Exercising After An Injury

How do you know when to come back to exercise after an injury?

Injury is a complete normal part of life and it happens to everyone. You can do all you can to try and prevent injuries from happening (and these preventative measures are a great thing), but at some point people DO get injured, whether that is from playing a sport, gardening too long, rigorous travel, picking up your grandchild, or having a stressful job. 

As a physical therapist, I come across people with various types of musculoskeletal problems, but often the people I see are not those who have sustained an acute injury, but rather people who have had a problem linger for several months or even years where it becomes chronic. When speaking with these people and getting their history, it usually starts from a specific incident, then the pain fluctuates from getting better and worse, and eventually just lingers on without explanation. They often say they have tried many different things to try and help their pain, but no matter what they do it always seems to come back. For many of these people, the cause of the issue is not actually in the tissue or biomechanical structure, but it’s actually in their behavior and relationship between how much work their body can tolerate and the demand that their desired tasks have.

Example:

Let’s say you have injured your knee from doing too many stairs one day.
From that injury, the knee’s tolerance to load will inevitably decrease. The problem people run into is that, once their knee starts to feel better, they jump straight into doing the same amount of stairs from before their injury in a state where their knee’s load tolerance has decreased. This will cause the pain to return, thus decrease the load tolerance even more and the next time you try to do stairs, you are doing even less. It’s this pattern that is repeated over and over again that leads to the problem to linger on and not actually get better. Below is a good illustration of how the body’s tolerance to activity changes from manageable to excessive pre and post injury.
 

Graph:

Load and frequency graph

If you look at the graph, there are a few things to note. First, both the intensity of the activity (load) and the frequency/duration of an activity are important to consider as they can cause the tissue to be loaded beyond its capacity that can lead to pain. Secondly, post injury, the manageable activity evidently is much less, but it’s important to understand that you do not always return back to the pre-injured state just by resting and unloading the tissue. Sometimes, this can be true and just by resting and preventing re-aggravation for a specific amount of time you can return to your pre-injured state, however, for some people you have to actually increase the tissues capacity to tolerate load again. We can do this by administering a progressive loading program that I will talk more about in a different blog post. 

Practical Application:

So next time, if you get a mild injury, don’t just jump right back into the same level of activity at the first sign of feeling less pain. Consider resting and modifying your activity to de-load whatever structure is causing pain first, then gradually introduce your injured area back to different loading activities. If running is what you want to do, maybe start with these steps.

1. Biking for 10-15 minutes pain free 3-4 times for a week.
2. Transition to exercising on an elliptical for 15-20 minutes 3-4 times a week for 1-2 weeks.
3. Work up to walking briskly gradually increasing distance and speed 3-4 times a week for 2 weeks.
4. Introduce running gradually, starting with a walk/jog. 

It’s important to stay relatively pain-free as you don’t want to re-aggravate your injured area. Give it at least 6-8 weeks before returning to full running. This approach can be frustrating for some as it will limit you from performing your desired activity for a length of time, but it will be far more enjoyable in the long-term as you will be able to enjoy your desired activities without any fear of re-injury. Give it a try, and I hope it will help you reach your goals!

Benjamin Kim PT, DPT is a licensed physical therapist at Mettler Center. Experiencing pain? Ask an Expert. Call 217-398-9800 to schedule a free 30-minute consultation with a physical therapist or request an appointment online.

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