I want to think through this issue together rather than go off on a rant. MD’s, physical therapists, chiropractors, personal trainers, athletic trainers and all other health providers need to get better aligned in our efforts because there are so many people relying on us and assuming that we all know what we’re talking about. I believe that helping someone solve their nagging injury issue is a 3 step process that health providers and consumers can all follow together:
STEP 1: The first step to helping somebody solve their nagging injury issue is to determine if the source of the discomfort is coming from somewhere other than the site of the problem area. This requires a detailed assessment of your injury history and your movement quality.
As a clinician, I understand that it’s hard to do a comprehensive assessment on every patient or client because this takes time. Time is no excuse though, because this is our duty. Doing a quality assessment will give you the information you need to craft the right plan. It will also help you to determine if the issue is more than a nagging issue that requires something more than what you can offer. As a patient or client, it’s important to look for health providers who require an assessment before dishing out advice.
STEP 2: The second step to helping someone solve their nagging injury issue is to identify the activities that they can do and encourage them to keep moving. Keep in mind that stretching and rest is typically not enough to solve nagging injuries. Stretching tissue by itself is not as effective at remodeling and bolstering cranky tissue in the way that loading or strengthening cranky tissue is.
As a clinician, it’s much easier to tell someone to stop doing things and see if the discomfort goes away. There’s a great chance that this approach will temporarily make things feel better, but there’s also a great chance that this leaves the person confused about when they can get back to the activities they love. The moment they try to go back to normal activities, the issue flares right back up.
This is a frustrating cycle that many people get pushed into from the advice of the health providers that they trust. This frustrating cycle can be avoided simply by explaining that the body doesn’t like doing nothing and it responds to carefully dosed stress or resistance by getting stronger. Stop for a moment and compare 2 versions of advice from a health provider:
“I know your elbow hurts so I want you to stop doing anything with that arm for 2 weeks. In the meantime you can take some Advil, stretch it gently a few times per day and ice it if you want. Let me know if it doesn’t go away.”
“I know your elbow is cranky but we’ll work our way through this and get you back to the things you love in no time! Those tissues are begging you to get them stronger so let’s do it. I want you to squeeze the round bell of a 5lb dumbbell or a coffee cup 3 times per day for 3 sets of 45s. It’s ok if it’s a little tender when you do this. In the meantime keep up with all of your normal gym and workout activities so the rest of your body stays strong and ready.
You tell me how the outlook of a person struggling with nagging injury discomfort will differ based on the 2 versions of advice above. As a patient or client, it’s important to look for health providers who encourage you to keep up with appropriate activities and attack the problem area by strengthening and working through it within tolerable levels.
STEP 3: The third step to helping someone solve their nagging injury issue is to guide them toward empowering and appropriate expectations of the process. As a clinician it’s important to explain that it likely took a long time for your nagging injury to develop. This means that it’s unlikely that there’s a quick, lasting fix for the issue. It will take some time and patience. Patience is required because it won’t be a linear process. There will be good days where you notice progress and then there will be days that suck because you feel like it’s the same or a bit worse. The process of solving a nagging injury area is going to have ups and downs.
Another key expectation to set early in the process is that it’s ok if some of the process leads to discomfort. In other words it’s ok if there are exercises that have been prescribed that result in 1-5 discomfort on a 10 point discomfort scale while you’re doing them. Levels 1-5 can be described as bug-bite level discomfort - it’s noticeable and annoying but certainly not enough to stop you. I always refer to this as stirring up the mud at the bottom of the pond and this is not only ok but it’s necessary. Let me clarify that if what you’re doing is causing 6-10 discomfort during or after the activity or if there progressive discomfort more than 24-48 hours after then you need to dial down the action or the amount of the action. Another indicator of overdoing it is if there is noticeable swelling in the area after the prescribed activity or exercise.
As a patient or client, it can be scary to sign up for a process that might aggravate your nagging injury before it resolves it. I get that but I ask what’s worse:
A. Being scared about doing the things you love for the rest of your life because they might trigger your nagging injury issue?
B. Pissing off the area in a calculated way for a relatively short period of time to finally get the area stronger, healthier and able to endure the activities you love for the rest of your life?
Setting your expectations correctly can make the process of untangling and solving your nagging injury issues much less frustrating and fruitful.
I want to qualify that every injury is different and should be evaluated by a licensed healthcare provider before action is taken. The category of injury that I’m referring to in this post is the chronic overuse injury that is often targeted at muscle, tendon, ligament, bone or other connective tissue. These are the nagging injuries that you sometimes fight through successfully and sometimes unsuccessfully. These are the frustrating issues that don’t require surgery but the classic rest, stretch and ice routine that you’ve tried has done nothing to help.
Tim DiFrancesco, PT, DPT spent 6 seasons as the Head Strength & Conditioning Coach of the Los Angeles Lakers and is the founder of TD Athletes Edge. He is nationally renowned for his evidence-based and scientific approach to fitness, training, nutrition, and recovery for athletes and fitness enthusiasts.