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
〰️
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.
3 Running Tips to Improve Overstriding
Overstriding can slow you down and make running feel heavy and painful. If this is something you do try these 3 tips to improve your technique.
Despite what you’d think, running isn’t something everyone naturally does well, and overstriding is probably the most common issue we see in beginners and even our more seasoned runners.
Simply put, overstriding is when your foot stretches out and contacts the ground too far in front of your body when you take a step.
This effectively causes a stopping, breaking action which can also be quite jarring on the body. It tends to make running feel heavy and hard, and is often the culprit of pain in the shins, knees, hips and back during running.
It also means there is extra time needed for your body to get into the right position to then push off for the next stride, which slows the whole process down even more and wastes precious running energy!
See the video below for an example:
3 tips to improve overstriding.
Stride faster, not longer.
A more efficient way to run faster is by taking quicker steps that land close to the body, avoiding the stopping action, and allowing you to be in a better position to push back to propel yourself forwards in the next step.
See the video below for our same client a few months after practising!
To do this you can try focus on these three things next time you run:
Take shorter, quicker steps, rather than striding out
Often we’ll see people striding out to try to pick up their pace, which may sound correct, but usually results in more overstriding.
Aim to land close to your body, more towards the middle of the foot.
While the research tells us that there is nothing wrong with a heel strike, in practice with our clients we find that cues to pull your foot back to land more in the middle to front of the foot can help to achieve this better.
Think about “staying tall” & leaning forward.
Imagine a string pulling you ‘up towards the sky’ as you run, this will keep you extended and stable in your hips and core.
Lean forward slightly with the whole body, as opposed to just bending at the hips. It should feel like you would fall over if you didn’t put your foot out to stop yourself.The faster you go the further forward you should lean (up to a point!)
Staying too upright, especially as you try to pick up the pace, will cause you to reach out too far in front of you again.
If you are having trouble getting your head around these tips, or for advice that is specific to you, book an appointment with us or come along to one of our running technique workshops.
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”
⠀⠀
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”
⠀
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.
⠀
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.
⠀
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!⠀
⠀
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). ⠀
⠀
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
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