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5 Secrets to Overcoming Your Injury

 
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 wouldn’t 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 reason 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 hypothesise 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?
 
It is really important to know how your signs and symptoms have started.  
 
Was there a trauma where you hit or were hit by something such as in a car accident or in a fall to the ground?
 
Was it a specific movement or activity that you felt something “go” such as when you swung a golf club or got out of the car?  
 
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. 
 
When your injury is examined, these structures are then stress tested to determine if they are indeed damaged and by how much.  
 
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.  
 
If you can’t remember when or how your signs and symptoms came on, then we need to do some “detective work”.  
 
Generally, signs and symptoms that start for no apparent reason indicate that there may be something “wrong” in the way that you are living that is the cause of your physical problem.  
 
It is often difficult to identify the causes of a 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 adapts to these repeated postures and movement patterns. Nerve pathways are reinforced. Muscles that are used more get stronger. Joints that are moved more, get more mobile. Joints that are used less get stiffer. And all these body 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 injury’s current phase of healing as well as the amount of repair that may have already taken place. 
 
For example, whilst there is some overlap and variability as to the different phases of healing, a general timeline might be:
  1. Bleeding Phase: 6 to 8 hours and up to 24 hours or beyond
  2. 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.
  3. Remodelling or Maturation Phase: Recent evidence indicates that the remodelling phase may start at around 1-2 weeks and may last up to 2 years.
 
Factors that affect your healing rate include:
  1. The type of tissue involved (muscle faster than ligament faster than tendon)
  2. The injury severity (Grade 1 faster than Grade 3 injuries)
  3. Your age (younger = generally faster healing)
  4. Your general health (e.g. diabetes results in compromised healing)
  5. Your nutritional status (e.g. inadequate protein intake)
  6. Your stress levels (greater stress = slower healing)
  7. The medication you take (anti-inflammatories delay healing)
  8. 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 need to be given to achieve optimal healing.  
 
For example, during the bleeding phase, Rest, Ice, Compression and Elevation is indicated to limit bleeding and excessive swelling.
 
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 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 optimise 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.
 
Knowing the behaviour and irritability of your problem gives clues as to what and how much intervention can be applied.
 
Knowing what factors aggravate or ease your pain, gives clues at the direction of forces that need to applied to facilitate healing and prevent re-injury.  
 
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.
 
For a complimentary assessment, advice and a personalised strategic treatment plan to get you better, please call 1 300 BODYWISE (263 994). 
 
Wishing you the best of health and life.
 
Michael Hall
Director, Principal Physiotherapist
Bodywise Health
 
For more information on how Bodywise Health can help you to overcome your pain, please call Bodywise Health on 1 300 BODYWISE (263 994).
 
Please note:
  • 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 on 1 300 BODYWISE (263 994).
 
References available on request

 

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Why You Need More than a Diagnosis To Get Better

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It has been said that “Treatment without diagnosis is malpractice”.

And it is true that in todays’ practice of modern healthcare, diagnosis provides the over-riding foundation which directs both the type, amount and sequencing of treatment interventions.

Our obsession with diagnosis is evidenced by the explosion of diagnostic tests that are performed every year.

However, not only can the increase in CT and X-ray scans pose a health risk, they can be misleading. Consequently the surge in CT and MRI scans has failed to boost diagnostic rates.

And yet, even if CT, MRI and ultrasound scans did increase the accuracy of your diagnosis, this may not be enough to improve treatment outcomes.

The reason is because while x-rays and scans might tell you what the source of your problem, they do not tell you the cause. In other words, they give you the what, but not the why.

And although it is important to know which structure or tissue is the origin of your pain or problem, it is perhaps more important to know why. Because unless the cause of your ailment is corrected, your problem will always return even if you replace the injured body part.

I spoke about this phenomenon in my blog The Surprising Cause of Pain. In modern healthcare, we strive to name your diagnosis. That by putting a label on your condition, we can somehow better encapsulate, understand and manage your ailment. However, in so doing, we risk becoming blinkered to other possible sources, causes and implications of your injury.

Being given a diagnosis often gives the impression that it is just one tissue, one structure or one body part that is at fault, when in reality, it is often many tissues, structures and body parts that contribute to the cause of your physical problem.

A case in point is osteoarthritis. Osteoarthritis refers to inflammation and the subsequent breakdown of the surface covering of the bone ends at joints. What perhaps is not so well known is that along with this, the underlying bone begins to breakdown.

