3 Ways Exercise Heals Injuries and Improves Pain
The reasons behind why your Physiotherapist makes you exercise when you’re injured.
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.
Is it DOMS or an injury?
How to tell the difference between DOMS (post exercise soreness) vs Injury, and what to do about both.
How to tell the difference between normal post exercise soreness (DOMS), and injury, and what you can do about both.
DOMS (Delayed onset muscle soreness) is the normal muscle achiness you get after starting an unfamiliar exercise, coming back to training after time off, or after a particularly heavy or high rep training session.
At a microscopic level it is tiny tears of the muscle fibres which is the necessary evil (depending how you look at it!) to stimulate your body to adapt and come back stronger/fitter once the muscle has repaired.
If you’ve never felt it before, or sometimes after a particularly intense session, the discomfort can be so intense that you might start to worry that you might have done something else this time!
We’ve got you covered! Read through the checklists below for the difference between the common DOMS symptoms vs Injury and what you can do about both.
DOMS
TIME FRAME: Usually occurs ~12-24 hours after unfamiliar or intense training, begins to ease after ~48-72 hours. DOMS straight after training often feels more like “jelly-legs” that can still function but are not painful.
WARMS UP: The soreness should ease with continued movement or a warm shower.
LOCALISED PAIN: You’ll be able to find it by pressing the muscle group or area of your body that you trained (e.g. quads if you did squats, lats if you did pull ups). Usually the pain will be about equal on both sides of your body if you trained both sides.
MUSCULAR ACHE WITH USE: No pain at rest - you shouldn’t feel DOMS unless you are using the affected muscle group.
SORENESS WITH STRETCH: Usually you will feel DOMS in the movement direction that stretches that muscle - eg: straightening your elbows with bicep DOMS, walking down stairs with quad DOMS.
WEAKNESS OR ”JELLY ARMS/LEGS”: You might feel like your limbs give way with similar movement patterns as above (we call this eccentric movements), this might improve with warming up.
What you can do about it:
1. Keep moving! Generally DOMS warms up, so once you’re up and going or moving the area it should ease a little. A warm shower can help ease the symptoms too.
2. Wait it out. Don’t worry - it should start to ease up after about the 48 hour mark.
3. Don’t take anti-inflammatories. The inflammation associated with DOMS is a necessary process in adapting and getting stronger/fitter after the training session. Reducing this process can reduce the effect of all your hard work.
4. Don’t over stretch, not to ease the symptoms anyway, it won’t do a whole lot to speed up the recovery so you’re better off just using the time to move gently!
5. Gentle massage might help ease the symptoms slightly for a little while, but it won’t really speed up the process either.
5. Train gently, but don’t go too hard on the same area or with a similar workout, give your body time to adapt or you may end up overloading yourself and in the injury section.
INJURY
TIME FRAME: More severe pain felt during/soon after your training session, or 1-2 hours later once you cool down and doesn't begin to ease naturally. If it worsens after ~48-72 hours it is unlikely to be DOMS.
MIGHT NOT WARM UP: Some injuries won't improve or will worsen with continued movement/use of the painful part. Be careful as some tendon/muscle injuries or strains will also warm up, but then are likely to feel worse once cooled down.
WHERE IS IT: One side notably worse, or pain felt further up or down from the area is likely to not be DOMS. Pain that doesn’t feel like it’s in the muscle, or if it’s very obviously in the joints or tendons is also not normal DOMS symptoms.
TYPE of PAIN: Burning/shooting or sharp, deep throbbing pain at rest, or when the muscle is unloaded is not a DOMS symptom. Catchy, pinchy or clicky pains are also not typical of DOMS.
OTHER SYMPTOMS/NIGHT PAIN: Pins and needles/numbness, and severe resting/night pain that keeps you awake is not typical of DOMS.
WEAKNESS: More severe weakness in a concentric pattern (opposite direction to the muscle stretching), that has no associated pain is less typical of DOMS.
