The human body is an amazing thing. It is the perfect harmony of stability and mobility, made up of over 300 joints, over 200 bones, and over 600 muscles each with a specific purpose to protect, move, and stabilize for any action that we perform. We often appreciate these things in photographs in books, online, or even on tv, but a still picture is an insult to what the body truly is and is capable of. Our bodies were born to move. Bend, Twist, Flex, Hinge, all of it, our bodies were built for it and grow stronger the more that we challenge it to do those things. For too long people have mis-interpreted the word “rest” after an injury to mean “don’t move”, don’t fall into that trap.
A good friend of mine recently sprained his ankle in an Ultimate Frisbee Tournament. He immediately called for a substitute and removed himself from the game. As I checked on him, he asked if he should follow the age old RICE technique to begin his healing, and to his surprise I advised him in the complete opposite direction. I instructed him to keep his ankle moving, in a limited pain free range of motion, walk around if he could without pain, and avoid letting his ankle stay in one position.
As inflammation and swelling sets into the joint capsule, it creates a feeling of discomfort and sends pain signals to the brain as damaged tissue feels in distress. Gentle motion not only helps prevent fluid from staying in the joint space and stressing tissue, but also allows for new nutrients to be brought in and heal the tissues. “Rest” does not mean “stop”. The longer the body is held in one position, the more the nervous system recognizes that position as “safe” and where the body should be, any movement out of that position can send signals of distress to the brain and be interpreted as pain or injury, especially if the person is already sensitive to the area due to the recent or recurrent injuries. Training the nervous system to accept movement and interpret it correctly is equally as important if not more important than the specific tissue healing. More and more research is coming out with regards to post-surgical protocols advising for early movement, passive in some cases, rather than prolonged immobilization.
Limiting even one joint from moving, immediately changes all other movement patterns and affects every other joint and muscle during everyday activities placing new stress on those areas. The sooner a person can return to moving, weight bearing, and gently using an “injured” body part, the faster they will return to full function. Rehabilitation is no different than any other aspects of training. Unless there is a complete avulsion or full grade tear in a muscle, that muscle continues to have contractile capabilities. During rehabilitation, the goal is not to over-stress the capabilities of the tissue, but the tissue must be “stressed” to heal appropriately.
Strength is gained by over-loading a tissue repeatedly in a controlled manner, increasing the load as the tissue capability increases. An already compromised tissue can not handle an over-loaded capacity without further damaging the tissue, but it can be loaded. During the rehabilitation process, load should be attenuated to the capabilities of the tissue with careful attention placed on not over-loading the tissue. Many times exercises and movements involved in sports can and should be continued in order to maintain proper form and prevent compensations, however speed, weight and other constructs should be altered to prevent over-load. Stopping the complete activity will lead to a much longer recovery process due to having to re-learn movement patterns that have been avoided for a long period of time.
The concept of “movement is medicine”, is not only in reference to post-injury. The more time a person takes to focus on their movement, whether loaded on unloaded, and move in any and every way that their body allows them to, the more protection they will have from injuries happening due to low-stress forces. Any event that causes extreme and uncontrolled overload of a tissue that is much greater than its capability will cause injury. But training the body in such a way that it is never “surprised” by a movement or event will allow for the tissues to withstand greater forces and provide a much better defense.
I spoke with my friend a few days later to see how his ankle was doing. He was amazed that it was not as sore as previous times when he had done the exact same thing and he was able to move around without pain, although was still not yet able to train at full speed he did not feel as restricted as normal. Just because you are not able to drive full speed in your car, does not mean that you must sit at a stand still. Motion is always better than doing nothing, and grading resistance and demands to match capabilities is the key to not only rehabilitation but also increasing and optimizing performance for all activities.
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