The following blog covers a number of considerations around what you can do to maximise your recovery from your injury or pain. The key areas of discussion include education and understanding of your injury, adhering to your recovery plan, nutritional considerations following injury, and sleep/stress factors that can influence recovery.
GET EDUCATED & understand your injury [Education]:
Taking ownership of your recovery and understanding your injury has multiple benefits, including establishing a plan of action, reducing your fear and anxiety around the injury, along with dispelling myths and mis-information.
Education about your injury is a cornerstone of management, and has been shown to improve outcomes even when treatment or rehabilitation hasn’t been implemented (Barton et al., 2018; Bleichert et al., 2017; Clarke et al., 2011; Esculier et al., 2018; Louw et al., 2011; Malliaras et al., 2015; McNeely et al., 2003; O'Sullivan et al., 2017; Sgroi & Cilenti, 2018; Sleney et al., 2014; Tenforde et al., 2016).
Aim to understand the following components regarding your injury. If your physiotherapist hasn’t detailed information around the following areas, it may be relevant to ask further questions to assist your knowledge and recovery.
About: establish a good understand about your injury (Sleney et al., 2014).
Expectations: what are the expectations on YOU to ensure you maximise your recovery (e.g. rehabilitation, progressive running plan etc). Establishing an understanding of these expectations is important to recovery success (Bleichert et al., 2017; Malliaras et al., 2015; Sgroi & Cilenti, 2018; Sleney et al., 2014).
Plan: ensure you have a plan. This might be for the short term, of have multiple phases over the longer term.
Rehab Timelines: rehabilitation and recovery timeframes vary depending on your injury (e.g. grade 1 ankle sprain versus ACL injury). Establishing understanding of your recovery timelime will assist you in planning mentally and physically (Sleney et al., 2014). Typically, building strength and muscle can take 6-10 weeks (or longer) (Fisher et al., 2013; Newton et al., 2002; Schoenfeld et al., 2015; Schoenfeld et al., 2016), therefore injuries which need to build this capacity may need extended timeframes.
Pain: pain is a complex process with many factors capable of influencing our pain levels and resolution. Some injuries require minimal or no pain during recovery, whilst other injuries it is beneficial to your recovery to work through a mild-moderate amount of pain (Malliaras et al., 2015). Establish an understanding of what pain thresholds are appropriate for your injury, as this can improve and speed up recovery. Additionally, understanding about how pain works is important for recovery, especially of injuries which have persisted for some time (Clarke et al., 2011). The following Youtube video is an excellent simplified resource explaining pain, especially pain that has persisted. https://www.youtube.com/watch?v=C_3phB93rvI.
Educate Your Support Network: getting the whole supporting team on the same page regarding your injury can assist your recovery. This could include parents, partners, coaches, other health professionals or teammates. (McNeely et al., 2003; O'Sullivan et al., 2017; Sleney et al., 2014; Tenforde et al., 2016).
Quality of online information sources:
A quick side note around online educational information. Evidence suggests a large number of individuals source online educational information regarding their pain and injuries (Sillence et al., 2007). The increasing boom in online healthcare resources and social media channels (my own included - @kywynnephysio) has many positives, including the dissemination of evidence-based education and resources (Adams, 2010; Ahmed et al., 2015; Merolli et al., 2019). However, medical professionals may not always author online information sources (Adams, 2010; Eastin, 2001), with varying in their quality of the education (Sillence et al., 2007), and mis-information often present (Hors-Fraile et al., 2016).
A few tips to ensure high-quality of online healthcare educational information include:
- get your advice from a qualified healthcare professional (e.g. a physio on social media/website, NOT from an influencer telling you how they fixed a problem),
- be wary of people selling a product as their main objective,
- and also have caution when people try to say that something will work for everyone (e.g. this exercise fixed my knee so it’s appropriate for you and all knees).
ADHERENCE TO YOUR PROGRAM:
Sticking to your rehab program represents one of the best ways to achieve a timely and high-quality recovery. However, everyone gets busy at times or loses motivation and doesn’t complete enough of their exercises or recovery plan. It can be important to address barriers to adherence due to poorer outcomes if the rehabilitation is not completed (Jack et al., 2010). Additionally, the principle of “reversibility” dictates that if you cease of stop completing a training stimulus, you will regress or lose that adaptation, with this relevant when aiming to adhere to rehab programs (DeWeese et al., 2015).
