the root cause of severe chronic pain. Usually the truth is in the middle: healing requires a complex mix of coping skills and personal responsibility. Through this kind of learning, people often find long term relief.
Of course, there are nearly infinite ways of approaching this challenge, and I’ve written about it in several ways. I discuss the theory in detail in Why Do We Get Sick?, and I get more thoroughly practical in Personal Growth. You might also want to read Dr. Gabor Maté’s excellent book When the Body Says No. However, the best thing you can do is just go straight to Haven. There is also one extremely useful personal growth tool that you can start leveraging right away: The Art of Bioenergetic Breathing.
#24 Breathe “bioenergetically”: an unusual and powerful tool for letting off some steam
This is the most sophisticated self-therapy suggested here, even more complex in its applications and benefits than massage therapy. Basically, it involves breathing quite quickly and deeply for up to a quarter hour, without controlling or shaping the movement of breath. This breathing pattern is strongly stimulating and can dramatically change your state of being. It is a “pattern buster” that interferes with habitual ways of holding your body and limiting self-expression, a vital personal growth and transformation tool.
See The Art of Bioenergetic Breathing for more information.
#25 General activity increase: do something, anything at all
Often, rest is actually the last thing patients need. A sedentary lifestyle is a major aggravating factor in many injuries and pain problems, and particularly problems caused or complicated by myofascial pain syndrome (muscle knots). A lack of exercise or variety of activity generally impairs circulation and the vitality that is needed for healing, but it also constitutes an irritant in itself: sitting is stressful for many tissues, for instance. An increase in activity generally can be essential for a healing process. Training regimens and/or exercise classes are appropriate for athletes and the athletic, but if you are bit of a couch potato, those are probably the last things you want to do, and they’re doomed to failure. What, then? Basics: start walking or cycling to work, take the stairs instead of the elevator, take the batteries out of the remote, etc ...
See The Still Life and/or Back Pain and Other Hazards of Sitting In Chairs (Way) Too Much for more.
#26 Blow off steam: breathe and shake stress away
Stress relief is a large topic, but I have a bit of good advice on the subject that I’ve been offering to my clients for many years now. Most people cannot easily get relief from stress, or get enough of it, from the usual methods. R&R holidays can be great, but we never get enough of them. Meditation and yoga are potentially powerful, but they are not quick fixes, and often those of us who need it the most — those of us under the most pressure, and/or the most naturally intense — are the least likely to succeed. Reducing chaos and solving serious problems would obviously be helpful, but “if I could do that, I wouldn’t need stress relief.” Many people use exercise as a way of blowing off steam, and that’s terrific — but it’s not personal or emotional enough to be really effective.
Stress is expressed in the body in amazingly strong habitual muscular tension and breathing patterns (among other things). One of the quickest and easiest ways of de-stressing is simply to interfere with those patterns: to more literally “blow off steam” with vigorous breathing exercises, and with movement, dancing, shaking, and vibration. This gets to the heart of the matter much more directly than any relaxation exercise, and provides more opportunity than athletic exertion to work with under-expressed and repressed feelings of anger, sadness, frustration, and anxiety. When people think of “taking a deep breath” to relax, they usually think of a slow breath: try a fast deep one instead. Try several of them in a row. Slow breathing and chillout time can come later, after you’ve blown off some steam. I don’t know about you, but the last thing I want to do when I am really stressed out is slow down and take a really deep, slow breath: I want to scream and huff and puff and run around in little circles! So I do.
For more about blowing off stream with breathing, see The Art of Bioenergetic Breathing. For more about vibration therapy, see Good Vibrations for Stress and Tension and Kundalini Meditation.
#27 Exercise classes: yoga, Pilates, aerobics, taiqi, bootcamp, etc …
Sometimes the goal of healing is to get to a point where you can actually think about doing a yoga class — but sometimes a yoga class is how you heal. There are many circumstances where I prescribe exercise classes to a client, usually yoga, and sometimes Pilates, taiqi, aerobics, or cross-training classes like the currently popular “boot camp” classes. Of course, nearly any kind of exercise, even a sport, can become a useful part of a rehabilitation program, but I have a specific reason for singling out exercise classes, especially yoga: for non-athletes who might not otherwise be interested, there is simply no better way to explore of body awareness and safely test your limits with a variety of new challenges. Also, I believe that a social environment is helpful to most healing processes: seriously, injury loves company!
