Spring is here. The weather is warming up (gradually) and the sun is up early and out later in the evening for the next few months. You want to get out for that run or track session, hit the gym, play more golf. So there you are, training happily, when you tweak the quad or hamstring on that last 300m interval, step on the berm of the road and twist your ankle, feel the bicep go while doing your curls, or pull your calf walking up to the 18th green. Now what? If you have suffered a soft tissue injury, then you want to get healthy again and as soon as possible. Injury can have damaging effects on your morale, motivation, fitness, and training. If mismanaged, that injury could leave you weeks behind in your training or caused you to miss several rounds of golf or club matches.

There are 4 phases to soft tissue injury and healing. Phase 1 is the acute phase and includes the moment of injury itself and the first 72-96 hours (3-4 days). This is the time for RICE (we'll come back to this). The body is in protection mode and is the most active time for bleeding and swelling. If you are proactive in this phase it will shorten the length of time you will lose. Phase 2 is called the sub-acute phase and is the time when your body begins to transition from protection to repair. This phase lasts up to approximately 6 weeks. Although you still need to protect your injury, your body is busy building new soft tissue and scar tissue. Exercise will help this tissue strengthen and mature. Phase 3 is the late phase or the remodelling phase. Although your new tissue and scar is relatively strong, it is still not ready to handle the increasing physical demand required to return to full training. A graduated, monitored return to full training will allow your body to continue to build additional tissue to strengthen and support the healing injury. This phase can last up to 3 months depending on the degree of the initial injury. Phase 4 is the chronic phase. This phase encompasses the pain that some people will have on return to sport. Pain on initial return to sport is common and relatively normal. This is a transient phase and the new tissue will continue to strengthen and remodel. Working with your chartered physio during this phase can be very helpful.

You are at your best in every way when you're healthy so the best policy is injury prevention (see my earlier post about warming up). All is not lost, however, if you do pick up a soft tissue injury. There are a few things you can do (including contact your chartered physio for a review) to maximize your recovery and minimize time lost. Do you remember RICE (I said we would revisit this)? It means Rest, Ice, Compression, and Elevation. Well today Rest has been dropped because it implies limiting activity and movement of the injured part. The new word is POLICE where P is protection against further injury and does not imply rest or immobilization. Research over the last few years indicates more and more that movement and loading the injured part improves and speeds soft tissue healing by encouraging the release of healing proteins and hormones. OL is optimal loading or finding the correct level of activity or exercise to induce the release of these proteins without causing further injury. Welcome to functional rehabilitation.

In the paragraph above, we outlined what to do in the acute phase (Phase 1). Now we will discuss Phase 2, the sub-acute phase. Although activity/exercise is encouraged, it is important not to be too aggressive in your desire to return to training/playing. In this phase, restoration of normal movement and biomechanics is emphasized as well as proprioception (awareness of body movement in order to maintain balance). Regaining strength is a component of phase to as well. Normal movement activities generally start with non-weightbearing exercises such as bending and straightening the injured joint or muscle. Proprioception generally starts with something as simple as drawing the alphabet with your leg or arm (dependent on injury site). Strengthening starts with isometric exercises (contraction without movement, i.e. pushing your hands against each other) and progresses to isotonic exercises (contraction with movement, i.e. bicep curl) to functional or weight-bearing activities which may mimic elements of your sport. Your chartered physio can guide and monitor your progress through these activities.

Keep in mind that this entire process should be pain free and progress gradually to optimally load the injured tissue and maximize the benefit on return to sport. The key is having a professional who has the knowledge to guide through this process. Any injury that causes pain, swelling, and bruising should be assessed by a healthcare professional such as a GP or chartered physio. The general advice above should not be considered as medical advice.

Run long. Play hard.