How do you know when your injury has fully healed or when it’s repaired enough for you to return to your usual activities or sport? Most people gauge healing or repair by remittance of pain. Whether the injury is caused by sport or exercise or everyday activities, once pain subsides or reduces, it’s common to move on as if it never happened (albeit with the niggling anxiety that it might flare up and we may have to, gasp!, see a physio).
In some cases, that may seem to be the end of it. But as physios, we are all-too-familiar with treating issues that result from injuries that in fact hadn’t fully healed or left a legacy of other issues that, over time, caused other problems. In some cases, people who have ‘thought they dodged a bullet’ and recovered without treatment exhibit problems such as excessive formation of scarring, which could have been prevented with treatment at the time. This is why our assessment includes questions about past injuries and treatment.
We are also too familiar with cases where a person has become frustrated with the restrictions of injury and, in turn, overestimated ‘how much better it feels’ and returned to usual activities only to experience re-occurrence of pain, weakness and movement limitations (familiar?). The reason these post-injury issues are so common is that, often, residual effects of injury are hidden, which makes it tricky to gauge your own recovery. So how can you avoid being that person re-experiencing injury or experiencing long-term performance deficits? The answer is a combination of knowledge, pro-recovery practices such as getting adequate sleep and eating well, exercises and precautions prescribed by a physiotherapist and, where appropriate, manual therapies (e.g. massage or dry needling).
Know the hidden effects of injury
The pain may have gone (or almost), but there are a number of hidden effects of injury that may remain without you knowing and fail to heal further without strategic rehabilitation.
- Tendon timing
Some experts say that, once a tendon is injured, it almost never fully recovers. That’s a bit extreme. With the right rehabilitation, carefully timed return to full activity or exercise, tendon injuries can become trouble free, but it’s important to realise that tendons heal slowly. Returning to full activity or exercise too soon can impair or inhibit this healing and set you up for long-term problems from a tendon that hasn’t sufficiently healed. On the flip side, it is important to engage in particular exercise tailored to facilitating recovery and to return to activity or exercise soon enough so it can be used to aid further healing and recovery of movement and strength.
- Range of motion
It’s not always obvious when range of motion (ROM) is limited compared to before the occurrence of injury, but this is a common residual effect of many common injuries. One cause of this is scar tissue. For exercise enthusiasts and athletes, this means compromised performance and, potentially, further injuries caused by trying to force a joint or muscle through full range of motion or overcompensation by other body parts to try to make up for the deficit. There can also be undue stress or strain on joints and/or muscles, increasing injury risk. Physiotherapy can help to minimise formation of scarring and other ROM issues using targeted movement, massage and other hands-on treatments.
- Impaired proprioception
After we experience injury, our ‘feeling’ or ‘perception’ of the injured body part or region (‘proprioception’) may be altered, resulting in awkward or sub-optimal movements or even misjudgment (for instance, after an ankle injury, you may be a bit unstable and make mistakes such as placing your foot down at a slightly different angle or misjudging your step, which, combined with lingering weakness, can result in re-rolling or activation of injury). Impaired proprioception can also negatively impact performance in sport and exercise. A positive fringe benefit of physiotherapy for injury rehabilitation is improvement of proprioception.
- Subtle weakness and stiffness
Even after ligaments and cartilage have recovered sufficiently to free you from pain, muscle strength may remain compromised. Weakened muscles are among the hidden residual effects of injury which, without targeted strengthening rehabilitation, may leave you vulnerable to re-injury or new injury. If your injury has required immobilisation or a support such as crutches or a sling, chances are, your muscles will need to be built back up with strenghening exercises. As well as weakened muscles, post injury, joints may be stiff and ligaments less taut, which may require prescribed exercises to facilitate return to normal range of motion and capacity.
- Medical complications
Certain medical conditions can inhibit complete or optimal healing and recovery of injuries. For instance, conditions with symptoms including poor circulation (e.g. cardiovascular disease) can slow or impair injury recovery due to lack of oxygen and nutrients in blood to the injured tissues. Diabetes can also disrupt expected healing processes. A physiotherapist will identify any such factors in an assessment and tailor treatment to overcome barriers to recovery as much as possible. Lifestyle habits such as smoking and excessive alcohol or consumption of recreational drugs may impair or prohibit a complete or optimal recovery from injury.
- Insufficient sleep and nutrients
Your body’s own repair mechanisms are at their peak while you’re sleeping, which is why your physio may ask about your sleep hygiene, sleep hours and sleep quality. Skimping on quality sleep can contribute to slower or compromised healing. Equally important is nutrition, which can work for or against tissue repair and recovery. This means consuming regular, balanced meals comprising protein to facilitate tissue repair, slow-release carbohydrate to fuel brain functions integral to sending signals for tissue repair and to provide adequate energy for your body to conduct repair functions and healthy fats including Omega-3s, which may help to promote bone and joint health. Hydration is also crucial, not least because good circulation is crucial for delivering blood and oxygen to damaged tissue.
If you’re not sure whether your injury has healed sufficiently to return to full activity or sport or exercise or wish to make sure there is no residual injury or damage that may cause ongoing problems, consider consulting a physio.
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