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How Long Will It Take Me to Recover from Injury?

The overwhelming majority of bone and muscle injuries heal by themselves with little or no treatment. Regrettably there are thousands of products and treatments on the market today that have no independent scientific evidence to back up any claims that they can accelerate tissue healing.

This isn’t to suggest that these treatments don’t help reduce pain, but the absence of pain does not mean an injury has fully healed. In fact, one of the many reasons people experience chronic pain is because they return to activity prematurely and re-injure themselves.

To use an analogy, it’s like assuming that once a lake freezes over in the winter, means it’s safe to walk on it. Every year people fall through thin ice because they assumed it was safe to do so (premature). See the expression, “walking on thin ice”.

Five Keys to Success 

Five keys to successfully managing your injury; 

  1. Reducing inflammation as soon as possible.
  2. Creating the optimal environment for your injury to heal AND giving it enough time for your repair tissue to fully mature.
  3. Listening to your body when it’s painful and making the right decisions to prevent re-aggravation that can lead to permanent, chronic pain.
  4. Designing a safe and appropriate exercise program for your injury at each stage of tissue healing.
  5.  Executing some form of exercise daily to maintain your fitness level and function in unaffected joints and muscles.

Why Some People Fail to See Progress

Five common reasons that people fail to see progress; 

  1. They ignore their pain and continue to do activities that cause more pain.
  2. They take medications to mask their pain and continue to do activities they know will flare their pain.
  3. They delay in getting an accurate diagnosis and appropriate treatment plan (‘live with their pain’)
  4. They attempt inappropriate activities or exercises for their condition and stage of tissue healing (‘too much too soon’)
  5. They expect that there is a treatment or surgery that will fix their problem without having to modify or stop their activities.

The following is an information outline of a ‘to do list' at each stage of tissue healing and rehabilitation as well as describes the criteria that must be met before progressing to the next stage in managing your injury or condition.It is designed to provide a framework that will be individualized by your healthcare professional for your injury or condition.  

It is not designed to replace or act as a substitute for individualized care from a healthcare professional.

What Stage Are You At?

There are two biological processes that take place in managing any musculoskeletal injury.

  1. The Restoration of Anatomy (commonly referred to as tissue healing).
  2. The Restoration of Physiology (commonly referred to as rehabilitation).

Very Important:

  • Reducing pain should not be confused with biological healing.
  • Just because a product or treatment reduces your pain doesn’t mean you’re healed.
  • The majority of products and treatments on the market DO NOT accelerate biological healing – they only offer short term pain relief.

There are three stages to tissue healing;

  1. Inflammation begins immediately and typically results in swelling of injured tissues. Goals are to reduce excess inflammation.  Methods commonly include rest, ice, compression, protection and elevation as prescribed by a healthcare professional.
  2. Early Repair begins immediately to create primitive immature repair tissue. Goals are to begin moving the affected joints gently while still protecting immature repair tissue at site of injury . Methods commonly include short periods of exercises prescribed by a physiotherapist, followed by periods of rest and protection by using an elastic bandage, brace, sling, a removable cast/splint or using crutches – again all prescribed by a healthcare professional based on a medical diagnosis.
  3. Middle Repair begins within days as the primitive repair tissue gains tensile strength. Goals are to restore range of motion and begin gentle strength to minimize stiffness and weakness. Methods commonly include safe and appropriate exercises prescribed by a physiotherapist.
  4. Late Repair begins over weeks as the repair tissue gains even more tensile strength and can tolerate more load from activity or exercise.  Goals are to restore full range of motion, muscular flexibility, muscular strength and function. Methods commonly include work or sport specific exercises that are safe and appropriate and prescribed by a physiotherapist.
  5. Re-modelling is a stage that occurs over weeks and months where repair tissue modifies itself into a permanent state (so-to-speak). As the tissue biologically refines itself, goals during this stage are to complete all necessary rehabilitation to ensure the repair tissue is as functional as the original tissue.  Methods include work or sports ‘hardening’ through progressive exercises prescribed by a physiotherapist.

How Fast Do You Heal?

 The speed that each individual heals at depends on the following variables;

  1. Severity of injury.  The deeper and greater the tissue damage, the longer it will take the body to repair itself.
  2. Blood flow to the injured tissue.  The less blood flow to an injured tissue, the longer it will take the body to repair itself.
  3. The type of injured tissue.  Some tissues, such as nerves, repair themselves very slowly. Some tissues such as articular cartilage have almost no repair capacity and are thought to, not repair at all.
  4. Age. The older we get, the longer it will take the body to repair itself.
  5. Genetics. Although there is no conclusive evidence, it’s thought that some patients may repair themselves faster than others based on genetics. 

