Injury is a pain! Literally! You want to get back to normal as soon as possible, this is obvious, but how do you get back to full fitness from an injury? This article is a rough guide for you to follow but remember everybody is different and so are injuries.
If you are unsure then get yourself booked in at one of our Physio clinics in Stoke on Trent for a thorough assessment specific to you and your injury.
So let’s get into “What to do when you’re injured”.
So we will go through some general actionable things that you can do from day one of injury.
Peace and love
Dubois et al (2020), advocates a new acronym for the first phase of an acute injury called P.E.A.C.E. & L.O.V.E.
This stands for the following: Protect, Elevate, Avoid ice and anti-inflammatory drugs, Compression, Education (For the first 48 to 72 hours). Then, Load it, Optimism, Vascularisation, Exercise. (After the P.E.A.C.E phase).
So, what does this all mean exactly?
- Protect – Avoid anything that irritates the injury. This doesn’t mean absolute rest though either. You need to move the area within its tolerance. So after or the next day, there are no signs or symptoms increasing.
- Elevate – Obviously this only applies to areas that you can and this is done in between your movement and activities.
- Avoid ice and anti-inflammatory drugs – New thinking is moving away from the icing of acute injuries as it doesn’t help and may even hinder. The reasoning here is based on when you apply ice you get vasoconstriction in the skin and superficial area, which is designed to stop the blood from cooling too much. This blood has to go somewhere else and that place is deeper. meaning you have to vasodilate deeper, which will increase blood flow to the injury site, hence worsening the bleeding and swelling. It’s obvious when you consider that cryochambers are used by athletes to speed up recovery from injury and training and how does this work? It INCREASES blood flow!
Why no anti-inflammatory medication?
Now remember this is a rough guide, but inflammation is what essentially heals your body so why would you want less? Surely this will slow down the healing process? However here is the caveat, if the pain is impeding your ability to progress your rehab then it may be worth taking them to lower pain and improve function but you shouldn’t use them for long and avoid them if you can.
- Compression – Using compression creates back pressure to the injury site, making bleeding and swelling difficult to enter the area. This truly works but can’t always be used depending on the area.
- Education – this is more about your physio. This is giving you all the help and guidance to get through the first phases of injury.
After the first couple of days, you should start the L.O.V.E phase
- Load it – The biggest issue with injury is deconditioning or how to minimise it. No better is this illustrated by Bayer et al (2017). They found that patients with calf and thigh strains who started to rehab their injury at 2 days after their injury, got back to sport 3 weeks earlier than if rehab was started at 9 days after injury. They also found no increased risk of re-injury too. So this obviously doesn’t mean just hammer things on day two. You need to work is within its tolerance levels, monitoring after and next day effects on pain and swelling. As long as no negative effects occur then you are rehabilitating things at the correct level.
- Optimism – Be optimistic about your recovery. Research clearly find having high expectations of your recovery leads to better outcomes and the reverse can be said about negative thinking.
- Vascularisation – The rest of your body isn’t injured remember! Train your upper body and the other leg as this is not a problem. Plus there is a phenomenon called the cross over effect, which is where you can actually increase strength in the untrained limb (Andrushko et al 2018). So why not! Don’t forget Cardio too! If you have a lower-body injury then you can train the upper body in things such as swimming or a hand bike. If you have injured your upper body then vice versa. So again, why let this deteriorate for no good reason!
- Exercise – Build up your exercises slowly for the injured area. Gradually stretch and load progressively up, while monitoring signs and symptoms.
Yes, that is correct just imagining that you are training can affect muscle strength loss when immobilised or injured. In this study, they found that mental imagery training reduced muscle strength loss during immobilisation by 50% (Clark et al 2014). So you should close your eyes and imaging that you are lifting the weight or applying resistance and you don’t need to tense up either. You should do it in real-time as if you were training so reps, sets, rests etc. should be imagined as if you were really doing it. This is weird I know but evidence supports it and it can’t do you any harm to try it now can it?
When you are injured your body needs more fuel and building blocks to repair and regenerate tissue and this has a lot to do with protein. Wall and Van Loon (2013) found that increasing protein intake during a period of illness or injury reduces muscle disuse atrophy. So it makes sense that increasing protein while injured can be helpful but how much extra should you have?
It has been proposed that between 2–2.5 grams of protein per kilogram of body weight each day is beneficial while recovering from an injury (Tipton 2015).
In a study by Johnston et al (2009) they looked at the short-term effect of creatine supplementation while immobilised and they found that it does attenuate the loss in muscle mass and strength during upper-arm immobilization in young men. The reasons proposed as to how this helps were explained by Parise et al (2001), where they found that the effect is due to decreased whole-body protein breakdown shown by plasma leucine rate of appearance.
Cross over effect
The cross over effect is when you get a strength gain on a body part that you didn’t even train. This can be from one leg to another leg, one arm to another arm and it has even been observed from upper to lower body and vice versa.
Pretty cool hey?
Check out the video below to find out more about this:
When you are injured you risk losing your cardiovascular fitness if you don’t keep working this aspect and there is no reason that you can’t. For example, if you have a knee injury you can use a handbike or swim with a pull buoy and go to town on training your cardiovascular fitness. This will give you something to focus on and a goal to strive for, not to mention it will get your circulation going and this will be great for your actual injury too!
So don’t neglect this, use this injury as an opportunity to improve and you will come back from injury fitter than ever!
Start rehab early and progress within your injury’s tolerance
The biggest issue with any injury is what you lose, especially in the earlier days, so you need to get onto rehabilitating the injury as soon as you can safely do so. Your injury can take some load and some stretch even in the early days so you should start with a small amount of low-level rehab work to minimise the loss in strength and range of movement. The key here is to listen to your injury tolerance and not cause any adverse effects after or later on from performing the exercises. From this early point, your job is to build slow up with your intensity but always monitoring any adverse effects.
General to specific rehab
Every sport is different but it makes sense start with the basics. For example, if your sport needs you to have strong Quads and you have injured your knee then you should train the Quads at whatever level that they can tolerate, rather than looking at the exact range and speed that your Quads would work in the sport that you do. So if you can only do a straight leg raise then it would be inadvisable to be doing a round the clock lunge, even though these are more like the sport that you do. So you start easy and simple and you build up to gradually harder and more specific movements that relate to your sport.
Phased into normal training
The next step is to start to incorporate drills that mimick the sport that you do but once again you would need to be gradual and progressive in your approach. For example, lower limb injuries for a footballer such as knee problems or ankle sprains would now be doing a rough progression as follows:
Jogging in straight lines
Jogging in straight lines but building up the time and speed
Jogging wide figure of eights
Jogging wide figure of eights but building up the time and speed and tightness of the curve
Zigzag runs building speed and time and closeness of cones
Shuttle runs building speed and time
Multi-direction runs building speed and time
Multi-direction runs building speed and time but with another player knocking into the side of you
Multi-direction runs building speed and time with another player and a ball to dribble
Multi-direction runs building speed and time with jumping and landing
Multi-direction runs building speed and time with jumping and landing with a knock off balance in the air (controlled)
If players can pass through this type of protocol then they should be ready to start with training and then once fully training fit and having successfully completed in game scenarios, then they can be phased into a real game.
Now, remember this is a rough guide and not intended to be specific to you but it hopefully gives you an idea of what it takes to rehabilitate your injury from day one back to full fitness.
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