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
3 Steps to Better Overhead Mobility
Mobilise, Activate, Cement for better mobility.
3 Steps to Better Overhead Mobility
Mobilise • Activate • Cement
Your body won’t maintain what it doesn’t use.
Mobility or flexibility is only useful if you have the coordination and strength to actively use the range of motion - meaning you use your muscles to move into the range rather than an outside force, like a band or a weight. Your body will not generally maintain mobility that it can't use regularly or does not sense that you are safe moving into - luckily too!
The M.A.C acronym is a reminder to always follow any “Mobilisation”, or stretch, with a simplified stabilising or coordination exercise - "Activate". And to then put that movement into context with your sport, training or everyday movement - "Cement".
Context is key with any form of learning, so the best way to understand M.A.C is to try it for yourself!
This sequence is specific for improving your overhead shoulder mobility.
1. Mobilise
The best mobilisation or stretch is the one your body needs most - which normally comes with a good assessment. Test these ones out but remember to seek advice if you are unsure if they apply to you!
Peanut Ball Thoracic Extension
For overhead mobility, having adequate thoracic (upper back) extension is important to give your shoulder blades, and therefore shoulders, a good base to move on.
Lie down with your knees bent with a peanut ball placed on either side of your spine on your upper back.
Support your head and tuck your chin in. Posteriorly tilt your pelvis so that your lower back is flat on the ground.
Push the back of your head towards the ground and hold for a few seconds, relax back up slightly and repeat.
Perform 3-4 sets of 4-6 reps, for each set you can move the ball up or down slightly on the spine depending on where you need it most. You don't need to go lower than the bottom of the shoulder blades or above the top of the back.
Prayer Stretch (for Lats)
The lats are your "climbing" muscles, they work by pulling your arms down from an overhead position and internally rotating the shoulder (rolling them in). So when they are tight or over-active they make a good overhead position a battle against your own body!
Hold a stick shoulder width apart with palms up.
Kneel down with your knees in front of the hips and rest your hands on a low bench.
Imagine you are “pulling” you body away from the hands while you sink your chest down.
Spend at least a minute in this position - you can break the time up if needed.
If you get pinching in the top of the shoulder, try it with your palms down or with your hands further apart.
2. Activate
Y- Raises encourage active thoracic extension, rather than lower back arching, with full active overhead flexion.
Lie on your stomach with your arms outstretched while holding a broomstick.
Posteriorly tilt your pelvis so that there is a gap under your stomach.
Lift your collarbones, face and stick off the ground and hold this position.
Start with 4x15 seconds and reduce the rest until you can hold 1 minute continuously.
If this is impossible you can bend your elbows, or hold the stick further apart initially.
3. Cement
Now to give this mobility some real life context.
For example an overhead press.
The important part here is to practise MOVING INTO the new range under added load. Think about pressing up to the ceiling and bringing the arms slightly back in line with the ears to encourage further range.
Back sure you keep your ribcage pulled down to the pelvis so you don’t arch your back (like you did in the Y-raise)
The reps/sets/weight will be completely individual here depending on your training experience and goals.
Remember that mobility and strength changes can take weeks to months to years and the key is consistency and creating good habits. This means incorporating these principles daily into your training and spending designated practise on your problem areas at least 3x week.
For help that is specific to you please get in touch or book an appointment with us.
Formotion Physio is a boutique Physiotherapy practice located in West Perth and Osborne Park
By Lucia Tennant
Physiotherapist & Founder of Formotion Physio
B.Sc Physiotherapy