You’ve being going to physical therapy for a few weeks now, and it ‘didn’t work’. Why isn’t your injury getting better? I wish it was as simple as, “You have lateral epicondylitis (tennis elbow), you need some in-clinic treatment and to complete exercise A, B, C and it will get better in X amount of time”. Typically, this is what many expect when going to physical therapy, seeing a chiropractor, or similar. But often — especially with those long-standing injuries — it’s not as easy of a path. First, the diagnosis is rarely as simple as that, and there are many components to your movement that must be addressed outside the specific diagnosis, if there even is one. But for this article, I’m going to discuss the aspects outside of your musculoskeletal movement that influence how you recover and heal. You need to consider how your sleep, nutrition, attitude toward injury and the duration of it may impact how you heal.
Sleep
More and more professional athletes are tracking and taking priority with regards to sleep as a part of their training program. Not only does a good nights sleep feel good, but it is imperative to optimal performance. While one night of bad sleep isn’t likely to create an impact, over time compounded affects will. Chronic lack of sleep (<8hrs) in adolescent athletes resulted in them being 1.7 times more likely to sustain an injury than athletes who slept for at least 8 hrs¹.
The same principle is similar for optimal rehabilitation after sustaining an injury. Sleep allows your body to go into a recovery state as the general demands on it are lower while at rest. During sleep, more energy can be used to repair muscles² and tissues. As less blood is typically required for brain function and overall body energy, increased blood flow can go to areas in need for required oxygen and nutrients for healing. Further, increased growth hormones are secreted during sleep which — in addition to stimulating growth — assist cell regeneration and repair. Levels of growth hormone have been show to be depleted in individuals who are sleep deprived³. Prolactin, another hormone released during sleep, helps to manage inflammation levels. Being in a state of chronic sleep deprivation essentially invites your body to be in a state of inflammation, which is not ideal for chronic pain management and healing. All of this means that getting adequate sleep provides optimal resources to help cell regeneration and repair!
Nutrition
In discussing the influence of nutrition on your rehab path, I spoke with my colleague and friend Emily Fulton. Emily is a Registered Dietician who works with both athletes and the non-athletic population in optimizing health and recovery using nutrition. According to Emily, “I’d like to think of nutrition as that missing puzzle piece, without the proper nutrition we can’t finish the puzzle and move to the next step. Often times if we are missing something in our diet it can delay, or even prevent, our recovery from a specific injury or progressing forward as it relates to chronic pain. Key nutrients for recovery include adequate protein intake and a foods high in antioxidants to help reduce inflammation. Dark fruits and vegetables typically are the highest in antioxidants, think bold fruits like blueberries, raspberries, strawberries or pomegranate, and dark leafy greens (spinach, broccoli, Brussel sprouts). It is also important to know that nutrition and nutrient recommendations are specific to the injury, a broken bone will require different nutrients or quantities than say a torn muscle or ligament; I recommend working with a Registered Dietitian alongside your physiotherapist or other practitioner to facilitate your rehab.” Remember, your body can only heal off of the fuel you provide for it. Again, it’s all connected. Even if we don’t always want it to be.
Attitude Towards Recovery
While getting injured is rarely a positive event in life, having a positive outlook influences the speed of recovery. First, do your best to not get stuck in the denial phase; injuries happen and the sooner you address them the sooner you can get back to doing what you love. Then once you do, move past only the physical impacts of injury and be mindful of how your attitude affects it. Realize that a negative mental approach can actually manifest physically as ongoing muscle soreness and fatigue, especially if it is something you have been dealing with for awhile. It has been shown that in adults one month post unexpected injury depression was a negative predictor of recovery at 12 months⁴. On the other hand, taking an active role and determination towards rehabilitation post hip fracture was demonstrated to increase speed and success⁵. What this means is you need to find social support (family, friends, others going through a similar situation), create a recovery plan including small and big goals with your therapist, and stay focused on the wins, because this will truly influence when and how you heal.
Duration of Injury
The longer you have been dealing with an injury or dysfunction, the longer it will likely take you to recover. This is because your body is very smart, and adapts to what it’s given. After sustaining an injury, or managing with ongoing pain or dysfunction, your body creates compensation strategies to achieve daily tasks. For example, if you need to reach a cupboard overhead but you have a rotator cuff injury, this may involve using your traps to shrug more or rotating through your neck or torso to move into the necessary pattern to reach the cupboard. Your body does this so you can function and live. Sometimes these adaptations are necessary — such as in patients with congenital physical dysfunctions or post spinal cord injuries. The body creates new patterns if typical ones aren’t available, to allow for task completion that may not be possible otherwise. But following a typical musculoskeletal injury, these compensation patterns can actually be a hinderance. Your brain learns this adapted strategy as its new normal. Then when you do start addressing and trying to rehab the initial injury, there is a lot more to uncover and change. Often these compensation patterns are unknown to you, and part of the ongoing struggle to figure out the root of the problem so as to not have it reoccur again. What this means for your rehab path: be patient! You can’t expect to be fixed immediately and never have the problem return. Remember how long you’ve potentially been dealing with it, and be respectful of the changes that must occur in your body to help recover.
In general, be aware that everything you do, don’t do, or eat affects everything else. The science and medical field has grown immensely with regards to this in the past few years, and new information is constantly being discovered on the ways the body is connected. I’m not expecting you to be the epitome of health all the time, but remember that addressing more than your physical injury can do wonders for recovery.