Bony projections (called osteophytes) form at the joint margins.

The membrane lining the inner part of the joint (synovial membrane) becomes inflamed and swollen causing excessive fluid to be secreted.

Joints become red and swollen.

The capsule and ligaments that hold joints together may become lax.

Muscles either spasm or become flaccid causing muscle imbalance and joint mal-alignment.

Nerves become hypersensitive and restricted.

Connective tissue (fascia) becomes taut and fibrotic.

Blood flow may be compromised.

The surrounding environment may become acidic.

Even your brain can become stressed, sensitized, reactive and magnifier of your pain.

And so the cycle of chronic pain begins and is perpetuated.

And this is not even to mention the incorrect motion in other parts of the body which may have led to the abnormal or excessive forces that caused the osteoarthritis in the first place.

The same goes for any injury whether it be a muscle strain, a joint sprain, disc injury, tendinopathy, bursitis or other condition.

I had a classic case of this a couple of weeks ago. Ann was suffering with intense inside right knee pain that came on “for no apparent reason” a couple of weeks before. So painful was Ann’s knee that I had to see her at home because she was unable to put weight on her right leg to walk.

Ann reported that she had had an MRI which revealed a burst Baker’s cyst (fluid filled sack behind the knee). This finding didn’t match Ann’s knee pain as a burst cyst would generally lead to pain, tightness and swelling behind the knee and Ann’s pain was on the inside just below the knee joint.

On examination, Ann’s right knee was indeed red, swollen and exquisitely tender on the inside of the knee just below the joint line. This corresponded to a different inflamed bursa (fluid filled sack called the Pes Anserine Bursa).

After applying cold packs and teaching Ann how to use crutches so that she didn’t weight bear on her right leg, Ann left to have another MRI for confirmation. This MRI revealed that she had a torn inside cartilage and this was the diagnosis that was given to Ann as a cause of her pain.

So Ann then underwent an arthroscope to “repair” this inside cartilage. To my surprise however, Ann returned to me two weeks later. Despite having an arthroscope, Ann’s pain hadn’t changed. In effect, the arthroscope may have corrected a condition, but this condition wasn’t the source of Ann’s pain.

On retrospect, I shouldn’t have been surprised, as again the MRI didn’t match Ann’s signs and symptoms; that of redness, swelling and intense pain just below the joint line on the inside of Ann’s knee over the area of this bursa.

Furthermore, on close questioning, it became clear that Ann’s knee pain was being caused by the way that she was sitting. So Ann was put on intense program to treat the inflamed joint tissues (synovium), fascia (connective tissue) nerves, muscles and bone surfaces. Ann was also shown how to sit and walk without aggravating her knee.

Two weeks later Ann left for overseas with minimal pain.

For the best, fastest, most complete recovery, it is essential that all the implications, complications and contributions to your ailment are adequately addressed, treated and resolved.

This is referred to as the Bio-Psycho-Social Model of Healthcare. It refers to the fact that the best outcomes will be achieved only when all the Biological, Psychological and Social factors have been taken into account and solved.

For optimal healing and recovery you must treat the muscle, the joint, the connective tissue and the nervous system.

You must correct the biomechanics, posture and movement patterns.

You must optimise the psychological and social environment to enhance recovery.

Yes, a diagnosis is important. But even more important is that the “diagnosis” given from an investigation such as an x-ray or scan is confirmed by a comprehensive assessment and professional clinical examination.

It is then critical, that all the information gained is used to devise a treatment strategy or Recovery Action Plan that treats and corrects both the source and cause of your problem.

This is the only way to achieve the best, fastest, most complete recovery possible.

If you would like any help with any aspect of Getting Better, Staying Better and Living Better, please don’t hesitate to call us here at Bodywise Health on 1 300 BODYWISE (263 994).

We would love to help you get back to living freely and without pain.

Wishing you the best of health and life.

Michael Hall
Physiotherapist
Director, Bodywise Health


For more information on how Bodywise Health can help you to overcome your pain, please call Bodywise Health on 1 300 BODYWISE (263 994).

Please note:
· Rebates are available through your private insurance extras cover;
· For complex or chronic conditions, you may qualify for the EPC (Enhanced Primary Care Program) 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 on 1 300 BODYWISE (263 994).

References available on request

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Victoria. Australia 3188

03 9533 4257

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