I like to make the analogy of the straw that broke the camel’s back. The patient has been doing the same thing, the same exercise, the same motion, over and over again, day to day, year to year. Tissue can begin to wear out. Over time, stressed tissues, such as ligaments and tendons, can start to wear down, producing micro-injuries. At the start the micro-injuries are so minute they don’t affect daily use. Eventually they add up, and then one day they add up enough to cause symptoms. That last injury was the straw that broke the camel’s back.
To use another analogy, human tissue is like a rope - thousands and thousands of individual tiny fibers, all oriented in the same direction. Individually they are not very strong at all, but together they have enough strength to pull very heavy loads. If we start to overuse the rope, the individual fibers start to break down. Eventually, if enough of them wear out, the rope begins to fray, and eventually it may fail.
Unluckily, unlike a rope, human tissue hurts when it’s injured.
Luckily, unlike a rope, human tissue has the inherent ability to heal itself. Sometimes we just need to help it along a bit.
How do we do that?
1. Stop doing that!
We all know the old doctor joke…
“It hurts when I do this doc.”
“Well don’t do that!”
Here it holds a bit of weight. If you're causing pain during an activity, back off a bit. Work just below the level of pain. I don’t want you bedridden, but I also don’t want you to cause more damage by working through pain expecting it to heal. This is where some patients can be their own worst enemies.
2. Take an aspirin and call me in the morning
Well, maybe not aspirin (might have to take a lot of it), but another NSAID (Non Steroidal Anti Inflammatory Drug) like Ibuprofen. These can decrease inflammation, decrease pain, and most off all allow some rehab exercises to be done. If you're an exerciser, and we all should be, finding a different exercise that doesn’t hurt while your injury is healing is a great idea.
Ice can also help to reduce inflammation. Ice about 15 minutes, 3 times a day. If you're icing over an area without much tissue between bone and skin (like the elbow or knee) icing through a towel may be a good idea. This helps to avoid injury to superficial structures like nerves from being injured by the cold. Ask your healthcare provider about the best way to ice if you have questions.
Some overuse injuries may be helped out a bit by braces, straps, taping, and other modalities which can reduce loads on the injured tissue and help aid in the healing process. Talk to your healthcare provider to discuss if one of these may be right for you.
4. Stretch and strengthen
Stretching tight tissues will help avoid further pulling and tearing. Strengthening others will help support injured tissues. I tell my patients, “It’s like building a brace under your skin.”
Talk to your provider about the best ones for your specific condition.
5. Don’t go back full force on day #1
Think of it as baby steps to recovery, just like in “What About Bob?” (Extra points to those of you who got the reference…great flick).
A graded return refers to slow and progressive steps every few days, starting slow, and progressing over a week or more, until you get back up to pre-injury level again. If you start hurting during one of the steps, stop! The next few days you stick with a step lower, and then try to advance again. Let your body dictate how fast it wants to return.