Fitness First Aid – Injury Recovery Basics
Ever wanted to save some cash on a visit to a physio? Want to know what to do if a little niggle occurs? Do you want to know when you should see a physio? Me too!
Over the years I have picked up a lot from physiotherapists. At the time, it seemed to me that physio degrees were so different to sports coaching degrees (maybe that’s changed now?). But when it comes to day-to-day training, there are often crossovers in what we prescribe. I always found it weird that I never got taught about prevention or early rehabilitation. I thought I could save people (and myself) so much time and money by understanding what to “tick off” before walking into a clinic.
Fast forward 10 years and I have a basic strategy, that I will share below, that will help you work through common problems. Like a fitness first aid kit! Sometimes all you need is a band-aid – a number of exercises to protect the injury while it heals and keep important muscles switched on. If the band-aid doesn’t work, and the wound is all weepy and yuck… then we go to the doctor. But we don’t need to go to a doctor to get a band-aid.
Before we continue, just a note on band-aids. They get a bad rap, but they are an amazing invention that supports the body’s healing processes. In this context I don’t mean band-aid as something we set and forget. Nor do I mean it to be something we use to cover a problem we don’t want to know about. Band-aid in this circumstance, is simply a tool to help aide the body’s natural healing intelligence.
Firstly, some context - our muscles, tendons and ligaments (collectively called “soft tissue”) have fairly predictable recovery timelines, shown here.
Once the inflammatory stage is over, the body starts cleaning up, and this is where intervention (specific exercises) can be really useful, because they can enhance cell proliferation and improve tissue remodelling.
For a long time, medical professionals advised large bouts of rest following injury (bedrest), but now we know that muscle wastage makes the healing process a lot longer. In cardiac rehabilitation and joint replacements (hip and knee), it’s a matter of DAYS before patients will be poked and prodded from their beds to take their first taxing steps and make a start on their rehabilitation. Physios in particular advocate for early intervention, because, from the pressures of professional sport, we know that early intervention works. Just like the emphasis on the Chain of Survival (Early Access, Early CPR, Early Defibrillation, Early Advance Life Support), we want to act EARLY.
Looking at the picture below, we can see that sports injuries heal in a matter of weeks or months.
(A note on ACL tears of the knee, there’s a growing body of evidence that says that surgery is as good as conservative management [learning to stabilise without the ligament]. I have a ruptured ACL in my left knee. Can you tell? Nope! My muscles are trained to do the job that the ligament used to do).
So, we know WHY it’s important to start early intervention for injuries, but WHAT do we do? There are a lot of movements we can tick off to try to solve the injury (using a band-aid). If we don’t solve it, then we can see a professional. If we do, then we have saved some time, learned some things and will get better at Fitness First Aid in the future. The good thing is, you don’t need a degree, you just need to know some language.
In the words of philosopher Ludwig Wittgenstein (adjusted a bit for our case) "the limits of my anatomical language mean the limits of my ability to find good fitness first aid ideas".
The great thing about today’s world is you don’t need to know anatomy, you just need to vaguely know what to search for. Let’s use my recent shoulder injury as an example. I will include my process of elimination, my fitness first aid, and how I knew I needed more than the band-aid.
In September last year, I was in pain inside and around the top of my arm, specifically when my arm was pressing from my chest to over my head. It was only painful during movement, not at rest. I knew how the niggle happened – I was doing something called a “toss to high bridge” (https://youtu.be/gBkcap4Xh0A). Two buddies held my arms and legs respectively, then gave me a toss, and my job was to hold a bridge shape while they held me above their heads.
Spoiler… I didn’t warm up properly. My left shoulder didn’t love it. But I did a couple of reps anyway then worked on other things. The next few weeks my shoulder would get better, then worse. It was annoying when practicing my wall handstands but got SUPER unhappy when I tried my favourite tumbling move, a backwards roll to handstand. Lifting my arm out to the side was fine, but as soon as it moved past shoulder height it was SO unhappy. I decided to try fitness first aid.
Our Fitness First Aid early action plan is three steps – 1. Deduction, 2. Building the Band-aid, and 3. Review.
So, that’s the context, now we will go into the process of Fitness First Aid – Step 1 - Deduction (feel free to follow my steps for yourself!):
1. What tissue is it? Tissues have some personalities, so we can often tell what has been affected from how it is “talking” to us.
Bone breaks hate to be cold – it will growl in a very specific spot if you apply an ice pack.
Tendons and ligaments injuries love to be warm and worked – they will be happier if you’re in the middle of a session but will growl if you cool down the try to move again.
Nerve inflammation talks through anything (rest or activity) – they hate being stretched at both ends and are tricky - they can show up in the shoulder when the problem is in the neck (for example). But they settle down quickly once they get what they need (a couple of days of gliding exercises).
Muscle injuries hate to be worked – they will hurt with more training and be happier at rest. Given their large bloody supply, they resolve faster than tendon or ligament injuries.
2. Google it - I knew that my shoulder niggle was fine at rest, only hurt during movement, and got worse throughout the session – a muscle issue. I started by typing into a search engine “which muscles work when the arm moves overhead?”.
3. Make a list of the muscles – in this case, deltoid muscles, supraspinatus muscle, infraspinatus, teres minor,
subscapularis, and trapezius.
4. Possible players – with my best guess, I narrowed down which muscles I thought were unhappy, disregarding those that I was pretty sure were OK. You can do this by trying each muscle into google and asking what pain you could expect from an unhappy muscle. I narrowed it down to deltoids and all rotator cuffs.
Deduction was done, then I moved onto Fitness First Aid – Step 2 - Build the Band-aid:
1. Isometric program – I made myself a rehab program, starting with isometrics (applying force in a non-
moving exercise). To do this, type the muscles you need into google and add the words “isometric
exercises”. You’ll see some trends in what people prescribe and you can give them a go. I did door frame
pushes and overhead holds.
2. Concentric and eccentric program - There was no pain during isometrics, so I moved on immediately to
exercises with movement. Type into google exercises for the muscles you need, and you’ll get a range of
good ones. I did these exercises slowly, and where I needed a weight, I used a light one. Each week I either
added reps or weight to the exercises.
Now to the final step of Fitness First Aid – Step 3 - Review:
Generally, we will see an improvement in symptoms if you’re roughly right about what is going on. I have solved many other niggles in myself and others this way, including knee pain, hip pain, back pain and plantar fasciitis. Some things I haven’t been able to solve, but it doesn’t matter because you’ve got a list of things you’ve tried so you’re already closer to an answer. This was my shoulder to the tee - I tried this program for a few weeks with no success. While some of my muscles were getting stronger, the same things were setting my shoulder off (when I tentatively and carefully tested them).
My Fitness First Aid was complete, but my metaphorical wound was still weepy and yuck.
At this point I knew I needed help. I went to see Tash at Elite Rehab in Deakin and she did a bunch of positional testing. The result? General instability and the need to improve the coordination of my muscles. BAH! OF COURSE!
Even though I followed my steps and felt like I made no progress, I shortened the investigation process for Tash, and saved myself a wad a cash! No wonder my training didn’t work, I was training isolated muscles rather than teaching them how to work together. Sometimes we need a second set of eyes to figure out the missing pieces.
Why not Fitness First Aid for your own niggles, and let me know how you go?
Next week I will go through how to strengthen an injury after Fitness First Aid to give you the best chance of it not happening again.
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