Recently Ryan covered the topic of “There Are No Shortcuts” where he discussed the return to your activity. This week we are going to look at a similar theme and something we are asked quite a bit, edging more towards why having some pain when returning to playing sport or work still might be okay.
Here’s what people want to know:
- When can I return to sport or work?
- Is it okay to return to sport or work with pain?
For Physios and Exercise Physiologists, at times this answer can be difficult to predict. The questions can be more complex, and the answer depends on the individual and the nature of their problems, but it’s not quite as simple as a yes or no.
Recent advances in pain science and our understanding of pain has shown that not all pain is associated with tissue damage. Pain can, at times, be an over-protection mechanism. In this over-protection scenario pain is not a good outcome by itself to decide when return to sport or work is suitable. Other features such as strength, power, movement control, flexibility, confidence and overall capacity reserve will influence an individual’s ability to adapt and compensate for return to sport or work, with less focus on the pain. These features might be the difference between someone having an appropriate adaptive capacity to return to sport or work successfully or not with pain.
There are stages of an injury when body tissues should be protected while they heal. Muscle, joint, ligament, tendon, nerve and bone injuries all have slightly different healing time frames. Most evidence suggests that gradually moving during the healing process actually helps. For example, a muscle tear should be allowed 2-3 days offloading and then be gradually re-strengthened before progressive return to running/sport or work. Arguably the re-strengthening component being the most important component, not just returning to sport once the pain has gone.
Should My Focus Be on Being Pain Free?
Quite often after a muscle injury, people can be too focused on being pain-free and mistakenly assume that this is the most important factor in their progress. This is a common misconception we see regularly and results in more re-injuries and prolonged recovery. In the muscle injury example, having good strength in the injured muscle and good patterns of movement in the surrounding muscles or body segments are much more important than not having any pain.
Rest, and how much of it is also an important factor. Too much rest can be a problem when considering how quickly return to sport or work can be obtained. It can lead to more weakness and also less optimal tissue healing, definitely not better healing in most cases.
Tendinopathy and tendon pain are one condition where pain is not the only variable to consider. When pain is under control and good strength in the muscles around the still “sore” tendon, and the muscle attached to the tendon itself, it can be safe to return with pain. Your Physiotherapist or Exercise Physiologist should be able to identify and address any of these features which might result in extra strain to the “sore” tendon. The goal with this is to not only improve return to play success but performance in general.
For other types of conditions, pain can influence muscle activation patterns and alter joint stability. This might mean playing with pain in conditions involving instability may need more consideration to prevent further instability episodes and damage, than in other conditions.
Injection Therapy – AFL Players Do It, So Why Can’t I?
Another example of the pain gone and return to play example is with injection therapy.
“AFL players get them, feel better and play so why can’t I?”
Elite sport is very different from our everyday non-professional sport, or worker. These elite athletes are highly trained and often have a big reserve of strong tissue around their injured area and once the pain is modified, they rely on this backup capacity to reduce the risk of further injury.
Corticosteroid injections for pain have been offered to painful tendon sufferers for years, and a number of people’s pain is really good after the injection. However, this can lead to having a false sense of security, overloading and suffering a subsequent tendon injury. The missing aspect is being appropriately and gradually strengthened while the pain is settled, allowing time for tissues to strengthen and be able to tolerate the desired tasks.
Remember: Quick fixes don’t work for everyone!
An individual’s delayed pain response, hours or days after activity is another feature to consider concerning readiness for returning to sport or work. This will often be assessed and predicted by your Physiotherapist or Exercise Physiologist by gauging your response to progressive exercises which work towards particular requirements. Exercises might even be considered as a great way to tolerance test someone, not just a great way to build back into function.
What to Do if I’m Unsure?
If you’re unsure if you should be returning to sport or work with pain from an injury, come in and see one of our Physiotherapists or Exercise Physiologists for an assessment. They should be able to help you plan and succeed in your return to sport and/or work, not just settle or manage your pain.
About the Author:
Jacob graduated from Griffith University before starting at Physiotas. In 2017 Jacob completed his Musculoskeletal Masters of Physiotherapy at La Trobe University, and enjoys keeping up to date with current clinical practices.
Jacob’s main areas of clinical interest include spinal, hip, groin and knee conditions.
His interests outside of Physiotherapy include soccer, surfing, technology/gaming, and more recently mountain biking and snow boarding!