In this post we look at why your injury isn’t getting better and what you can do to make progress.
If you hurt yourself a while back and you’re frustrated that you don’t seem to be making progress with your rehab, there’s probably a good reason why.
Before we dive in however, let’s take a quick look at the healing times for parts of the musculoskeletal system that are commonly injured.
This will ensure the information I’m about to give you is relevant.
Healing times of common injuries
Most bones will heal in 6-8 weeks.
Ligaments heal in anywhere between 3 and 10 weeks depending on the severity of the tear.
Tendons heal in around 12 weeks depending on their location and how badly they were injured.
Muscles take around 8-12 weeks to heal, again depending on the severity of the tear.
If you injured any of the above tissues and you’re now outside the healing time for that particular area of the body, read on.
Changes that occur immediately following injury
When you hurt yourself a number of processes begin. These include the inflammatory process to promote healing, and most critical to this post, an almost instant change in how you move.
Your central nervous system (CNS) programmes movement to avoid placing force through the injured area. Think how you adopted a limp, or noticed you were moving your shoulder in an unusual way following the injury.
Rather like a diversion that’s put in place whilst a road is being repaired, this becomes your default way of moving for the time being.
Whilst this will weaken the muscles no longer being used, it’s necessary to promote healing and avoid further injury.
This is the primary reason you were given exercises by a rehab professional in an attempt to recover strength in the affected area.
Yet you still don’t feel like you’re getting better. Perhaps the exercises even make you feel worse. So what’s going on?
Muscle compensations persist unless addressed directly
There’s research to suggest the cause of this issue is related to the diversion that was put in place at the time of injury.
Over time this becomes hard wired and unless addressed specifically, it may sabotage your rehab.
This new way of moving may also leave you prone to future injury when you return to activity.
How to reduce muscle compensation after injury
At a foundational level the problem lies in an alteration of the feedback mechanisms present in the injured area.
The picture your CNS has of the area as a result of these changes becomes somewhat unclear. This effect is known as smudging and has been shown in recurrent back pain patients for example.
Think about it like this, would you take a road that isn’t clearly marked on a map? Or would you prefer to stick to the tried and tested route that got you there last time?
Rather sensibly your CNS chooses to do the latter.
The challenge therefore is to increase feedback from the previously injured area. This will help your CNS feel confident to use this route once again.
How to improve feedback from previously injured areas
The first challenge is to locate the areas that aren’t providing sufficient feedback to the CNS. These will be found by looking for restrictions in range of motion.
Fortunately you have two sides to your body so this gives us a way to compare motion.
Whilst this is best done by somebody who knows what they’re looking for, you can assess yourself.
Start by checking motion at joints in the immediate area of the previous injury and move outwards.
If it’s a knee that’s causing you issues for example, check how far you can bend and straighten one knee compared to the other.
Isometrics are the magic bullet
If you find a restriction the most effective way to increase feedback from the area is to perform isometrics.
Isometrics are muscle contractions without movement of the joints those muscles act upon.
Isometrics have been shown to both reduce pain and cortical inhibition. This is the first step towards restoring normal muscle function around previously injured areas.
The video below will show you how to both assess motion at the knee and improve it if you find limitations.
Summary
If you’re outside the known healing times of the tissue you injured, but you’re still experiencing issues, these are most likely related to changes in how your muscular system is currently functioning.
Look for restrictions in range of motion as tell tale signs this has occurred and use isometrics to restore feedback and improve muscle function.