What you can do about it:
If your symptoms are mild you can try to wait-and-see for a few more days and just keep the area moving gently to give the area time to heal on its own.
If the niggling lasts longer than about 4-5 days after the training session in question, it may be worth getting it checked out.
For any severe symptoms, pins and needles/numbness or shooting pain, painful clicking and locking, or simply if you are worried its best to go and see your Physiotherapist or another health professional.
Check out our blog on managing Acute Injuries with “PEACE & LOVE”
Often when we catch and manage injuries early they are easy to manage and you’ll reduce your time off in the long run!
We’d love to hear from you and answer any questions if you are concerned. Or click through to book an appointment.
Formotion Physio is a boutique Physiotherapy practice based in West Perth , Joondalup & Osborne Park, Western Australia
How to talk to your clients about women's health issues
Personal trainers and coaches are in a unique position where they can screen the general population and the athletes they work with for issues that they may otherwise not feel comfortable bringing up, or not even know that there are solutions to in the first place.
For personal trainers, coaches and fitness professional.
Women’s health issues are very common, but sadly there is not much awareness around it which leaves huge gaps in potential not only for health and quality of life, but also performance.
Women’s Health Physiotherapists and other health professionals who specialise in this area will often only see people when the symptoms have become very extreme.
Personal trainers and coaches are in a unique position where they can screen the general population and the athletes they work with for women’s health issues that they may otherwise not feel comfortable bringing up, or not know that there are solutions to in the first place!
We know that it can be pretty daunting and uncomfortable talking about these issues, especially for men.
Some advice we can give on this is to try and include regular general discussions about it in all of your sessions. Many women may feel embarrassed to raise these issues themselves which is why it’s important to not make it taboo by discussing it regularly, so they know that whatever they are experiencing is nothing to be embarrassed about.
Upskilling in this area will also help you to feel more confident talking about it, see the end of this blog for some links to great resources.
If you don't feel comfortable talking about it, putting a few of the questions below into your initial screening can alert you to refer on if necessary.
Women’s Health Questions to ask:
1. Do you ever experience leakage, or feel like you may leak, during things like heavy lifting, skipping, sneezing or coughing?
Answering yes to this could indicate Stress Urinary Incontinence.
2. Do you ever experience the feeling of pressure in your pelvis/pelvic floor during during things like heavy lifting, skipping, sneezing or coughing
Answering yes to this could indicate symptoms of prolapse.
3. Has your menstrual cycle been normal the past couple of months? (Assuming client is not pregnant or on hormonal contraceptive).
Changes to menstrual cycles can alert you to signs of RED-S in athletes or people that train intensely.
4. How does your cycle affect your mood/energy levels?
Understanding your client’s individual responses to their cycle can help you to plan sessions around this to help them perform at their best.
What to do if your client is having issues?
Considering the pelvic floor and menstrual cycle during training is important, but if your client is having issues they will often need a health professional to diagnoses and treat, at least initially.
Normally these health professionals will aim to work with you and your client to get them back to training with confidence.
At Formotion Physio we have an interest in Women’s Health, and are able to assist with returning to exercise with consideration of the pelvic floor, but we would recommend referring to a Women’s Health Physiotherapist for pelvic floor issues first.
For menstrual cycle or hormonal issues we would recommend referring to a Women’s Health GP or Sports Medicine Physician, particularly if you suspect RED-S (see below) or other more serious health issues.
You can find directory of Women’s Health Physiotherapists on the Australian Physiotherapy Association - Find Physio page here.
A few resources on the topic that we think are helpful and important are listed below:
Continence Foundation of Australia
Julie Wiebe - Women’s Health Physical Therapist
“Pop Up Lift” Instagram page & Website
Jessie Mundell - Pregnancy and Post Natal Fitness Coach
RED-S Relative Energy Deficiency in Sport
RED-S Clinical Assessment Tool
If you know of anymore to add to this list please get in touch or comment on this blog.
