Any active person has had it happen. You are doing whatever activity you enjoy and suddenly feel a bit of a pull, cramp, sharp pain or something not quite right. Hopefully you’re smart enough to stop what you are doing and not push through the pain to complete whatever you are doing, but maybe not.
Then the inflammatory feeling starts kicking in. Your tissue will feel full, there may be lingering low level pain or sometimes acute high level pain when you move. Sometimes you can’t move without your body telling you not to through a jolt of pain. Often this is a bit indicator of the severity of whatever injury has happened.
So you realize that this is beyond a simple pull, mild strain or simple fatigue. You’ve done something that may require intervention and some sort of attention. You’ve injured yourself.
First things first: if you have acute high level pain and can’t move a limb or joint please GO TO A HOSPITAL. You will wait a while because musculo-skeletal injuries aren’t triaged as a priority but at least you will likely get some imaging immediately. There may also be things going on underneath the surface you have no idea about so better safe than sorry.
If that’s not the case, what is your next step. Well, there is a simple routine that you should follow, and it can be done in this order:
This is what you do immediately. The biggest thing to do with any injury is STOP MOVING IT. Don’t stretch it right away, don’t think that you can “push through the pain”. You will make things worse. Stop what you’re doing. Your body is very intelligent and is already doing what it needs to in order to start fixing things. Give it a chance and don’t make things worse.
Don’t ignore pain. Pain is a signal saying “QUIT IT”. Your body is literally telling you to stop what you’re doing just like taking your hand off a hot stove. Once you have stopped moving, the next step is…
Some questions to ask yourself:
- Is the pain acute with movement or does it come and go, for example it stiffens up during sleep or is painful at different times of day?
- Is my strength compromised for certain movements, ie can I not pick something up, reach over my head or extend my leg without a problem?
- Is there soft tissue damage? Swelling is one thing, but bruising typically means a much more severe trauma that requires attention faster.
The more you have information, the easier the next step will be because you can figure out which practitioner to see first and not waste your time. Have a soft tissue problem? Massage might be best? A serious joint issue? Maybe an osteopath or chiropractor (more on this later in the article). Arming yourself with answers and figuring things out on your own can be valuable in not wasting your time. That leads us to…
This does NOT mean going to someone like me and asking them what it is, because I have no authority to diagnose anything even with my years of experience. What is does mean is going to someone with the words Doctor in front of their name and ideally getting some testing and/or imaging. I always tell my clients to push for imaging because ultrasound and x-ray can reveal things simple testing cannot. If MRIs were more easily accessible that would be my default for many things. For those of you in Canada, remember that some provinces (ie Quebec for those of us in Ottawa) do allow paid MRI’s – you just have to pay for it.
As much as I appreciate the access to General Practitioners or walk in clinics, regular MD’s have little to no experience with bone and joint injuries and often will suggest exactly what I just said anyway, so don’t waste your time. And if a GP does give you a “maybe it’s this” diagnosis please get it confirmed by someone with experience and ideally imaging as I said.
Be proactive – once you have a diagnosis, learn everything about it that you can. It will not only educate you on what the injury is, hopefully it will make you realize WHY it happened and how to prevent it in the future. Often during my initial consultation I have found that clients have never had their injury properly explained to them by anyone and have no idea what happened to them and why. Knowing the why is very important for any recovery model. And that allows me to discuss…
After you have a diagnosis, depending where you get it the first suggestion is always physiotherapy. It’s covered under benefits, didn’t you know? The only problem is that there are lots of other ways to treat an injury and in my experience physio yields the worst results overall for my clients and others I have spoken to. If I was going to suggest the order you should look into things and why, here’s my list. Again, not to knock any practitioners – there are lots of good and bad ones out there – this is simply my experience in dealing with all of them frequently.
#1: Osteopath. These people frequently have had experience in another modality and decided to move into osteopathy. From an assessment and treatment perspective the results from these practitioners seems to be consistent, and they don’t ask to see patients frequently.
#2: Massage Therapist. With the disclaimer that this is for soft tissue injuries only, a good massage therapist can help with things like scar tissue, blood flow to improve tissue and relieving stiffness and immobility. This should be included with any recovery plan.
#3: Chiropractic – Again, with the disclaimer that this does NOT mean back cracking or neck cracking. A good chiropractor who knows other treatment protocols like ART or myofasical release, or even relieving nerve entrapment are usually your best bet.
The thing with chiropractors is that a lot of them are salespeople who try to lock you into long term treatment plans where you see them three times a week – please don’t fall for this and if it is suggested, find another practitioner. This generally doesn’t have any interest in your recovery, it has interest in your wallet and benefit plan. If you need to see a practitioner three times a week they need to justify it.
#4: Physiotherapy. Again, there are good physios out there. The problem is that in my experience they are few and far between. Look for someone who doesn’t use outdated methods, someone who will actually spend time with you individually (not hook you up to a machine and walk away or leave you with an assistant), and who will progress you session to session properly.
How long does it take for proper recovery? The general rule for serious soft tissue injuries is 6-12 weeks, more serious damage like tendons and ligaments can be up to 3-6 months. Anything requiring surgical intervention can be 6-12 months. This is not carved in stone, but it will give you some perspective in that you need to assume that this is a long term fix and not a temporary thing.
In my opinion surgery should always be a last resort. It is done when there is no other option for restoring tissue. Full tears, severe arthritis, and things like broken joints often carry this load and it is totally necessary. If you have the option, see how well you can get first without it and then see about surgery if all else fails. Realize that if you meet with a surgeon, they are going to likely push for an operation – that’s their job. You have options, consider them all wisely before making a decision that can affect your body for the rest of your life.
As a final note, the number one thing I see that causes injuries to recur is that the person rushed back into exercise and doesn’t do what they need to do to fully recover. This just makes things worse and more often than not will result in a worse injury down the road. Listen to your body and ease back into exercise. Sometimes my clients have to start off ridiculously easy and it drives them crazy, but it takes time for recovery and having a guided path is absolutely essential.
So you’re hurt – there are lots of options for you to pursue and the good news is an injury doesn’t have to be the end of the world. If I told you the laundry list of injuries I’ve had (including a disc herniation and multiple tears in various places) you would be surprised – but I can still move easily and lift heavy things without a problem. Be smart, apply things properly and keep moving forward.
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