Author: Dennis Meszler, MPT, SCS
We deal with many athletes looking to get back to sport as soon as possible. When most athletes hear the doctor say it is going to be 6-9 months before you get back on the field they immediately think, “I’m going to be the 6-month person!” Many probably even say to themselves, “well, if everyone else does it in 6 months I’m going to do it in 5.” Some people may be blessed enough and have the luck to have all the outside influences line up right for them so that it happens that way but they are in the minority for sure. Most people will not make that early, safe return. And that is ok. It doesn’t mean they didn’t do all they could or didn’t try hard enough. Most of the time it just takes time to do it properly. The last thing we or the client wants is to rush back and have something catastrophic happen that takes the right back out of the game. Whether that is re-injury to the same joint we were working on, or some other joint breaking down because they were compensating and not trained enough to tolerate getting back to the forces of their sport.
Understanding how to interpret what your body is telling you after doing exercise is an important part of allowing your recovery to proceed as safely, efficiently and quickly as possible. I’ve had the pleasure of working with a couple of clients recently that came to us from situations where they started their rehab with other clinics. They were towards the longer end of their expected rehab time but were both still having significant pain and thus significantly limited functional abilities. After evaluation and discussion regarding their situations both of them had the “type A” athlete mentality I mention above. They were going to make it happen as quickly as possible no matter what.
With that drive pushing them they frequently pushed through some inappropriate pain and by doing so they reinforced it and made it worse to the point where they couldn’t even jog 8-9 months after their surgeries whereas it would be typical to jog 3-4 months after the procedures they had. In order to get things under control we had to step way back in activity levels and really talk about how to understand proper progression in the face of some stress to the healing joint. Thankfully after readjusting their mindset in regards to the stresses they were feeling around the rehab and exercise activity they both are doing much better and nearly ready to be cleared to play.
Most of the shift had to do with understanding the concept that more is always better. When we are talking to about healing joints and building up muscle strength after surgeries it is imperative to react to symptoms appropriately. I use a fairly simple rule to help guide out decisions regarding what to do next following a workout session: the 24-hour rule.
If you complete a workout and the joint reacts adversely we know we have stressed it beyond what it is capable of handling. “Adversely” means either joint pain or swelling. This has nothing to do with normal muscle soreness from working out. If someone experiences normal delayed onset muscle soreness but the joint is fine then we are in a good place. Keep going. If the joint is painful or swollen then we want to see how quickly it recovers. If it gets back to normal within 24 hours then I typically stay at about the same level of stress for the next workout. If it takes more than 24 hours to recover then we probably did a bit too much with the last workout. I make sure enough time passed to actually let the joint calm down and then pull back on the next workout. When we do a workout and the joint doesn’t show any adverse reactions then we move forward with the next workout.
Simply understanding and utilizing that concept helped both of these clients control their pain and allow a more normal progression of training activity. Prior to really being educated about this and guided to implement it into their decision making they were both “biting the bullet” so to speak and just pushing through pain in order to complete the next workout. That is, until they couldn’t complete the next workout anymore because the pain had gotten so bad.
More isn’t always better!