Do you really need to squat so straight?
Why it’s ok for your knees to go over your toes and for your feet to be wider than your hips when you squat.
There are a few old ideas and myths that come up in the clinic, which we often have to spend a good chunk of time re-educating about. A few of which relate to how you should squat.
The two main ones which we’d like to bust with this blog are:
“You should never let your knees go over your toes”
&
“You need to squat with your feet and knees straight forward, or in line with the hips”
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These misconceptions are based on some old research, but as we know, research is continuously being updated and improved on. These ideas have since been found to not be true as a blanket statement.
If you have been told and believe either of these things, this blog is to free you from these ideas and give you permission to move and squat how your body was designed to!
Lets break them down:
Myth 1. “You should never let your knees go over your toes”
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In short, in healthy populations, it is completely fine, and actually good for your knee joints and muscles to move and get stronger throughout their whole range of movement.
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It can also help improve your squat technique by allowing you to distribute your weight better. Without bending your knees enough you have to compensate by either leaning forward or excessively bending the hips to get your full depth squat.
Your body is designed to squat low - think of the movements of a child, almost everyone in Asia, or you, when camping and nature calls! (Possibly not quite as comfortable looking, yet!)
Watch this video to see the difference:⠀
We will say though, if you have been avoiding this for a while, you’ll need to slowly re-introduce it so your knees have time to adapt to moving into a range they are unaccustomed to.
Myth 2. “You need to squat with your feet and knees straight forward, or in line with the hips”
Everyone’s hip joints are a slightly different shape, check out these two femur (thigh) bones to see what we mean!
This means your squat will look different depending on your body’s anatomy.
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Forcing your knees/feet to move straight forward when your body and bones aren’t designed to is often a reason for finding the whole experience difficult, “pinchy in the hips” or uncomfortable, no matter how much mobility work you do!⠀
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Watch this video for the difference in ability to squat to full depth with the feet and knees in line with the hips vs wider than the hips.
In short, the best position is whatever is most comfortable for you, and whatever is best for you to produce force (lift heavy things). ⠀
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We suggest playing with a few variations of foot width/turn out and see what works best for you in terms of comfort/force production. Generally it’s best to pick somewhere in the middle of your ideal range (not too wide/narrow) so you have room to move either in or out if required, or to land slightly wider for our olympic weightlifters.
Please note that if you have been told to squat in a particular way for a specific medical reason, then please carry on with whatever works for you!
Still stuck? Let us help you.
Formotion Physio is a boutique Physiotherapy practice based in West Perth & Osborne Park, Western Australia
By Lucia Tennant
Physiotherapist and Founder of Formotion Physio
BSc Physiotherapy
4 Reasons You Can't Maintain your Mobility
There is more to flexibility than you might think.
4 Reasons You Can't Maintain your Mobility
“I stretch every day before bed but I never seem to get any more flexible?”
Sound familiar?
Here we’ll go into some other things you probably aren’t considering much in your flexibility/mobility routine - but they may have a bigger impact than you might think!
We’ll be using the terms flexibility and mobility interchangeably, as they are often both used to simply refer to how much your muscles, tendons, joints and nerves allow you to stretch and move freely.
1. You're only moving for 1 hour out of 24.
Possibly the most important one that we don't consider enough. Your body will adapt to what is continuously demanded of it. If the majority of your day involves being in one position - sitting at your desk or in an Uber, or standing at a checkout or reception desk, your body will change to allow you to do these things well. In this example, most likely tightening up the muscles that help to hold you in these positions like your hip flexors and glutes!
If you really want your 30min/day mobility gains to stick, you need to put your body in those positions as often as possible or it won't bother to maintain them. Things like an interchangeable sit/stand desk and taking regular breaks to move or walk can help. If your work makes this difficult you'll need to make sure that every chance you get to move or put your body in different positions outside of work is used.
