If you’re reading this we’ll assume that you’ve probably experienced an injury at some stage in your life. You might already have seen a Physiotherapist and possibly been a bit surprised when they gave you exercises to treat it? You may have wondered how exercise would make it better? Maybe you thought things like rest, ultrasound, bandages, surgeries or massage would be the recommended treatment?
In some cases those things are required, but in a lot of cases of musculoskeletal injuries, (those which concern the muscles, tendons, ligaments bones and nerves) exercise is one of the most effective forms of treatment.
For this blog we’ll describe injuries with regard to the 2 major ways they are experienced by you:
Loss of strength/movement/function
Pain
There are countless ways in which exercise improves the healing process, but for now we’ll describe the 3 ways that most directly impact these two “experiences”.
1. Exercise guides your body’s natural healing process.
An acute injury can be described as one that comes on suddenly and often after an obvious “event” where you weren’t injured one minute, and then you were. Like a trip and fall onto your outstretched hand or that sudden “pull” in your calf as you lunged to get that epic tennis backhand.
This is where the demand on the body very suddenly and excessively outweighed what your body could handle and the tissue was damaged in some way. Depending on the severity or complexity of the injury your body has a relatively straightforward plan for healing this kind of thing.
Healing Phases
The first phase is mostly to do with damage control - like clotting any bleeds, sending in more blood vessels, fluid and cells to get rid of damaged tissue and bacteria.
Usually, it also includes a bit of pain to stop you doing any further damage! After this initial phase, “building materials” - like proteins and connective tissues are sent in and set up to begin “rebuilding” the injured site. Together these processes can last several weeks, and usually require a degree of relative - rarely complete - rest to allow your body to do its natural healing thing However this usually overlaps with something called the “Maturation” or “Remodelling” phase where guided exercise, movement and strengthening is so important!
How does exercise help?
The pattern of how your body heals and develops is ingrained somewhat into your DNA, but this acts mostly as a guide (like the blueprint of a house), and your body will only supply what there is a demand for.
So, you need to let it know how much you’ll be “demanding” with regard to how much tissue capacity you need, which you can think of as strength or fitness. During the remodelling phase, the kind of forces, like exercise or movement, you apply directs how and how much of the new tissue - like bone cells, muscle cells/fibres or tendon collagen - is laid down. Bones need pressure to stimulate a strong organisation of bone cells. Muscles and tendons need tension and load to be applied to encourage the cells/fibres to grow in a particular way to be able to do things like contract, stretch or resist tension properly.
Now this doesn’t mean you’re going to wait a week and suddenly go and run a marathon to stimulate your calf tear into healing strongly. This would be creating a sudden demand that far outweighs the current capacity of the still-weak tissue, and can break things down again.
The level of stimulation over time (demand) needs to be at the level, or at least only a little bit more, than the current level of capacity of your injured tissues as well as the recovery capacity, which includes supply of your bodily raw materials (like proteins, fluid, biochemicals, hormones etc) and time necessary for the healing processes to happen. Certain tissues, like tendons and ligaments need a longer time to heal and remodel than muscles or skin.
If you don’t allow for these things you can end up with either not enough, or the wrong kind of cells in a disorganised formation (like scar tissue) which creates poorer quality tissue that is weaker, or less functional, than you would like.
In summary, like all exercise programs, an injury rehab program is one that progresses slowly, where the supply is able to match or catch up to the demand and with enough recovery time or rest to allow periods of adaptation after the stimulus (exercise) is applied.
This is where an experienced Physiotherapist comes in handy to help you find that balance!
2. Exercise takes the stress off the healing part by strengthening the areas around it.
Chronic overuse injuries are ones where the demand has gradually outweighed the supply or ability of the injured part a smaller amount, but over a longer period of time. These injuries usually creep up on you slowly in terms of pain/niggles, and often affect tissues that don’t adapt very quickly - like your tendons. You might not notice the loss of strength/function as much, especially in the beginning. For example, in contrast to the earlier Nadal inspired backhand resulting in the sudden calf “pull/strain”, this would be experienced more as a gradually worsening pain in your achilles, after you made a New years resolution to start playing 4x week - after doing no exercise for the 3 months prior - resulting in our ever common “Too much too soon” explanation for why an injury happened!
How does exercise help?
There are actually 2 ways we can look at this kind of injury:
The affected area itself is too weak or tight for the activity and becomes overloaded/injured.
The structures, like muscles, tendons or ligaments, that should normally support or help out in that activity are weak or tight or the whole system is uncoordinated and that tendon/muscle is having to do all the work and so becomes overloaded.
Often it’s a bit of both, but this is where a specific assessment to figure out which one it is is important so you don’t end up overloading an already overloaded tendon/muscle.
From there you can see how exercise can help - either by strengthening the injured area (see point 1) so it can handle the things you want it to do. Or by strengthening its muscly friends and teaching them how to work together, so the injured bit can get a bit of help to keep up with the demand.
This idea would also apply in instances where a tissue is potentially unable to heal naturally, like in some full thickness tendon/ligament tears where surgery may be an option. Often in these cases strengthening the surround or supporting structures to the point that it can compensate well enough for the damaged tissue is an option - like in a complete biceps tendon tear, which is often not surgically fixed if the patient isn’t bothered by the aesthetic of it!
3. Exercise reduces pain and sensitivity
Pain is probably the most complex part of this list, and we are continually learning more about it.
Pain can be thought of as our body’s “alarm system”. It is a complex combination of nerves detecting things, and your brain deciding if the things are dangerous or not (danger will normally be experienced as “pain” for you).
When you have been acutely injured, or chronically injured, your nerves and brain become super alert to things being dangerous, like movements, touch or even thoughts - particularly ones that are similar to what caused the initial injury. Usually this is a good thing and is designed to keep us safe, and the alarm quietens down as the injury heals, you get stronger and the risk of further injury/danger goes away.
But, in some cases, like if the initial injury was quite severe or traumatic, or lingered for a while, this alarm can become overly sensitive to smaller things that might not actually pose any real danger - like the smoke alarm in your house that is annoyingly set off by the steam of a hot shower!
This also helps to explain how things can be painful but not necessarily injured or have damaged tissue in the way we might expect.
How does exercise help?
Exercise can be used as graded exposure that slowly returns the body to the movements or activities that are painful. Normally the pain settles automatically over time with the increasing sense of safety as the tissue heals and/or you get generally stronger.
In more complex cases like chronic pain, a specifically designed exercise program that takes into account the complex and delicate interaction of your body, nervous system and mental and emotional state is necessary to desensitise things.
There is also growing evidence that cardiovascular exercise acts as a natural painkiller by improving mood through endorphin release as well as increasing blood flow to all areas of the body which can help with healing, as well as nutrient and oxygen delivery to areas of the body.
The body is rather amazing in its abilities to heal, or at least compensate for parts that can no longer do what they’re meant to. Hopefully this gives you some more confidence in your own ability to heal, and will empower you to take action when dealing with injuries!
As Physiotherapists, our role is to guide you through this process.
Movement is Medicine
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Movement is Medicine 〰️
If you would like some guidance on exercise rehab for your injuries please get in touch or book an appointment.
Formotion Physio is a Physio practice located in West Perth, Joondalup and Osborne Park.