The vast majority of the time somebody has pain, the true cause has nothing to do with the area that hurts. This is why I see so many people who have already gone through therapy unsuccessfully. If injury recovery was as simple as foam rolling the area that hurts, most people would bounce back quickly. The problem is that this is just not the case. The area of pain, in many instances, is really just the tissue that was overworked due to a much larger dysfunction somewhere else in the body. For example, a very common injury is IT (Iliotibial) Band Syndrome. This pain is felt in the outside of the knee and can be extremely painful. However, it is almost always due to poor health and/or function of the hip and/or pelvis. Attacking the IT Band with soft tissue therapy and a foam roller is really not going to get you anywhere. Once the primary cause is addressed and restored to normal function, the IT band will then cease to be overworked and the pain will resolve. This same philosophy applies to almost all other injuries. The only time this doesn’t apply is when there is a trauma. If you slam your knee into a wall and your knee hurts, it is because you slammed your knee into a wall. Those are the obvious ones, but are by far the minority of injuries. The vast majority are due to overuse injuries and typically there is no specific incident of injury.
Knowing that the area of pain can have very little to do with the reason for the injury, diagnosing the primary cause becomes crucial to proper rehab. However, once that is done there are also a sequence of events that must take place in order to return someone to activity as quickly as possible. So, let’s look at the proper steps that must be taken in order to really overcome an injury:
#1 Figure out the primary cause of the injury
This seems obvious, but many times is not actually done. If this is accurately diagnosed then you can simultaneously work on the area that is damaged as well as the areas that are the primary cause of dysfunction. This is by far the fastest and most efficient way to recover. It can also be a good diagnostic tool. Many times, if recovery from injury is not happening at the expected rate, the primary cause for the injury has not been discovered and/or addressed. The best way to do this is not just assessing the area that hurts. That information only tells you what tissue is damaged and causing pain. That is the easy part. The more difficult part is analyzing movement, strength, posture, joint function, and tissue health to determine what are the biggest dysfunctions. Once you uncover these dysfunctions it becomes more obvious why the area that hurts began to hurt in the first place. Once you can connect these dots it tells you exactly what needs to be done in the treatment plan. Address the area that hurts while correcting any abnormalities in movement, strength, posture, tissue health, and joint function.
#2 Restore the health of any damaged tissues
This can mean muscles, tendons, ligaments, and even nerves. When these tissues are not healthy you cannot expect them to work in the correct manner. And you can especially not expect to be able to strengthen them. Trying to strengthened damaged tissue only leads to more pain and potentially more damage. Fix the tissue first, and then corrective exercises will actually work like they are intended to work. This step is vastly overlooked in many instances.
#3 Improve local and associated joint function
Each joint is supposed to move in specific ranges of motion to do the job that it was intended to do. When a joint loses this mobility it not only puts more strain on that specific joint, but it also puts excessive strain on the neighboring joints that are trying to take up the slack. This not only leads to increased pain, but the body also cannot function normally until this is addressed. It is like trying to turn your car to the right when the front right tire won’t move. In some instances this can be the primary culprit. For example, if your sacroiliac (SI) joint is not working properly (this is where your sacrum and your pelvis meet), there is no possible way that your hips, knees, and feet can work properly. Properly pelvis motion is critical to lower extremity function.
#4 Improve muscle firing patterns
In order for the body to move in the correct motions all of the muscles must contract in a specific order. This is especially true when you are referring to ball and socket joints like the shoulder and the hip. Sometimes this pattern can become dysfunctional and certain muscles can contract too early, too late, or just never contract at all! When this happens the body is stressed in ways that it shouldn’t be and specific areas of the body get overworked and overused. In this case, healing tissues and fixing joints will only be temporary as the body will continue to work poorly and stress the same areas.
#5. Increase strength and stamina of muscles
Once the tissues are healthy, the joints are moving well, and the body is moving correctly you can now start to improve the strength and stamina of the muscles. This will give you more resilience and prevent the injury from returning. However, strengthening a muscle that is not even working properly is not the best use of time.
One of the reasons that therapy often fails is that people skip directly to step #5. Trying to strengthen muscles when they are not actually healthy and the joint structures are not moving properly is just not effective. This can not only lead to pain during rehab, but also minimal to no progress in healing.
Now, this doesn’t mean that you always have to fully complete one step before moving to another, as many times they can overlap. For instance, improving the soft tissue health and joint mobility many times happens simultaneously. You can also start to work on basic movement patterns and basic strength while the soft tissue is still improving. Finding the correct balance can be tricky sometimes and can determine whether progress continues or setbacks ensue. However, understanding that there are many levels to injury recovery can lead to a better understanding of why a particular injury just isn’t getting any better.
If you, or someone you know, is struggling with an injury let us help reveal what steps need to be taken for optimal recovery. Call our office today and set up consultation so that we can comprehensively and accurately determine what you need to do to get back to activity as quickly as possible.