Getting out of the Injury Cycle

"A man who views the world the same at fifty as he did at twenty has wasted thirty years of his life"- Muhammad Ali

First and foremost, injuries suck! They put our training goals on hold and throw a monkey wrench or regular wrench into our routine.

Perspective is a way of viewing a particular object or thought. The ability to reflect on our perspectives and allow them to change with gained knowledge is difficult, but leads to wisdom.

Maybe injuries don't suck? Maybe injuries are a great time to allow you to realize some movement deficiencies or how external and internal loads affect you as an athlete? Maybe it actually enhances your training and allows you to come back better than you have ever been!

Insanity can be defined as doing the same thing over and over again but expecting a different outcome. Tip: don't do this with injuries. If you have an injury, recover, then go back to training and have the same recurring injury PLEASE consider other options.

In these upcoming posts we hope to challenge your perspective to create wisdom, view injury as an opportunity, and hopefully decrease insanity to guide you in the process of getting out of the injury cycle!

If you are a youth athlete, recreational athlete, or any other type of athlete the chances are you will likely have an injury during some point in your athletic endeavors. The choices you make after this initial injury will help to set up success allowing you to reach your performance goals, or potential failure leading to absenteeism from your sport/passion.

I'm a believer that nearly all training-related injuries can be prevented with appropriate loading/skill progressions and recovery strategies. I'm also a realist and know that we are all going to overreach during training at some point and injure ourselves. How do we know how far to push it if we never overstep some boundaries? When this does happen, though, the next steps taken are crucial. Why?

The number one risk factor for future injury is previous injury. Injuries are extremely difficult to predict and are likely never due to one isolated incident. We have to take into consideration what happened leading up to the injury including sleep, nutrition, stress, and the training program. All of these variables play a part in the injury experience, which makes prediction of injury nearly impossible. Regardless, if you have had an injury you are at risk for another injury. Our goal is to briefly outline strategies in this series to get out of the injury cycle. 

Our bodies have been through years of evolution in order to adapt and create healing environments to take care of most injuries, as long as we don't get in the way of this process. Most of the research shows this to be true and is called regression to the mean. Simply, this means that you can use a modality or particular intervention or do nothing and you will likely still get better. This is especially true in the case of non-specific acute low back pain. A systematic review completed by Artus et al. included 118 trials of varying treatments and found symptoms seem to improve in a similar pattern in groups receiving active treatment, placebo, usual care, or no treatment. Furthermore, recent research comparing functional outcomes with surgical treatment vs. placebo surgery vs. conservative for mild rotator cuff tears or cartilage injuries in the knee show us the power of mindset; for symptom management to occur, believing that the treatment is going to help is very influential. 

In these first few days after injury it is helpful to conduct a cost-benefit analysis. If you are in pain and have the resources for symptom management such as massage, electrical stimulation, or "adjustments" (future blog post) and believe that they are going to help then utilize them. If you do not have resources to get these treatments or do not believe they are helpful, don't worry! Research shows us that you will likely get better in a similar amount of time because of our internal healing environments. As with everything, there are definitely subgroups who do not get better in this initial time period and do not regress to the mean. If this occurs then it is time to seek out treatment. It is likely that something is getting in the way of the healing process. The role of health care providers that specialize in the movement system is to provide guidance to identify the obstacles and create new paths to overcome them. Slam weights, run really fast, or make it to the bathroom in time again! 

In this upcoming series, we will be writing about treatment methods that are recommended to help you get out of the injury cycle along with explanations of why things seem to work. 

Stay curious, stay strong friends 💪🏼

Dr. Dillon Caswell, PT, DPT 

Topics coming up in this Series: 

- Soft tissue mobilization: effectiveness of instrumented soft tissue massage 

- Stretching 

- "out of alignment" what do adjustments/manipulations really do? 

- Changing from RICE to Peace & love for initial injuries 

- Do you need surgery? Rotator cuff, Glenohumeral labral, hip impingement, and meniscus injuries 

- Managing Internal load and using mindset to improve the healing process 

- Preventing injury in sport: GET STRONG 

- Returning to sport: how do you know your ready? 

After this series we will be diving into strategies to improve performance with the assumption that you are no longer in the injury cycle! 

- What causes us to stop Exercising? 

- "mouth Sensing Carbs" for runners 

- Recovery to optimize performance 

- Role of heart rate Variability for performance 

- and then....... (aka more to come) 

References: 

1. Mine and Dr. Jason Tuori's thoughts
2. Majid Artus, Danielle A. van der Windt, Kelvin P. Jordan, Elaine M. Hay, Low back pain symptoms show a similar pattern of improvement following a wide range of primary care treatments: a systematic review of randomized clinical trials, Rheumatology, Volume 49, Issue 12, December 2010, Pages 2346–2356, https://doi.org/10.1093/rheumatology/keq245
3. Wallwork SB, Bellan V, Catley MJ, Moseley GL. Neural representations and the cortical body matrix: implications for sports medicine and future directions. Br J Sports Med. 2016;50(16):990-6.
4. Butler DS, Moseley GL. Explain Pain. 2nd edition. Adelaide City West, South Australia. Noigroup Publications; 2013.
5. Wallwork SB, Bellan V, Catley MJ, Moseley GL. Neural representations and the cortical body matrix: implications for sports medicine and future directions. Br J Sports Med. 2016;50(16):990-6.
6. Milewski MD, Skaggs DL, Bishop GA, et al. Chronic lack of sleep is associated with increased sports injuries in adolescent athletes. J Pediatr Orthop. 2014;34(2):129-33.
7. Sihvonen R, Paavola M, Malmivaara A The FIDELITY (Finnish Degenerative Meniscal Lesion Study) Investigators, et alArthroscopic partial meniscectomy versus placebo surgery for a degenerative meniscus tear: a 2-year follow-up of the randomised controlled trialAnnals of the Rheumatic Diseases 2018;77:188-195.
8. lasini M, Corsi N, Klinger R, Colloca L. Nocebo and pain: An overview of the psychoneurobiological mechanisms. Pain Rep. 2017;2(2).
9. Wiech K, Tracey I. The influence of negative emotions on pain: behavioral effects and neural mechanisms. Neuroimage. 2009;47(3):987-94.
10. Gabbett TJ et al, Br J Sports med October 2017 vol 51 No 20
11. Gabbett TJ. The training-injury prevention paradox: should athletes be training smarter and harder?. Br J Sports Med. 2016;50(5):273-80.