Introduction to injuries

When a client comes in with an injury, it’s like having a puzzle without knowing what it will make and guessing what image it will create; The pieces have to be organised to see the entire picture.

The following need to be organised:

1. Details and factors behind the mechanics of the injury.

2. A professional perspective on how the person injured uses their body regularly.

3. Insight from your professional experience and education

Sometimes you can guess earlier than other times what the end picture is. Once obtained, you know what their road to recovery looks like.

Myself, sometimes it takes me 20 minutes into the massage to be able to give specific advice on an injury. It often comes after my hands are on their body for a bit. Feeling how their body moves, how the layers of tissue feel, and how their body interacts with itself.

When it comes to the consultation at the start, I understand I won’t be able to uncover everything but I have someplace to lead from. For example, it may have happened during sex so they will never tell me but the injury will often relate to many other things. So I try to get as many of the other pieces of the puzzle as possible.

This is how I look for those pieces and the details/factors I consider:

1. “What are you looking to get out of today’s session?”

   This gets the ball rolling and I get to know their goal.

2. When and how did they notice the pain?

   This tells me a few factors, their relationship with pain, how they understand their body’s ability to do things and it starts outlining the mechanical factors and stresses of the injury.

3. How severe was it and did it interfere to a large degree immediately after they cooled down, or the next day?

   Here I’m looking for whether it’s muscle, tendon, ligament, something else or something more complex. Muscle is usually after the cool down or the next day. Tendons and ligaments are usually right away. If there are multiple factors, it could be something complex (such as a secondary injury)

4. How do they describe the pain, when it happened, the day/s after, how it is now, and when they notice it?

   I am uncovering more details and allowing them to vent like it’s therapy.

5. What are the mechanics of the event/s that caused the injury?

   There are 2 things here. The first is what they need to be mindful of during the injury and recovery stage and
   the second thing is generally, uncovering more pieces of the puzzle.

   This has to get done. Sometimes it’s a lead-up of events that causes it. One example for a client, who had a weekend of bad sleep, worked out hard on Monday, felt something a little funny in the shoulders at the gym, 2 days woke up with neck pain. This information tells me to look at the structures involved with the gym work as that could have been an injury that wasn’t major but led to a secondary injury. Or the gym work was a minor injury but the primary injury is the neck.

6. How long has it been since the initial event?

   I learn how they are coping and how I play into their recovery goals.

Knowing what questions to ask will determine how fast all the information is communicated.

Phases of Injury and recovery

The 3 Injury Phases are something I learnt from Paul Massey’s 2004 book “Sports Pilates”. I used it as a model to overcome many of my injuries. The final phase I’ve listed is to address more chronic and complex conditions.

Biomechanical response to injury.

Acute Phase Hour 0-72.

The body tries to make you stop using the affected area, and quickly patches it up so it doesn’t fall apart on its own.

If you can’t stop, say are in the middle of the competition. Take the pressure away from it by using it less. If you can put ice or compression on it asap, use that opportunity to assess what happened. Rest until you’re comfortable to jump back in as you don’t want your body to cool down if you still need to compete.

Sub-acute Phase Week 1-6.

Use pain as your indicator, and keep as much stress/weight away from the area as possible and support it with compression/bandages in training and throughout your day.

Training pain-free ROM is fine, according to Paul Massey. Personally, I have seen it beneficial to combine that with low-level proprioception work and visualisation. Never train through pain.

Remodelling Phase Week 3-14.

Depending on the injury and if the healing has been facilitated or if it has been agitated, this stage will start sooner rather than later.

If you’ve played your cards right with the other phase, here strength and ability gradually return/rebuild naturally without much need for a push. Depending on the tissues that are damaged there may be very little endurance or the endurance seem to be there with a remarkably longer recovery combined with a lack of strength.

Using the area must be done with caution, at this point it’s common for athletes to return to training but having it modified to still keep the stress away from the area, and using compression, occasionally testing the functionality to see what stage it’s at.