#28 Progressive training: break up the challenge into baby steps
Progressive training is a (really) basic concept in athletics and injury rehabilitation. It is most easily understood as the “baby steps” school of training and rehab, in which challenges are broken up up into small intermediate goals. All serious athletes train progressively, because it’s the only way to get the job done. It is the basis of every running group. Runners who patiently increase the length and intensity of their runs are training progressively, and are at much lower risk of injury. The principle is the same whether you are fit and working towards an athletic goal, or injured and simply trying to get back to normal. It’s as powerful an idea as it is simple, and a great example of advice that is both “boring” and yet desperately needed by most clients — this probably means you!
For more information, see Progressive Training.
#29 Trigger point massage: usings tools, your own hands, or someone else’s
Because of the surprising clinical importance of knots in your muscles — a common muscle tissue dysfunction technically known as “myofascial pain syndrome” — self-massage is relevant to a surprising number of common pain problems. Even when trigger points are not the cause, they almost invariably complicate, aggravate and retard healing, so they are well-worth considering even in cases that do not seem especially “knotty.” The main limitation, of course, is your reach! Self-massage is only useful if relevant trigger points can reasonably be reached by your own hands, with tools that you have improvised or purchased for the job, or with the help of a partner or spouse.
Trigger points are right at the heart of my professional expertise, so I have published several relevant articles. If you aren’t familiar with trigger points and how important they can be, please visit Save Yourself from Trigger Points & Myofascial Pain Syndrome! For an in-depth look at how muscles knots work and why they tend to make you feel weak, why they resist stretch, how they can be so stubborn, and why rubbing them probably works, see Dance of the Sarcomeres. For detailed information about self-treating muscle knots, including tips for using tools like tennis balls and massage sticks, see Basic Self-Massage Tips for Myofascial Trigger Points. You may also want to consider picking up a copy of The Trigger Point Therapy Workbook. Another valuable resource is my own “perfect spots” series, which describes several ideal spots in the human body for massage. The series starts with Massage Therapy for Tension Headaches: Perfect Spot No. 1, in the suboccipital muscles of the neck.
#30 Friction massage: for tendinitis only
Friction is a specific self-massage technique applicable only to cases of tendinitis. It is a method of stimulating tissue when use of the tendon will only irritate. Rub back and forth across the most painful spot on the tendon for five minutes, increasing the intensity whenever the sensation fades. If it doesn’t fade, stop.
For more details, see Friction Massage Therapy for Tendonitis.
#31 PF-ROM exercises: use it or lose it
“Early mobilization” is an important concept in rehabilitation, and has been proven to speed healing from traumatic injuries. Even when an injury is acute (fresh), it is important to use whatever pain-free range-of-motion (PF-ROM) you have got. It stimulates circulation, metabolic activity, and normal neurological function. At the same time, of course, you have to be cautious not to irritate the injury — that’s why it’s pain free. Chronic and non-traumatic injuries and dysfunction also require mobilization, although the approach is a little different.
For more detailed information, see PF-ROM Exercises. To learn more about striking the right balance between rest and movement, see The ‘Use It Or Lose It’ Principle.
#32 Mobilizations: massaging with movement
“Mobilizations” are rhythmic, repeated movements that alternately stretch and contract musculature and other soft tissue — massaging your tissues with movement. I prescribe at least one or two key mobilizations to nearly every client, usually in preference to stretching. Mobilizations are more “neurologically interesting” than stretching and stimulate more metabolic activity in the tissue while remaining gentle. They are more practical and efficient than stretching in many ways, especially because they can affect more tissues more quickly, and because they constitute both a better warm up and a better warm down for more intense activity.
See Mobilizing! for more information.
