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Kathryn Dane Mar 29, 2020 1:00:00 PM 12 min read

Confessions of a Restless Rehabber - Part 3

This is the third topic I would like to discuss in a series of fortnightly blogs- The Consequences of Premature Return to Sport post Injury. See my previous articles on The Physical and Emotional Impact of Injury and The Importance of Rest during Injury Rehabilitation.
 

Returning too early to sport

As discussed in the previous articles, I sustained two labral tears in my shoulder which sidelined me from playing rugby for 6 weeks. Injuries keep us away from what we love to do and as discussed in previous articles the rehab process can be long and physically and emotionally demanding. As much as you might want to get back quickly, you must make sure you have fully recovered so that you don’t return from an injury too soon.
All my life I have been guilty of ignoring the physiotherapists and doctors, as well as my body’s orders to rest properly. Instead, headstrong and impatient, I was always determined to get back to Rugby earlier than I had been told.
 
“Just strap it up, I’ll be grand”.
“I’ve taken two paracetamol, I’ll be grand”.
 
When I look back now, I feel slightly embarrassed as a student Physiotherapist I really should’ve known better. In this article I would like to discuss the reasons why premature return to sport after sustaining an injury is a bad idea and why you should follow the instructions of your physiotherapists or doctors.

 

How Long must I rest for?

 
As long as it takes, of course.
 

With some injuries, you can tell whether or not you’re better yet, and you don’t have to guess about how long you need to rest: you just rest until you can tell that it feels better, and then add another couple weeks just to be safe. Easy! But lots of injuries are “quiet” when you are resting. They only act up after 30 minutes of running, say. Some injuries are completely undetectable with anything less than competition intensity. Running soccer drills might be fine, but soccer itself still impossible. Skiing itself might be fine, but falling down is still a problem.

Plantar fasciitis, whiplash, carpal tunnel syndrome, iliotibial band syndrome, tennis elbow … these common problems, and many more, can feel more or less completely fine until you’ve been working/playing for a little while, and then you discover the hard way, after already irritating it, that it’s still vulnerable. How can you know how long to rest such a condition? How can you “test” it without irritating it again? Every case is different. In some cases you can (sort of) test it without irritating it (much). In other cases, there is no hope of this: testing will irritate the condition and potentially delay recovery.

You can see why I avoided saying “how long” at first: it depends on the individual’s situation and risk tolerance. There is no “right” answer. It’s like — exactly like, actually — trying to tell someone whether they should choose safe investments, or riskier but more profitable investments: it all comes down to your personal situation and style, and how you feel.

 

WHAT HAPPENS IF YOU RETURN TO SPORT TOO SOON POST INJURY?

RE-INJURY

 

Sometimes it is obvious when a certain activity should be stopped. Following a sprained ankle, for example, you will naturally want to keep off it until any pain or swelling has subsided and rest it for the first two or three days following the injury. Naturally, ice and compression will help to reduce the swelling as will elevation. However, if you have an injury that seems not to be healing or are suffering from unexplained pain, the importance of rest is less evident. Every individual and every injury are different so it is impossible to say exactly how much rest is needed in any given situation. The important thing is to avoid placing undue stress on severely fatigued or injured tissues but to stay relatively active.If you try to get back to full activity before an injury has fully healed, you are putting yourself at an increased risk of re-injury. A hamstring injury is a good example. How many times have you heard of people “pulling” their hamstrings season after season? It is crucial to stop straining the tissue or it will never have a chance to fully recover. Make sure to take enough time for the injury to heal so you don’t set yourself all the way back to the beginning.

 

DELAYED RECOVERY

 

Once again, rest and recovery are absolutely key ingredients in any athletic performance or training program. Make sure you take it seriously, because if you don’t recover well, you are literally training for nothing. Your body needs a surprisingly long time to recover from a normal workout, let alone an injury. Every workout is like a mild injury that you have to recover from, shielding yourself temporarily from additional stress on the recovering tissues. And yet few active people and amateur athletes give their tissues enough time to recover and adapt. This can really increase the risk of injury, lead to feeling run-down, and is far from optimal for fitness. Often we see patients who try to return when they are at 60% recovery. They can play or exercise but not as well as they would like. By returning that early, they slow their recovery and end up taking even longer than it should have to get back to 100%.

LONG TERM ISSUES

 

Many athletes are guilty (including myself) of “playing through the pain” and ignoring the signs of injury. Pain is a natural sensation produced by the body to let you know something is wrong. It can either be acute, which is short and intense, or chronic, which is long in duration and may seem to change constantly from a dull ache to severe pain. If we don’t seek a diagnosis or help from a physiotherapist, we ignore the signals our body is sending. This can escalate the damage to muscles, joints, and tendons and moves the injury from an easily treatable condition to a chronic problem which may result in permanent damage to the body part.

For example, shoulder tendinitis that is not treated properly in the early phases may progress to chronic pain and degeneration that may require surgical repair. If you take them seriously and follow the Physiotherapist’s guidance on graduated return to sport, you can return in a few days or weeks. But if you ignore it, you could turn what should have been easy to overcome, such as tendinitis, into a long-term problem that could even need surgery.

 

PAIN LATER IN LIFE

 
Probably the best reason of all to ensure proper rest and recovery is to preserve your long-term health. We all want to be healthy enough to play with our children, grandchildren and run or lift weights in your fifties and sixties. If you have an injury now, I seriously recommend you to see a physiotherapist, listen to them, follow their advice and do everything you can to recover fully.
 

SOME KEY PRACTICAL TAKEAWAYS:

  • Seek advice and listen to health professionals when they talk about rest and recovery, they may know what they are talking about. And again, as long as you don’t rest for too long, then you are doing the best thing for your body.
  • Partake in some modified sessions as you wish, reduce your training volume and intensity; that way you are still doing something rather than nothing.
  • Enjoy the benefits of rest and recovery. Change your mindset around this, because it can add to your performance in the end.

Find Out More

If you need advice, a physiotherapy assessment or feel your team/business could learn more about workplace ergonomics, contact Kathryn at kathryn@ffs.ie or visit www.ffs.ie/physiotherapy.
 
FFS Physiotherapy are now offering online video consultations and workstation assessments. Book in as normal and the team will be in touch.
 

 

 
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Kathryn Dane

Kathryn Dane is a Chartered Physiotherapist working with FFS Physiotherapy, a practice based on Leeson St Lower. Chartered Physiotherapists have specialist knowledge in the field of work-related injury management. She also plays for the Ulster Senior Women’s Rugby team and Irish Senior Women’s rugby team. If you need advice or a physiotherapy assessment, contact Kathryn at kathryn@ffs.ie or visit www.ffs.ie/physiotherapy.