Given that no two people will share the exact same injury, age and genetic profile, it’s generally assumed that no two injuries are identical, nor will two similar injuries necessarily heal at the same rate.

In order to estimate the length of time it will take your injury or condition to heal your physician or physiotherapist will educate you on the speed they believe you will progress through the healing process so you can establish realistic timelines to return to work, sports or other activities.

Stage One – Inflammation

  1. Reduce any excess or residual inflammation at the site or injury as soon as possible.
  2. Prevent further inflammation at the site of injury.
  3. Maintain motion, strength and cardiovascular fitness at unaffected body regions.

Depending on your diagnosis, your practitioner or physiotherapist may recommend one or more of the following;

  1. Resting, icing, compressing or elevating the site of injury or affected area.
  2. Modifying or stopping any activity known to trigger more inflammation and/or pain.
  3. Educate you on a flare-up prevention program to identify  your pain triggers before they trigger a flare-up.
  4. Educate you on a flare-up treatment program with quick steps to reduce the impact of a flare-up of pain.
  5. Doing safe and appropriate exercises at unaffected body regions.

 Criteria to progress to Stage Two:

  1. No night pain.  If you’re experiencing night pain that prevents you from falling asleep normally or wakes you up at night, then you should see a physician before progressing to stage two.
  2. If you notice a reduction in the frequency or intensity of your pain at rest or with low-level activities.

Stage Two – Early Repair

Very Important: Despite ANY reduction in your pain, early repair tissue is immature and can take upwards of months to re-gain sufficient tensile strength, to take full dynamic load through it. Therefore, the absence of pain DOES NOT mean you are healed and you need to be careful to avoid any pre-mature activity or exercise that may trigger damage to the repair tissue and cause your pain to return.

Depending on your injury, age and your genetic profile, you may be vulnerable to re-injury for the rest of your life.Therefore the key is work with a physiotherapist to educate yourself on what activities are safe and appropriate for your condition and those that are risky for your condition.

Stage Two Goals

  1. Prevent a flare-up of pain and inflammation at the site of injury.
  2. Restore full painfree passive range of motion at the affected joints.
  3. Restore full balance and proprioception at the affected joints.
  4. Restore full painfree isometric muscle recruitment at affected muscles.
  5. Maintain motion, strength and cardiovascular fitness at unaffected body regions.

Depending on your diagnosis, your practitioner or physiotherapist may recommend one or more of the following;

  1. Executing a flare-up prevention plan to self-monitor your pain and to make the right decision to prevent or minimize the intensity or duration of a flare up.
  2. Safe and appropriate exercises for your condition to restore range of motion, balance, proprioception and early strengthening as tolerated.
  3. Avoiding premature exercises or activities that may result in re-injury.

Criteria to progress to the Stage Three:

  1. Restoration of full painfree passive range of motion at the site of injury.
  2. Restoration of 75% of painfree active range of motion at affected joints
  3. Restoration of 75% of full balance and proprioception at affected joints.
  4. No pain with isometric muscle contractions at affected muscles.
  5. Your physiotherapist believes its safe and appropriate to progress to Stage Three.

Stage Three – Middle Repair

Stage Three Goals

  1. Prevent a flare-up of pain or inflammation through premature activity or exercise.
  2. Restore full painfree active range of motion at the affected joints
  3. Restore full balance and proprioception at the affected joints.
  4. Restore full painfree Grade 5 muscle strength at the affected muscles.
  5. Restore full muscular endurance for non-sport activities of daily living. 
  6. Maintain motion, strength and cardiovascular endurance at unaffected body regions.

Depending on your diagnosis, you practitioner or physiotherapist may recommend one or more of the following;

  1. Executing a flare-up prevention plan to self-monitor your pain and to make the right decision to prevent or minimize the intensity or duration of a flare-up
  2. Safe and appropriate exercises for your condition to restore motion, balance, strength and endurance as tolerated.
  3. Avoiding premature exercises or activities that may result in re-injury.Criteria to progress to Stage Four
  4. Full painfree active range of motion at the affected joints. 
  5. Full balance and proprioception at the affected joints.
  6. Full painfree grade 5 muscle strength at affected muscles
  7. Full muscular endurance for non-sports activities of daily living.
  8. Your physiotherapist believes it is safe and appropriate to progress to Stage four. 

