What Can We Learn From Injury? Will I Ever Learn?
Time out due to pain or injury is rarely a welcome occurrence. Whether it be an athlete missing time from their sport, a runner not being able to run or anyone missing out on a routine competitive or recreational activity; it is frustrating and they are keen to get back as soon as possible. When an injury occurs some people want to ‘fix it’ or rehabilitate it and not look back. In every injury there is opportunity for learning. A client recently remarked ‘Will I ever learn?’ in response to an injury setback. There are a few basic questions to ask that our learnings underpin.
What It Is?
Knowing the injury and what it is, is the first step to understanding why. What tissue is injured, or; is it not an injured tissue at all because pain is complex and not always as simple as pain being a result of tissue damage. Understanding different types of pathology, what a bone stress injury is (stress reaction or fracture), tendinopathy, strain or sprain. These all have distinctive features that impact why it happened, how to prevent recurrence and what rehab needs to look like. Getting a good diagnosis and explanation about this is key, followed by additional information from a trusted source to build upon this. Knowing what the injury is can help you gain greater control over it and the rehabilitation process ahead (Flint 1998). This may in term help compliance and coping skills (Arniven-Barrow et al 2007).
Why did it happen?
The why can be very straightforward, a complete mystery or somewhere in between. It is imperative to not assume that every injury just happens without doing a reflection or dive into potential contributing factors. Below is a useful diagram to help unpack a complex interaction of factors that can lead to pain or injury. At its simplest, why many injuries occur is due to a greater load that can be tolerated over a period of time. There are many factors that influence load on the body and many factors that influence our ability to handle it. For example, the most significant variables for a runner may be restrictive eating habits and recent illness, combined with building volume. Reflecting on the ‘why’ early after diagnosis is an important step in avoiding future errors, as it’s difficult to recall months down the track and too easily forgotten. The first step in making changes to address the why is to identify what went wrong (and importantly what didn’t go wrong). It is important to note that although loads may not change our ability to handle them can decrease, as an example this may be due to reduced sleep and/or stressful life events.
What does good rehabilitation look like?
The primary aim of rehabilitation is to return the injury to their chosen sport or activity at a preinjury physical and emotional level, whilst also doing the upmost to prevent reinjury (Dhillon et al, 2015). It is important to have the end goal in mind and planned steps and progression to work towards the demands of the sport. Understanding the load demands and the speed demands of given sports on the tissues. A gradual progression of exercises that respects tissue healing times and targets the key tissues and movement patterns. In addition to injury-specific rehabilitation, it is important to address any risk factors identified above. Another issue of note is the prevention of overall deconditioning, which has to be factored in when designing the rehabilitation protocol.
A common poorly executed part of rehabilitation is the transition back to sport and sport specific exercises and drills. Many underestimate the time and effort level to make a full recovery. It is common for many people to feel ‘ready’ well before they are physically capable of returning to sport, full training or competition. It is important to discuss with your treating professional how long your injury should take and what markers are useful to determine readiness to return to sport.
What do I need to do to reduce the risk of subsequent injury?
Soft tissue injuries are one such area where there is increased risk of re-injury and /or subsequent injury. The new data on professional players presented here confirm that injured athletes, irrespective of their level of play, can sustain both new injuries and the same injury again and that either type of injury can be dependent upon earlier index injuries. Taken together, these data suggest that related injuries account for 1 in 8 injuries overall and about one third of all subsequent injuries (Tohey et al, 2017)). The answer to this question lies in understanding any errors that led to onset of initial injury, a gradual return to pre-competition level and in depth rehabilitation.
What other skills or weaknesses can I work whilst Injured?
An injury can present a unique opportunity to devote extra time and effort to build upon skills, weaknesses or even strengths that do not usually receive the same attention in a normal training block. For example a triathlete may be able to devote extra time to swim technique or cycling fitness if they need to cease running. A field based athlete that has a lower limb injury can devote extra time to game tactics, on field positioning, technical upper body skills (passing, catching, trapping) and or upper body physical characteristics important to their sport. Not only can you work on perceived weaknesses but also for some an opportunity to build on strengths. For example an AFL player with a significant calf strain, may have great fitness but lacks overhead marking ability; he or she can devote time from kicking based skills and drills to handpassing and overhead marking, whilst swapping out one form of cardio for another (running or riding or swimming). This helps continue their strength (fitness) and build on a weakness.
Injury can provide a gratitude for one’s health and being able to complete sport and exercise that is rarely truly understood and appreciated until it is taken away. It can provide a unique opportunity for reflection and appreciation for when you are at full health again.
Will I Ever Learn?
Everyone makes mistakes. Mistakes sometimes lead to injury. Sometimes injuries will happen without any mistakes. Learning from one’s mistakes can only be done by knowing the mistakes from the questions we ask (what, how, why). Answering the questions above will help us better understand any mistakes that were made and give us the opportunity to learn from them. Albert Einstein said, “Insanity is doing the same thing, over and over again, but expecting different results.” If we understand the result (injury) and we understand what we did to achieve it, then let’s hope we can remain sane and uninjured.
Lewis Craig (APAM)
Masters of Physiotherapy
Featured in the Top 50 Physical Therapy Blog