Returning to Sport part 1
Working with athletes for the past ten years I have come across a wide variety of injuries and set backs that have all required time off from training. Everything from sprained ankles to an ACL repair will require the patient to step away from certain activities and focus on the rehab process. Depending on the type of injury and location this may be weeks or months with hours of recovery training and various types of therapy. Progressively things will start to come together; there will be less pain, better range of motion and improved strength. Inevitably though, the question that always comes up is “how do I know when I am ready to return?” The questions is much simpler then the answer but by examining several aspects of injury, rate of tissue healing, training and loading strategies we will be able develop a more systematic approach to determining when we might be ready to return.
**Please note that individual healing and training specifics are unique to every situation. If you are working with a surgeon, physician or other health care provider regarding your injury and care it is very important that you communicate with them regarding your post-operative/post-injury protocol**
Type of injury
When it comes to real estate we always here “location, location, location.” We can think of injuries in the same way. But don’t just think of location as where on the body we hurt but more in reference to what structures were involved and to what extent the tissue has been damaged. Muscle, ligament, tendon, bone and everything in between all have the potential to sideline you or significantly limit performance and each one will carry a slightly different rate of recovery.
Ligaments, tendons and muscles
When referencing injuries to structures like ligaments, muscles and tendons a grading system is often used. A grade I strain or sprain (F.Y.I. we strain muscles/tendons and we sprain ligaments) indicates that some level of trauma has been experience with possible minor tearing. Grade II is more severe with trauma and tearing to the structure but the ligament or muscle/tendon is still intact. A grade III is the most severe with complete rupture of the ligament or muscle/tendon and often significant loss of function. Surgical repair is a separate type of trauma category for ligaments that is common with the grafting procedure that is done for ACLs and with severe joint instabilities. Ligaments and tendons don’t have the blood supply that muscles have so recovery time is typically longer for those structures or may require surgical intervention if severe damage has occurred.
Bones don’t carry a grading system like ligaments or muscles but can be classified by the type of fracture. Compound, spiral and stress fractures might all be terms you will hear to describe what is seen on an x-ray. The more traumatized or displaced the bone the more likely some type of significant intervention will be needed including surgical fixation (pins, plates and/or screws) of the fracture bone.
Phases of Tissue Healing
For all types of tissue, the initial phases of an injury usually start out the same, an event results in trauma to the tissue, the body initiates a specific series of physical responses to reduce further injury and the healing process begins. Tissue will go through a cascade of events as it moves from acutely injured to a more stable healed state. The bleeding stage is typically short in duration, 6-8 hours on average, and dictated by the level of trauma sustained and the location of the injury. Muscles, rich with blood vessels, will tend to bleed more where tendons and ligaments have a limited vascular supply and don’t tend to bleed as much. Keep in mind we are referencing internal bleeding here and usually swelling, bruising and discoloration is present. The inflammation phase is a necessary component of the healing process and will immediately follow the bleeding phase. Within this phase a series of events take place that help remove some of the traumatized cells and tissue and allow the body to prepare for healing to start. The healing phase, or proliferative phase, occurs next and is when the tissue starts the restorative process. The final phase, the remodeling phase, occurs as scar tissue is formed and becomes a more dynamic part of the tissue again. The tissue will continue to change during this time becoming progressively more like the original tissue as it matures over time.
Healing rates for each specific type of tissue is somewhat generalized and should be used as a guideline not a hard and fast rule.
Typical rates of recovery are as follows:
Grade I 0-3 weeks
Grade II 4 days -3 months
Grade III 3 weeks-6 months
Grade I: 0-14 days
Grade II: 3 weeks to 6 months
Grade III: 4 weeks to 2 years
5 weeks-3-4 months
Tendonitis: 3 weeks-2-3 months
Laceration: 4 weeks-6-12 months
2 months-2 years (example: ACL)
As you’re healing
Often time injuries occur as a result of something that is preventable and avoidable. Even in the presence of a traumatic event most of our injuries occur due to inadequately prepared tissue, under recovered systems and poorly organized movement patterns. With injuries like a sprained ankle or strained quadriceps muscle, there are likely multiple variables that can lead down the path of mechanical failure, pain and ultimately limited sport participation. During the time that the injury is healing is a perfect opportunity for the athlete to address certain areas that have left them vulnerable. Tendonitis of the shoulder limits overhead activity? Fine, spend the time looking above and below the shoulder at other areas that could be contributing to the problem like a stiff thoracic spine, a weak rotator cuff system or poor hip/core control. Calf strain from soccer camp? Use that relative rest period as a time to look at the ankle, knee, hip and core to see if the strain is a result of other poorly moving joints. When the tires wear bad on your car you certainly don’t blame the tires. You step back and say, “Huh, tires are wearing funny, better check the alignment.” The human body is no different. When we find ourselves hurt or injured it is important that we take the time to recognize that the issue is likely not just about that structure, but a combination of factors that leave us vulnerable at our weakest point.