Stage Four – Late Repair

Stage Four Goals

  1. Restore full painfree muscle strength, flexibility and endurance at affected muscles.
  2. Restore psychological confidence to perform individual work and sports specific skills or tasks well.
  3. Return to non-competitive, non-contact sports specific activities and exercises.

Depending on your diagnosis, your practitioner or physiotherapist may recommend one or more of the following;  

  1. Executing a flare up prevention program to self-monitor your pain and to make the right decision to prevent or minimize the intensity or duration of a flare up.
  2. Safe and appropriate exercises for your condition to restore work or sport specific neuromotor skills involving speed, agility and endurance.
  3. Avoiding premature exercises or activities that may result in re-injury.

Criteria to progress to Stage Five

  1. Full painfree active range of motion at affected joints.
  2. Full painfree muscle strength, flexibility and endurance at affected muscles.
  3. Full speed, agility and psychological confidence to perform sport-specific skills without pain or re-injury.
  4. Your physiotherapist believes it is safe and appropriate to progress to Stage Five.

Stage Five – Return to Work / Sports

Returning to work, sports or exercises prematurely can result in;

  1. Re-injury
  2. Secondary injury (example; a head injury because you lacked the speed or agility following a knee injury in order to avoid contact with an opponent)Returning to work and sports also requires re-gaining great confidence that you have the necessary individual skills to perform well and without worry or apprehension.

Stage Five Goals

Return to all full unrestricted work, sports and activities at:

a. Lowest possible risk of re-injury.

b. Lowest possible risk of suffering a secondary injury

c. Highest probability of performing your job or sport well and achieving success.

Depending on your diagnosis, your practitioner or physiotherapist may recommend one or more of the following; 

  1. A progressive increase in the frequency the number work shifts or sports practices.
  2. A progressive increase in the physical intensity of work activities or sports drills (speed, physical contact)
  3. A progressive increase in the duration of work shifts or sports practices  (endurance)
  4. Practicing with the use of an aid or appliance to prevent re-injury such as ankle or knee brace for sports.

Criteria to graduate to full unrestricted work, sports or activities;

  1. Written clearance from your physiotherapist that it is safe and appropriate for you to return.
  2. Written clearance from a physician that it is safe and appropriate for you to return.

Flare Up Prevention and Management Plan

At some point in time, you will experience a flare up of pain during your treatment or rehabilitation.Flare ups are common and normal, but it is unrealistic to expect your injury to heal itself well or quickly if you continue to do activities which you know flare up your pain.Continuing to push through pain prejudices you to fail at any form of treatment you try (waste of time and money) and potentially can lead to permanent chronic pain that no medication or surgery can fix.

To use an analogy, continuing to push through pain is like trying to bake a cake with the oven door open.  It’s just doesn’t work.  In the end, you need to close the oven door and give the cake the necessary time to bake (heal).Therefore the key to success isn’t treatments, it’s preventing flare-ups and doing your best to reduce the intensity and duration of any flare up as soon as possible.

There are two important questions you need to answer to prevent and manage any flare up.

1. “What did I do?”

a. Flare ups are not accidental.

b. Flare ups are the result of doing an activity prematurely (too much too soon).

c. Returning too soon to a given sport or exercise can be due to ignorance (“I didn’t know it would make me sore”) or arrogance (“I was told not to do “x”, but I tried it anyway“).

d. Don’t beat yourself up. It happens…. it just isn’t a good idea to repeat it.

2. “What do I do?”

a. Immediate self-talk “I knew this could happen. It’s not the end of the world. I can see what I did and I know what I have to do. I have a plan”.

b. Ten minutes to minimize inflammation. If you re-irritate your injury, it will trigger immediate inflammation within seconds every time.  The more inflammation that establishes itself, the longer it will take to get back on schedule with your healing and rehabilitation.  Your goal is to get ahead of the inflammation within ten minutes by following the strategies used in Stage One.

c. Expect you will feel sorer for upwards of 48 to 72 hours,  so modify or cancel your plans for the next two days. Remember pushing through pain is not smart and will only delay healing and your rehab.

d. Modify or stop the activity you identified as a trigger for your current flare up. It’s only temporary but it’s essential to healing as fast as possible.

e. Remain positive. Flare ups happen to everyone. The key is to learn from them and not to repeat them.

f. Talk to your practitioner or physiotherapist and get their input and advice.

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