There are numerous factors causing individuals to drop out of exercise programs, include a lack of time, failure to achieve the goal, a lack of improvement, motivation (or lack of), difficulty with performing exercises and technique, fear of injury, lack of interest, fatigue, work schedules, and more (Jack et al., 2010; Picorelli et al., 2014; Phillips et al., 2004). Factors such as poorer mental health, low social support, high number of perceived barries, and pain during exercise are associated with poorer adherence to exercise programmes (Jack et al., 2010).
How can adherence be improved?
The recommendation is to identify the potential barriers which may impact on your ability to complete the program as desired. This may affect your goal achievement (Jack et al., 2010). Utilize strategies such as setting realistic expectations, settings short and long term goals, ensuring social support (consider group-based exercise), and having a health professional overseeing the program (e.g. physio, personal trainer etc) (Wilson et al., 2009; Jack et al., 2010). Furthermore, it is recommended to choose a type of exercise that you have enjoyment or preference for, as this will increase adherence (Thompson & Wankel, 1980). If you are an exercise or health professional, work with your patients to help them set goals, and identify any potential barriers which may impair their ability to successfully achieve their goals (Jack et al., 2010).
Read more on goal setting, factors that influence adherence to exercises, and training load management here: https://www.kywynne.com/post/new-years-resolutions-that-work.
DIET & NUTRITION:
I have previously written an in-depth article around the importance of nutritional considerations after an injury, and during injury recovery. The key messages of this article are summarised below, including maximising protein intake, especially during immobilisation and rehabilitation phases. Other dietary considerations, including maintaining energy balance, and considering supplements, may be beneficial for you and your specific injury.
Read more here: https://www.kywynne.com/post/nutrition-for-injury-recovery.
SLEEP:
Sleep is recognised as one of the most important components of recovery, and has a large impact on athletic performance (Calleja-Gonzalez et al., 2016; Nédélec et al., 2015). The recommendation is that adults obtain 8 hours of sleep per night (Halson, 2014), as periods of sleep deprivation or poor-quality sleep can impact negatively on cognitive and physiological function (Charest & Grander, 2020).
Poor sleep:
Increases the difficulty of exercise (increased perceived exertion), risk of injuries, & impairs muscle repair and regeneration.
Negatively affects cognitive function & performance, with this especially relevant for alertness, decision making and reaction times in sport.
There are numerous other factors impacted, including immune system, increase inflammation, increased pain sensitivity, along with risks of mental health and chronic diseases.
(Calleja-González et al., 2019; Charest & Grander, 2020; Chennaoui et al., 2015; Fullagar et al., 2015; Halson et al., 2014; Milewski et al., 2014; Nédélec et al., 2015; Simpson et al., 2017).
Therefore, increased sleep can improve athletic performance (Charest & Grander, 2020; Lee et al., 2018; Mah et al., 2011).
For those interested, you can read more here: https://www.kywynne.com/post/the-impacts-of-poor-sleep.
STRESS & MENTAL HEALTH:
Stress, anxiety, and mental health concerns can often occur post-injury, or be exacerbated due to the impact of the injury psychologically (Putukian, 2016). The impact of stress and mental health can impact on your physical and psychological recovery from injury. This is often particularly relevant with injuries that have been around for a longer period of time, or when considering return to sport. Whilst this falls outside of the scope of my practice as a physiotherapist, there are some important factors to consider:
Control what you can control in your recovery, including sticking to your rehabilitation (see above) and learning about your injury and what is required for recovery (see above).
Maximise your sleep, as sleep deprivation has been shown to have adverse impacts on mental health (Charest & Grandner, 2020).
Early identification (either by yourself, or those supporting you) can assist with seeking assistance and improving recovery (Sleney et al., 2014).
Mental health should be managed my professionals, including psychologists in a multidisciplinary team (Reardon et al., 2019).
Addressing mental health can aid recovery and performance (Reardon et al., 2019)
Want to read more about the impact on stress on injury recovery? https://www.kywynne.com/post/does-stress-affect-injury-recovery
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