In this post we take an in depth look at what to do when physiotherapy doesn’t work for your injury and the potential reasons why.
There are few things more frustrating than not being able to do the things you love because of aches, pains and limitations.
Even more frustrating however is the feeling you’re not making progress with your injury rehabilitation.
In this post we look at why physiotherapy hasn’t worked for your injury and what you can do now.
First a little background.
A few years ago, when I was an amateur cyclist, I had a couple of injuries that kept me off my bike.
I remember during one extended lay off for a knee injury, I got really depressed. All I wanted to do was get out on my bike, but instead I was hobbling around my apartment obsessing about my knee.
What I remember most was the feeling of helplessness. I visited the usual practitioners for assistance, physiotherapists, osteopaths and massage therapists. All of them were nice but nobody seemed to really understand me or my injury.
I wanted to understand why this had happened and how to prevent it from happening again in the future. But I didn’t receive satisfactory answers to these questions.
In fact everybody seemed to have a different opinion.
Fast forward a few more years than I’d like to count and I meet many people in exactly the same situation. So many in fact that I can probably take a guess at how things have gone for you so far.
Is this your experience?
Unless your injury was particularly serious, you likely first sought advice from a physiotherapist.
Physios are a great bunch of people in the main. I’ve worked with many of them in the past and all of them want the best for their patients.
No doubt they made you feel better about things and advised you to stretch some muscles and get some others working better.
This may well have worked in the short term, but just when you thought everything was going well, that familiar sensation came back.
It may have happened when you returned to your activities, or perhaps you didn’t even get that far.
Whichever the case, it was obvious to you things still weren’t right.
You probably took the logical next step of either returning to the physio, or seeking a second opinion.
Now things got a little more serious.
At some stage it’s likely you were told your injury was due to at least one of the following things.
Tight: hamstrings, calves, pecs, IT band, quads, upper traps, hip flexors / psoas, piriformis, adductors or lats.
Weak: glutes, core, VMO, serratus anterior, lower traps or deep neck flexors.
Plus any of these listed below:
One leg longer than the other.
Too much sitting down.
A large Q (quadricep) angle.
And my personal favourite, you’re moving wrong.
Does any of this sound familiar?
The solution to these issues will have involved more stretching, perhaps a foam roller and some agonising massage.
No doubt you were given more exercises which you did diligently but without any long term success.
Every time you returned to your activities, so did the pain.
Now you’ll have been moved along the medical conveyor belt to more intrusive interventions.
Depending on the exact nature of your injury, you were probably offered a scan.
Unless you’ve spent your days wrapped in cotton wool, the scan likely found ‘something.’
Whether that something was the cause of your issues, you can probably tell me. What I’m certain of however, is that if you underwent a procedure, it didn’t turn out to be a panacea.
The very fact you’re reading this now suggests it wasn’t.
So what is the solution?
Great question, I’m pleased you asked.
In order to find the solution, we first have to understand the problem.
Why did you develop this issue in the first place?
The root cause of injury is always the same thing, force.
Let me repeat that because it’s important. Any injury, be it runner’s knee, plantar fasciitis, IT band friction syndrome, Achilles’ tendinopathy, hip impingement, shoulder impingement, an ACL rupture, or being hit by a car, is caused by the same thing, force.
It’s whether your muscular system is able to tolerate those forces that’s the issue.
Those forces don’t have to be applied in a single incident either. A smaller force repeated over time can cause just as many problems.
So if the fundamental issue is a mismatch between what you’re asking of your body and what it can currently cope with, you have two options.
1) Do less.
2) Improve your ability to tolerate your activities.
I’m guessing if you’ve read this far, you’d like to take the second option.
So you need to get stronger.
But wait I hear you say, I’ve already tried a bunch of exercises and they didn’t work!
Good point. I’m about to explain why.
The biggest issue with the medical approach.
Here’s a surprising fact for you. Physiotherapists, Osteopaths, Sports Doctors, in fact everybody you’ve likely sought help from so far, will not have studied exercise.
Yes really. The better ones may have taken some additional qualifications in the subject, but they’re unlikely to have studied it in any depth.
Any why would they if you think about it? Their job is not to apply exercise. Their priority is to get you out of pain.
So who studies exercise? Personal trainers?
They do but here’s another surprising fact. During both my undergraduate degree in exercise science and my postgraduate studies in injury rehabilitation, I was never once required to step into a gym.
Rather like a car mechanic who never gets to work on a car, all I had was theory.
Would you let somebody work on your car who had never been under a bonnet?
Vocational courses in the field are certainly no better. You can get certified as a personal trainer online. The main focus of these courses is a basic grasp of anatomy and developing a working knowledge of the tools you find in a gym.
Sure you get shown how to teach a squat for example, but not what to do if you encounter somebody who can’t squat.
And guess what, there are lots of people who can’t squat.
So perhaps you can start to see what the problem is?
You fall into a grey area between a medical world that is untrained in how to apply exercise and the fitness industry that is mostly concerned with aesthetics and cookie cutter solutions.
It’s not that exercise won’t work for you, it’s just that you haven’t been shown how to apply it correctly.
The long term solution.
The long term solution, put simply, is resistance training that’s customised to you.
Your current strengths, weaknesses, and your unique structure all need to be taken into consideration.
There is no protocol for this. There are however principles you can apply which will make a big difference.
The Little Book of Injury Rehab, which is FREE when you sign up to our mailing list, contains 9 key principles which you can immediately apply to start making progress.
Our resistance training guide will show you exactly how to set up and apply resistance training exercises for your lower body.
Although it may be of small consolation, there are lots of people in your situation. The problem is not you but rather the methods you’ve used so far.
Every single one of my clients has had exactly the same experience.
Try to view your injury as an opportunity to learn more about your body and how to train it.
Learn how to use exercise to recover from your present injury and you’ll have that knowledge for life.
Not only will you become less vulnerable to injury in the future, you’ll also become much better at the activities you love.
All those years ago that’s exactly the information I was looking for. I hope my experience can help improve yours.
If you’d like to explore the possibility of working with us, please see our Rehab programme for more details.