NOV 2015 - HEALTH & FITNESS
I Wish I Knew That
Facts about Pain and Injury from a Physical Therapy Perspective
By Alison Synakowski
Working as a physical therapist with an active population day in, day out is such a pleasure. People are motivated, excited and anxious to participate in their activity; be it running, cycling, hiking or soccer. It can also be challenging, as many times people are in the office with an injury and pain. They are defeated, frustrated and just do not understand why they hurt. If you are active, you know that once you are told you need to “rest,” your world can become a very different place. Those of us that are active often depend on our workouts or activities to relieve stress, maintain our body image, and connect with other people. If you take away our workouts, more than just our bodies suffer.
Often times in a physical therapy office you hear the words, “I wish I knew this a long time ago.” People are typically referring to understanding their injury, understanding how the body works, and understanding what they can specifically do to help heal their injury. For example, somebody says “I have IT band syndrome.” Okay, so you have pain over the outside of your knee. IT band syndrome is a very common diagnosis, however it does not tell us WHY you are overstressing this area. Many times for this diagnosis you may self-treat, follow a friend’s advice, or look up some treatment online. Now three months into having pain, you’ve been foam rolling like crazy, stretching, and not participating in your activity.
Then, as soon as you return, BAM, pain returns. Not every IT band syndrome happens for the same reason. Maybe you need to tweak your running form or get your bike properly fitted. Maybe you need to build hip and core strength or stretch or roll other muscle groups. Each individual is so different, there is no way to know what you should do until you have been evaluated and know exactly where you are limited or restricted.
Here are the top three statements where people are constantly saying “I wish I knew that a long time ago.” Simple tweaks in your movement, strength, endurance, and mostly knowledge can allow you to stay active and healthy longer.
- Location of pain does not allow us to understand WHY it is happening.
- Immobilization or “resting” is typically not enough.
- Training with improper form may be making you worse.
Location of pain does not allow us to understand WHY it is happening – Unless you have had an acute injury, a blatant event that caused injury (example: sprained ankle, sprained knee, fractured ankle), the true “problem” is likely not at the site of pain. Examples could be plantar fasciitis, tendonitis in your ankle, knee pain (bursitis, tendonitis), and IT band syndrome. If there is not a KNOWN cause, you likely need to be addressing deficits not only in this area, but other areas as well. How your body is moving may be causing you to overuse or overload the painful area. You can (and need to) treat the specific area of pain, but if you do not get to the root cause, it will likely continue to come back or never fully go away.
Immobilization or “resting” is typically not enough – While short term you may do great, if you have had an injury that lands you on crutches, in a boot or in a cast, you need some type of specific intervention to return to your body’s pre-activity level. Too often individuals return to their activity before their body is ready to handle it, leading to yet another injury. One of the best examples of this phenomenon is the fact that spraining your ankle is associated with immediate loss of hip strength. You sprain your ankle: maybe you need to use crutches for a few days as it is painful to put weight on it, or you needed to be in a boot to assist with healing. You wait a week or so, return to your activity, and despite some ankle soreness you are alright.
However, three months later you develop knee pain for “no known reason.” The knee pain is likely due to a deficit you acquired secondary to that ankle sprain. Oftentimes you may not realize the ankle joint never got back its proper movement, the whole leg from the ankle to the hip is weaker compared to the non-affected side, or even your movement pattern has changed to protect you from stressing that ankle. This is crucial for people to know, especially our young kids, who are so resilient and bounce back quickly. Ensuring you or your child gets back proper strength and movement is essential to reduce the risk of FUTURE injury.
Training with improper form may be making you worse – If you are an avid cyclist, runner, rower or team sport athlete, and you are also working on strength training and core straining, kudos to you! You recognize this is an important supplement to support your body during the activities you love the most. It is good to be cautious and ensure you are using, and are educated on proper form for your exercises. If you are moving or working incorrectly during an exercise, you are building a pattern of movement, improper movement that can, over time, cause you to overstress and break down tissues.
A great example is SQUATS. We all know they are good for us, as much as we hate them. Things to watch for include rounding your back, your knees coming in together (should be in line with your hips), and your feet staying in a neutral position (not “pronating”) when you are at the bottom. There are many other components to a squat, however watching out for these three things are crucial to not build bad habits.
For runners, soccer players and hikers, if you are working on squats, and your knees are consistently falling in (picture) you are creating a painful and dangerous movement pattern. This will lead to increase stress on structures throughout legs and potentially put you at increased risk for injury. Simply backing off weight and working on form first, you will likely see and feel better results.
There are so many reasons that pain or injury occur, it is impossible to talk about them all in one article. However if you understand that pain is a signal of something, you are far ahead of the game. Pain is a way for our bodies to protect us and tell us something is wrong. It does not have to be your job to understand what is going wrong, there are health care providers that can help you determine that, and more importantly set goals to help you change it!
This is one of the many reasons physical therapy has evolved into an important and autonomous profession. Now you can see a physical therapist without a prescription. Physical therapists can be part of the medical team to help you understand the “why” behind what is going on. They also assist you in goal setting, and changing movement or deficits, so you can return to your activity as soon as possible – and as safe as possible. I always encourage you to seek understanding and ask WHY!
Alison Synakowski (firstname.lastname@example.org) is a doctor of physical therapy. She is an orthopedic clinical specialist and a certified athletic trainer. At Sports Physical Therapy of NY, in Saratoga Springs, she and her colleagues specialize in the treatment and education of orthopedic injuries.