If you are like me, you want to avoid injury. And if you do get injured, you want the best, fastest, most complete recovery possible. After all, the financial, time and life costs of not getting better can be immense, affecting adversely every aspect of your life – your physical and mental health, your relationships, your work, your home life, everything.
But what if you had to know just 5 critical pieces of information to get better? Recovering from injury would be such a mystery. Suddenly, getting better may become less costly, less time consuming and less frustrating.
These 5 critical pieces of information form the basis upon which we, physiotherapists decide the treatment strategies which are most likely to give you the best, fastest healthcare outcomes.
These pieces of information are the sign-posts which direct what treatment modalities and techniques we use, when we use them and how we use them, to ensure that you experience the best results.
If followed, these secrets virtually ensure that you will get better no matter what. To find out what they are, please read on.
Secret Number 1 Where Is Your Pain or Physical Problem?
I say pain because this is almost always these reasons why people attend for healthcare. They have a pain which stops them from doing something that they love to do.
However, your physical problem might also be one of weakness, stiffness, tightness, clicking, grating or the feeling of instability. All of these signs and symptoms are legitimate reasons to seek professional treatment, especially if they are not going away and/or are worsening.
Where you have your problem is a key question because it enables you to hypothesize as to what tissues and structures might be the possible source(s) of your pain. In other words, answering the where question helps you to answer the what question.
Asking the Where question also helps you to explore other possible associated pain or problem areas.
Do you have some discomfort in your neck or back even though your main concern is pain radiating down your arm or leg?
Is there a relationship between signs and symptoms in what seem to be unrelated areas of your body? To read more on this, please click The surprising cause of your pain.
Secret Number 2 How Did Your Pain or Physical Problem Start?
Or did your signs and symptoms come on for no apparent reason? You may have a vague idea of when, but you can’t remember exactly how your signs and symptoms started.
If you suffered a trauma, where there was some kind of external force that caused your injury, then almost always it is a good idea to have an x-ray or scan to check the extent of the damage. This is because it is really difficult to quantify the forces involved. What might seem to be the most minor force can cause extensive damage.
If there was a specific activity or movement that caused your injury, this gives an indication as to the amount and direction of forces that were involved, the structures or tissues that might be injured and the extent to which they might be damaged.
The direction of injuring force is also important as this indicates what further forces are likely to re-injure that structure or assist in healing.
It is often difficult to identify the causes of pain because often it is not so much what you do which is the culprit, but how you do it. How you stand. How you sit. How you get out of a chair. How you walk. How you do anything, is unique to you.
Your brain and your body then adapt to these repeated postures and movement patterns. Nerve pathways are reinforced. Muscles that are used more to get stronger. Joints that are moved more, get more mobile. Joints that are used less get stiffer. And all these bodies changes not only perpetuate your physical habits, they actually make them stronger and more likely to happen again.
Doing a slightly faulty automatic posture or movement occasionally might not cause any issues. But doing them daily, weekly, monthly, yearly, will eventually cause you a physical problem, guaranteed.
Ultimately, how your signs and symptoms have come on hints at whether your problem is mechanical, inflammatory or insidious. In other words, is your problem generated from your interaction with the external forces of the world or are they generated internally?
Is, in fact, your brain, nervous system, immune system and/or other body processes generating the pain as in the case of Rheumatoid Arthritis, Osteoporosis or Cancer? Yes, physios do screen for cancer.
Secret Number 3 When Did Your Pain or Physical Problem Start?
If knowing where your pain is gives clues as to what structures might be the source of your problem and how your injury started gives clues as to the cause of your injury, then knowing when your injury started can give clues as your injuries current phase of healing as well as the amount of repair that may have already taken place.
- Bleeding Phase: 6 to 8 hours and up to 24 hours or beyond
- Inflammatory Phase: The first day or two post-injury through to its peak at 2-3 weeks and decreases thereafter through to a matter of several months post-trauma.
