Excellent, very thorough and thoughtful. Although the older me still benefits from this explanation, the younger me who took all the damage needed it more. Like many people who have active lifestyles, I hate doing nothing. So when injured -- even seriously -- I wanted to recover as quickly as possible. But some things as it turns out -- and as you explain very well -- cannot be rushed. But if we accept that and find a balance, and active and productive recovery is possible. I've been guilty of too much black & white thinking in the past. When you can't do what you're used to, sometimes you don't want to do anything. If I had memo to my younger self: be more patient when injured. You can stay active, but give yourself more time than you think you need to fully recover.
Optimal loading below tissue tolerance sounds great but hard to find the area below the curve. I have knee osteoarthritis and was doing strengthening exercises for my quads and gluts. Did too much and walked with a limp for weeks. I know it’s individualized and difficult to find the right loading. And at age 69 do I ever recognize how many months it takes to heal/repair/remodel! GOT to be patient I guess and ignore the surgeons who say “A chance to cut is a chance to heal”……
Exactly, simple, not easy. I'm sure sometimes the inclusion of surgery in the treatment plan will result in a better outcome, but definitely impossible to make any blanket recommendations. Determining the optimal path requires input from folks with detailed knowledge about your situation (subjective and objective exams, goals etc.) and exceptional clinical reasoning. Surgery is also more dependent on technical skill, and it is hard to get that intel on any given ortho. Fortunately, if you do things to maximize systemic health and develop a habit of periodically progressively overloading your musculoskeletal system (engage in resistance training), if just keep moving forward and you'll often find yourself in a better place, regardless of the particulars of the treatment path you choose.
As I read the first half of this article, I related much of what you said to the concept of exercising for the purpose of injury prevention. I was delighted to read a mention of this idea towards the end of your post as many of my own experiences with injury have left me feeling relived I had been diligently engaged with optimal loading prior to the onset of injury. Not only does experience with regular exercise help me find ways to work around injuries, I believe it contributes to faster healing. I like to check in with PT before ever consulting with an ortho specialist even if I am offered a referral to a surgeon by my primary doctor -- it seems too often that surgery or pain medications of a more addictive breed than those you mention are recommended before the patient has a chance to let their body heal under the conditions you outline here and I generally believe PT as a first line of treatment is most conservative and worth the trip. It can be a vicious feedback loop when both primary care provider (or substandard PT) and patient alike are just as inexperienced or ignorant to helpful training modalities. One doesn't know how to answer questions and the other doesn't know what to ask. Perhaps a remedy for this will result from widespread adoption of regular training in the life of the average person as being intimately familiar with even the simplest of things such as the difference between pain and soreness, whether rest and gradual resumption of activity is likely going to result in healing, and whether or not a "clicking knee," for example, that doesn't hurt is any real cause for concern. There may not be a perfect substitute for a well reasoned PT, but I do think some personal knowledge and experience lifting heavy yet manageable weights with responsible form does wonders to inform MSK awareness on a personal level, at least it has for me. I've had a number of primary doctors misdiagnose an MSK injury. In a couple of cases, I knew they were wrong from the start and only endured the appointment with them to check the box required to get a referral to PT. A couple of PTs have also disappointed in their inability to provide rehab programs that produced clearly beneficial results. Not surprisingly they were all physically unimpressive. Seems like a clue. I will say, though, that was a sufficient condition for their inability to provide an adequate program to fit my needs, but it wasn't necessary (shout out to the physically unimpressive yet very honest PTs that have actually helped me achieve a better outcome, or at least not a worse one). Could you recommend a good litmus test for your readers to use for vetting a new PT? Something along the lines of asking, "How much ya farmer's carry?" maybe?
Excellent, very thorough and thoughtful. Although the older me still benefits from this explanation, the younger me who took all the damage needed it more. Like many people who have active lifestyles, I hate doing nothing. So when injured -- even seriously -- I wanted to recover as quickly as possible. But some things as it turns out -- and as you explain very well -- cannot be rushed. But if we accept that and find a balance, and active and productive recovery is possible. I've been guilty of too much black & white thinking in the past. When you can't do what you're used to, sometimes you don't want to do anything. If I had memo to my younger self: be more patient when injured. You can stay active, but give yourself more time than you think you need to fully recover.
Unfortunately these are often lessons we need to learn the hard way!
Optimal loading below tissue tolerance sounds great but hard to find the area below the curve. I have knee osteoarthritis and was doing strengthening exercises for my quads and gluts. Did too much and walked with a limp for weeks. I know it’s individualized and difficult to find the right loading. And at age 69 do I ever recognize how many months it takes to heal/repair/remodel! GOT to be patient I guess and ignore the surgeons who say “A chance to cut is a chance to heal”……
Exactly, simple, not easy. I'm sure sometimes the inclusion of surgery in the treatment plan will result in a better outcome, but definitely impossible to make any blanket recommendations. Determining the optimal path requires input from folks with detailed knowledge about your situation (subjective and objective exams, goals etc.) and exceptional clinical reasoning. Surgery is also more dependent on technical skill, and it is hard to get that intel on any given ortho. Fortunately, if you do things to maximize systemic health and develop a habit of periodically progressively overloading your musculoskeletal system (engage in resistance training), if just keep moving forward and you'll often find yourself in a better place, regardless of the particulars of the treatment path you choose.
Or cure.
As I read the first half of this article, I related much of what you said to the concept of exercising for the purpose of injury prevention. I was delighted to read a mention of this idea towards the end of your post as many of my own experiences with injury have left me feeling relived I had been diligently engaged with optimal loading prior to the onset of injury. Not only does experience with regular exercise help me find ways to work around injuries, I believe it contributes to faster healing. I like to check in with PT before ever consulting with an ortho specialist even if I am offered a referral to a surgeon by my primary doctor -- it seems too often that surgery or pain medications of a more addictive breed than those you mention are recommended before the patient has a chance to let their body heal under the conditions you outline here and I generally believe PT as a first line of treatment is most conservative and worth the trip. It can be a vicious feedback loop when both primary care provider (or substandard PT) and patient alike are just as inexperienced or ignorant to helpful training modalities. One doesn't know how to answer questions and the other doesn't know what to ask. Perhaps a remedy for this will result from widespread adoption of regular training in the life of the average person as being intimately familiar with even the simplest of things such as the difference between pain and soreness, whether rest and gradual resumption of activity is likely going to result in healing, and whether or not a "clicking knee," for example, that doesn't hurt is any real cause for concern. There may not be a perfect substitute for a well reasoned PT, but I do think some personal knowledge and experience lifting heavy yet manageable weights with responsible form does wonders to inform MSK awareness on a personal level, at least it has for me. I've had a number of primary doctors misdiagnose an MSK injury. In a couple of cases, I knew they were wrong from the start and only endured the appointment with them to check the box required to get a referral to PT. A couple of PTs have also disappointed in their inability to provide rehab programs that produced clearly beneficial results. Not surprisingly they were all physically unimpressive. Seems like a clue. I will say, though, that was a sufficient condition for their inability to provide an adequate program to fit my needs, but it wasn't necessary (shout out to the physically unimpressive yet very honest PTs that have actually helped me achieve a better outcome, or at least not a worse one). Could you recommend a good litmus test for your readers to use for vetting a new PT? Something along the lines of asking, "How much ya farmer's carry?" maybe?
Yeah, see how much they can farmers carry and ask if they think children should get vaccinated for COVID :)