Why Some Injuries Seem to Take Forever – Part 2

There are a few reasons why recovery from an injury is slow…or seems slow.

First, an incorrect or incomplete diagnosis. I’m not sure how many referrals came my way from physicians who had diagnosed their patients with “knee pain”, for example, but it was a lot. Knee pain is a symptom, not a diagnosis.  Same thing with back pain, shoulder pain, neck pain. Knee pain can stem from a number of underlying pathologies and from a number of biomechanical abnormalities. Telling me someone has knee pain does two things. It identifies the primary complaint and, most of the time, has ruled out man-eating diseases like bone cancer.

It doesn’t do much else and you can’t build an effective recovery/rehab strategy on a complaint.

For most orthopedic problems, and well, almost all medical issues, pathology drives intervention more than anything else.

If you walk into an ER with chest pain,  you won’t get a referral for myofascial release even if your chest muscles seem tight or inflexible or your posture sucks. You first get worked up for the complaint of chest pain. You have to rule out bigger, badder things first.

Nearly all musculoskeletal problems – back pain, knee pain, shoulder pain, neck pain – have both an underlying pathology and an associated biomechanical abnormality. Sometimes the pathology is the biggest issue, sometimes the biomechanics, sometimes both.

Second, assuming you have an accurate diagnosis, you make unwise choices and continue to overload weak, deconditioned tissue. You decide to keep jogging on a knee that’s swollen. You just can’t seem to stop going to Crossfit despite unrelenting lower back pain. Your wife tells you that you simply must attend her dear friend’s wedding which will consist of countless hours of standing, meandering around, and yes, even dancing, while your plantar fasciitis is in full bloom.

The body always wins.

Third, you have a mismatch between the source of the problem and the focus of the rehab program. When the source of the problem is a low metabolic rate tissue – cartilage, tendon, fascia, ligament – and the program is for high metabolic rate tissue such as muscle, not much change happens. Sometimes people get better anyway which is more likely regression to the mean than the program itself. If the problem stems from aberrant biomechanics, say, for example in the knee, inadequate control of hip rotation and the program fails to address it, then progress will be slow.

Fourth, you don’t believe you will improve. When you think like this, all you see are failures and setbacks and every time you do, it reinforces the belief. Everyone has setbacks. Progress is never linear. You have to go over the edge to find it. And when you do, you can choose to see that as a setback or as a marker.

Fifth, you fail to “edge” your program. This happens a lot. Exercise routines, to be effective, must be progressed. This means you have to track what you do and have a way, a method, to change the dosage. If you want to slow down your progress, be arbitrary with your dosage.

Sixth, you progress your program too much or too fast. We all want to be better faster but the body moves on an agricultural tempo, not digital. It takes time to change tissue strength, learn new movements, stop doing things that derail yourself. How long does it take for a broken bone to heal? At least 8 weeks but it takes months for it to “harden”, become sturdy. Ligaments take a longer, cartilage longer still. You show up, do your work, pay attention, be patient.

Seventh, you don’t move enough or you move too much. Arthritic, weak joints need motion. A lot of it. You can be spot on with the rehab program and then sit too much all day. But weak joints can be easily overloaded so the movement has to be within the joint’s load tolerance. The Goldilocks Principle – not too much, not too little, but just right.

Eighth, you think pain is “bad” and are overly focused on eliminating it. Pain is neither good nor bad. It just is. Pain is a symptom like elevated heart rate is a symptom. And, in some instances, pain can take on a more ominous meaning than others. Pain that persists, is constant, wakes you up in the night is not the same thing as lower back pain that shows up while sitting in a lousy movie theater chair and then subsides when you get up and move around. And, sometimes, you need pain to understand your limits. You can use it to fine-tune your program. Pain is your body’s way of getting your attention inviting you to change. I won’t say pain is your friend but it’s not the enemy either.

Ninth, Ego leads the way.  This is related to #2 but deserves its own discussion. I was teaching a client, a guy with lower back pain, how to do an exercise designed to strengthen the supporting spinal tissues. The exercise is a version of the “side plank”. In less than 10 seconds, his lower back muscles started visibly quivering. This means the exercise is too hard so I suggested he lower his body to his knees. His response was, “No way! I don’t want to be seen doing it like that!”

Side-plank exercise

I explained to him that although he had back trouble, his bigger problem was his unwillingness to accept what his body could do for now. It wouldn’t always be this way. If he could adjust his program to match his body’s capability, he would improve much faster. He refused and, last I heard, still has back trouble.

Tenth, you don’t get enough sleep. This might seem odd to include but a surprisingly high percentage of people don’t sleep enough. Sleep is when all the good stuff happens from your diligent work. Short change yourself on sleep and your body can’t get its repair/restoration work done.

Get an accurate diagnosis(es), make wise choices, get the program right, believe change is possible, edge the program, move  – but not too much -, avoid focusing on pain, leave your ego at the door, and get some sleep.

Thanks for reading.

PS – If you’re interested in my books, click or tap here.  For my training routines, click or tap here. To work with my colleague Laurie Kertz Kelly, click or tap here.

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