- Remodeling or Maturation Phase: Recent evidence indicates that the remodeling phase may start at around 1-2 weeks and may last up to 2 years.
- The type of tissue involved (muscle faster than ligament faster than tendon)
- The injury severity (Grade 1 faster than Grade 3 injuries)
- Your age (younger = generally faster healing)
- Your general health (e.g. diabetes results in compromised healing)
- Your nutritional status (e.g. inadequate protein intake)
- Your stress levels (greater stress = slower healing)
- The medication you take (anti-inflammatories delay healing)
- Whether you smoke (smoking impedes healing)
Knowing the phase of healing and the healing rate of the different types of tissue also directs the type of intervention that needs to be given to achieve optimal healing.
During the inflammatory phase, gentle movement in elevation may be indicated to facilitate waste product removal and facilitate the delivery of oxygen and nutrients to the repair
Secret Number 4 What is the Behaviour and Irritability of Your Physical Problem?
Physiotherapists also want to know if your pain or problem is getting better, same or worse.
As your body’s natural state is to heal, if your problem is not getting better, we need to find out why.
Are you re-aggravating (re-injuring) your problem?
Is inflammation breaking down the healing tissue and if so why?
Are any of the above factors impeding your healing response?
What other factors might be acting as roadblocks to your healing and how can you remove them?
If your injury is worsening, you need to see a health professional immediately to have it assessed and get remedial intervention.
Physiotherapists also use a concept called Irritability to determine how assertively techniques should be applied to achieve the best and most long-lasting effect from each treatment.
This concept refers to the amount of pain caused (on a 1 to 10 scale, 0/10 = no pain, 10/10 being the worst pain you could imagine), and how long it lasts with regard to the intensity and duration of the force that caused the response in the first place.
For example, if you gardened for 8 hours and following experienced 15 minutes of back discomfort at a pain level of 2/10, we would say that your injury is not irritable. This would be an indicator that more assertive treatment is unlikely to lead to a flare-up.
However, if you bent over to pull up a weed and then experienced 10/10 pain which lasted for two days, this would indicate that your condition is highly irritable and as therapists, we would need to be very careful and gentle in-out treatment intervention.
Secret Number 5 What Postures, Movements or Activities Aggravate Your Pain?
Along with knowing how your pain or problem started, knowing the factors that aggravate and ease your pain tends to indicate why your condition started and the direction of the force that will both help and or hurt you. Obviously, you want to do more of what helps and avoid what hurts your injury to enable your condition to heal.
Applying too much force too soon (including exercising too hard) will re-injure your injury.
Judging when and how much force to apply to optimize tissue repair takes great knowledge, experience, and skill. Even then, it is easy to get wrong.
What you need to know is that at 1 month of healing, the tensile strength of collagen is around 40% of its original pre-injury strength and at 1 year it reaches 70%. The absence of pain is, therefore, no indication that your injury is 100% better. It can take years.
Knowing where your pain or problem gives clues as to what the possible sources of your pain or problem.
Knowing how your problem started gives clues at why your pain or problem has started.
Knowing when your problem started gives clues as to how long it may take for your injury to get better.
Please note that whilst this information gives the principles of treatment, it is general in nature and does not address your personal, unique circumstances. If you do have any questions or concerns, please seek individual advice and get be assessed and examined by a qualified health professional.
At Bodywise Health, we have treated over 14,000 people and delivered over 100,000 treatments over 21 years. We would be delighted to help you overcome any pain or physical problem that may be holding you back from getting the most out of life.
Wishing you the best of health and life.
For more information on how Bodywise Health can help you to overcome your pain, please call Bodywise Health on 1 300 BODYWISE (263 994).
- Rebates are available through your private insurance extras cover
- For complex or chronic conditions, you may qualify for the CDM (Chronic Disease Management) allowing you to receive 5 allied health services each calendar year with a referral from your GP. For more information, please call Bodywise Health now on1 300 BODYWISE (263 994).