In a previous blog post I wrote the following: “trust that your body is much, much stronger than you realise”. Injury and fear of doing more damage makes us understandably cautious. As patients or therapists we have to tread that fine line between over-caution and recklessness, and it’s no easy task, often involving some educated trial and error. I decided to write this post because recklessness is quite easy to recognise – rapid increases in volume, escalating pain, and so on. On the other hand, it is a bit more tricky to recognise when we’re being over-cautious, and I think this has to do with a few misconceptions.
Posture and alignment
These two are absolutely worth considering from a therapist point of view, because they offer clues as to what might be related to our patient’s pain. However we are not defined absolutely by our posture and alignment. Leg length discrepancies, rounded shoulders and a forward tilting pelvis are often asymptomatic, and completely normal. You might have noticed one of your shoulders sits higher than the other. This might be relevant, it might not – posture is just one piece of a complicated jigsaw. Certainly, having a strong, robust body that moves well is far more important.
What this means for you: Please, please do NOT think that because you have a leg length discrepancy, rounded shoulders or some other kind of “misalignment” that this is a fault which absolutely must be corrected. Invest your energy into getting strong and moving well – trust your body!
Understand what is and isn’t tolerable
Massive grey area, but here goes! When returning to running after a calf injury, for example, many people find that even on short runs the calf feels “tight”, or “not quite right”. This is definitely worth noting down in your training diary and discussing with your coach or therapist. Remember the difference, though, between this type of sensation, and what it feels like when pain increases with every step until running becomes unbearable. In the second scenario you should stop running, employ the RICE principle, and get yourself checked out – let’s not be reckless! In the first scenario, however, I generally advise runners to mentally assess whether the “feeling” is low level, stable and tolerable – if it is, continue running. Assess again a minute or so later – still low level, stable and tolerable? Carry on, assess, repeat. If the “feeling” increases, becomes uncomfortable or affects your form, call it a day. If it doesn’t, and you manage to complete even a 10 minute rehab run with nothing worse than a calf that “felt strange”, I would call that much better than stopping after the first minute, because it will develop running-specific strength and condition your calf (well, your brain, really!), to tolerate this amount of loading.
What this means for you: Your body has evolved to adapt to stress, and it is phenomenally good at it. Make a mental note of, but please don’t overthink, sensations of “tightness” or “feeling strange”. We often hear of elite athletes who “know their body well”, who know when to push on and when to hold back. This is a skill developed through years of practice and experience being injured, and it is something we can all learn. The LOW LEVEL, STABLE and TOLERABLE guide can be applied to any activity – trust your body!
Studies show that tissues respond better to small, repeated stimuli. In terms of rehab, this suggests that little and often is better than sporadic. As a runner coming back from injury you might think that running 4-5 times a week might be excessive – not necessarily so! Rather than two runs of 20 minutes each you’re likely to get better results from 4-5 runs of 10-15 minutes each, perhaps interspersed with walking. And the same applies to other activities. Can you add non-aggravating activities to this – most likely you can, and if you can, you should!
What this means for you: Listen to the advice of your coach or therapist, but just as importantly learn to listen to your body, and use your experience to make judgements. If a rest day is planned between rehab sessions (let’s say running) and you feel good, why not try a shorter run, or a swim or bike session? How have you responded to this injury in the past? How does it feel? Do your own assessment – trust your body!
Thanks for reading!
- Dealing with injury – a VERY rough guide!
- The Stepping Stones of Rehab