2. You have nervous nerves.
Your nervous system (Including the brain, spinal cord, and peripheral nerves) is what allows your joints and body to move - it also serves as a protective mechanism by preventing movement if it senses that what you are doing is unsafe or risks causing you injury. In terms of mobility and range of motion - there is a threshold of when your nervous system starts to sense something as "risky" and it subsequently tries to protect you by doing things like tightening up the muscles so you don't move any further, or perceiving a movement as uncomfortable or painful so you stop the action.
Your nervous system can begin to reign you in earlier (i.e. lower the threshold) when it is sensitised or feels out of control - things like overloading in training with back to back difficult, heavy or repetitive sessions without adequate recovery time can cause neural sensitivity or pain. Think of that feeling in your hamstrings/lower back when you try to touch your toes after a heavy deadlift session.
Image: firepowerteams.com
By foam rolling an already overly sensitive structure, or trying to "stretch through the pain", all you are doing is playing tug of war with your own neural system and adding to the sensitivity.
One of the ways you can avoid excessive sensitivity is by discussing optimal training loads and recovery times with your instructor, coach or Physiotherapist.
3. You're not in control.
Uncontrolled or unstable movements can also stress out your nerves to the point they revoke your movement privileges. Your nervous system will allow movement in joints when it feels there is enough stability further up the chain to make that movement safe. For example hamstring "tightness" can often be caused by poor lower back and pelvic control and similarly poor shoulder range of movement can be caused by poor scapular stability.
Image: angliahandling.co.uk
Imagine a crane trying to raise a heavy cement block to the top of a building when its base has not been properly secured and stabilised. It would most likely reach a point where the torque would topple it over. In the case of the human body our sensory system aims to stop us before this point of fail.
By working on your proximal control and stability (joints closer to your midline), you can improve the achievable range of movement in the joints further away. This is a principle that is used often in disciplines like Pilates and Yoga, as well as the bracing techniques taught in weightlifting.
4. You're not cementing movements.
Image: kingofthegym.com
So you've done all the right things - kept moving throughout the day, ensured your loading and recovery is correct, stabilised proximally to the joint you're working on, and have spent hours doing all the cutting edge stretches and mobility exercises you can find. Yet you are still pulling up a couple of days later feeling just as stiff?
The last point to consider is cementing. If you are not strengthening and training into this new range of movement soon after, your body isn't going to bother maintaining it. For mobility routines I generally encourage the steps of active mobilisation, specific strengthening and then application into your training; the cement!
By being strong into the new range you will be able to use the movement as you are able to move into it actively under load during your training. You will also calm the nervous nerves by showing them that you are in control of this new range and are therefore not at risk of any injuries.
In closing remember that improving mobility is a long process and your body needs time to change and adapt to new movements and exercises (weeks to years!). So as cliché as it might sound, patience and commitment to the process is what will allow you to reach those goals in the end.
Please get in touch if you need advice that is specific to you.
Formotion Physio is a boutique Physiotherapy practice based in West Perth & Osborne Park, Western Australia
Lucia Tennant
Physiotherapist and Founder of Formotion Physio
BSc Physiotherapy
Stretch Series for Tight Lower Backs and Hip Flexors.
Your QL (quadratus lumborum), obliques and hip flexors are often tricky to find a good stretch for, these are our go to!
How to stretch your tight lower back and hip flexors
Your quadratus lumborum (QL), obliques, and hip flexors often get tight if you have been doing any heavy lifting, running or sitting for long periods. They can also be quite tricky to find good stretches for!
This series are a few of our favourites and cover all 3 of those areas.
Give them a go and let us know how they feel, but please remember that not all pain and injury is because of tightness. Sometimes the tightness that you feel is because of injury or weakness and is a protective mechanism that your body is using to keep you safe!
Stretching during these times might not be helpful so if this is the case rather get in touch with us before trying these!