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Pain as a Guide

Written by Chad Morris MSPT, MDT
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Chad MorrisIf you are like me, sports are a big part of my life. I love watching sports, playing sports, and helping my kids with sporting activities. I work with athletes of all ages, and eventually we get to the point where that client feels they may be ready to start back to their sport. It does not matter if they were injured playing the sport they love, or something else has disrupted them being able to participate. The questions start coming out, “Am I ready? Will I be okay doing this again? How will I know if I am doing damage?”

There are a few base attributes that we need to participate in a sport. We need to have enough mobility in certain areas of the body to move correctly and not cause damage to tissue or force other areas to work harder. We need to have enough stability to maintain good position and form to perform the activity without overloading or breaking down tissue. We also need to have enough endurance to perform the activity without fatiguing our muscles and losing control, causing poor mechanics and leading to injury.

 

Let’s start out with the first question – Am I ready? If the mobility and strength have returned to the injured area, then we can start to work on drills to replicate the demands of the sport. We never just jump right back in and pick up where we left off, that would only cause another injury very soon. We have to build back up. Drills, moving around faster, challenging the balance, control through rotation and side to side movements leads us to have the stability to maintain better form. If we have this, we can then move on to sport specific activities and going through our return to sport protocol. Yes, everything has a recipe to follow, especially when trying to return to higher level tasks without injuring yourself all over again. We can do short bursts of testing the waters with the activity. If we get to this point without issue, we can coordinate with our Sports Medicine Specialists on staff to do a Return to Play or Functional Movement Screen to determine if the body is truly able to perform and meet the demands of the activity. If not, then we work on more drills, but if so, we can move on to sport.

 

So we made it through testing and pass, but we are not out of the woods yet. We still have not actually ran, or jumped, or played basketball, whatever the sport is. There is still doubt in that person’s mind as to whether they are really healed and ready to do this again. Welcome to Question 2 – Will I be okay doing this again? Well, with this we still have more protocols we can follow. If the sport is running, we have a training guide to follow for re-introducing running in a short, controlled manner that will allow us to see if you are really able to do this. Walk-run intervals are great in that they get us moving, but allow us the recovery between to work on endurance, limit the fatigue, and limit injuries.

 

Now that we have started back into doing some activity, people get anxious, they are mving a little different because they are afraid they will hurt themselves again. We start creeping into question 3 – How will I know if I am doing damage? As we get to this phase, I give my clients 3 guidelines for return to activity: 1) set a threshold for your pain – do not let it get worse than 3/10, 2) if it does increase, stopping the activity should lessen the pain, we should not have pain lingering after 10-15 minutes of stopping an activity, and 3) pain should not cause you to limp or move differently. These rules are huge in returning to sport because it gives you instant feedback on what you should be feeling. We know we will feel some discomfort – we have not done this activity in a bit. Muscles are going ot be working harder, it is okay to feel that, to even welcome that. We just want to make sure that once we stop the hard activity then our body feels okay and is not worse.

 

runIf you stick with asking yourselves these questions after an injury, go through the proper protocol for getting back, regain all the crucial attributes you need to perform your sport correctly (stability, flexibility, control, response), test things out to help make you aware of any deficits and work on those, follow a return to play protocol, and monitor what you feel, then you will be back in the game in no time. Good luck!

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