Physical injuries, both minor and serious, are so common in our daily lives that most people don’t even realize the pain they experience can be treated. I am so often asked if it’s possible to treat pain and injuries without surgery, and the answer is, more often than not, yes.
To name some of the most common physical injuries: joint pain, shoulder impingement, neck pain, plantar fasciitis, low back stiffness, sciatica, muscle strains, tendonitis, carpel tunnel, herniated discs and spinal chord injuries can take its toll on your mental health and prevent you from participating in your favorite sports and activities of daily living.
These are often the results of over-used muscles and adhesions, which can be a long time in the making, and require rehabilitation over time.
"A new client called me the day after his first treatment to say that his “carpel tunnel” symptoms were entirely gone. He had been dealing with the weakness and tingling sensations in his forearm and hand for about a month. He cancelled his appointment with a hand surgeon for the following week and saw me twice more instead for treatment on his forearm. He’s never had any of the hand and forearm issues come up again since then." - Mark
How do overuse conditions occur?
Over-used muscles (and other soft tissues) change in three important ways:
acute conditions (pulls, tears, collisions, etc),
accumulation of small tears (micro-trauma)
not getting enough oxygen (hypoxia).
Each of these factors can cause your body to produce tough, dense scar tissue in the affected area. This scar tissue binds up and ties down tissues that need to move freely. As scar tissue builds up, muscles become shorter and weaker, tension on tendons causes tendonitis, and nerves can become entrapped. This can cause reduced range of motion, loss of strength and pain. If a nerve is entrapped you may also feel tingling, numbness, and weakness.
What are adhesions?
Our bodies contain special protein structures called connective tissue, also known as Fascia. This substance connects each part to other parts and the whole, very much like a flexible skeleton. When this tissue is healthy it is smooth and slippery, allowing the muscles, nerves, blood vessels or organs to move freely and function properly.
Imagine a piece of scotch tape; the smooth side is healthy fascia and the sticky side is scar tissue or unhealthy fascia. Rub the tape along your skin, both sides, to "feel" what an adhesion is like. The drag that you feel, the "pulling" sensation, is what an adhesion is like. These adhesions arise in and attach to muscles, nerves and lymph, decreasing their ability to work properly. You really know when you have an adhesion on a nerve; you get many abnormal sensations like numbness, tingling or pain.
For lesser injuries and pain, a sports therapist may be all you need, which include treatments such as corrective exercise and medical massage.
“I've sustained some pretty serious injuries from sparring in martial arts. If I ever have any difficulties or injuries, Mark is my go-to guy. Mark's specialization in Active Release Technique (ART), his deep understanding of body mechanics and overall movement make him an expert in injury repair." - Clay
Corrective Exercises and Personal Training
Corrective Exercises is a general term that refers to a strategy and subset of personal training and injury rehabilitation therapies that corrects movement and postural issues through exercise. The premise is simple: in order to avoid and recover from injuries, we need to correct the postural imbalances, asymmetries and weaknesses that contribute to the Injury in the first place.
Often times an injury is the result, not the cause. Too often, however, sports injury therapists “chase pain”, which means they treat the symptoms. While treating symptoms is important and in some cases may be all that's necessary, many times the picture is more complex and requires a skilled, outside-the-box approach. This is where corrective exercises comes in.
After identifying the postural and movement deficiencies, a corrective exercise specialist will devise a plan to release shortened muscles, activate weak and inactive ones and integrate it all using specific exercises to change the way a person moves. Doing so can prevent future injuries and help eliminate current ones because the contributing factors are no longer causing problems.
Having a Corrective Exercise Specialist who is also licensed to perform manual therapies such as Active Release Techniques helps kill two birds with one stone because the practitioner can both activate and release the affected muscles during the same sessions. - Mark
Medical Massage and Manual Therapy
For injury and pain that needs specialized attention, it’s a good idea to see an injury therapist, especially one who is well versed in medical massage therapy, which includes deep tissue, trigger point therapy, myofascial release, rolfing, neuromuscular therapy, Active Release Techniques (ART) and many more.
The benefits of medical massage for the treatment and resolution of musculoskeletal injuries are well-established anecdotally and through a substantial body of research.
For example, in the acute phase of a muscle strain (pull), medical massage helps increase blood, oxygen and nutrient flow to the injured area. The inflammatory response by the body brings important antibodies and blood cells to the affected tissue which enhances and speeds the healing process. The traditional injury therapy of 'ice, ice, ice' for acute muscle strains is being challenged by new research. It is now thought by many in the medical and injury recovery world that ice, while alleviating pain, actually impedes healing. So the next time you pull a muscle, perhaps see a clinical massage therapist instead of simply icing it.
Schedule a free injury therapy consultation and get referrals for your specific needs. Or, you can schedule an appointment...
For chronic muscle injuries, medical massage can be transformative. For example, Active Release Techniques (ART) is a comprehensive system of soft tissue therapy that specifically treats injuries to muscle, ligaments, nerves, tendons and joints. It accomplishes this through a simultaneous combination of client movement and hands-on treatment that breaks up scar tissue, releases adhesions within and between muscles and helps
muscles get back to their normal length.
ART quickly became my go to manual therapy technique of choice because the client outcomes were impressive. I was able to help clients end nagging injuries once and for all and alleviate chronic pain they had been living with for so long that they couldn’t remember how and when it started. - Mark
Dry Needling/Acupuncture
This is a form of acupuncture that specifically treats the musculoskeletal system by using needles to target trigger points in tight muscles. Dry needling can be amazingly effective in treating muscle injuries.
Chronic muscle strains often respond exceptionally well to dry needling. The reason for this is that the therapy gets below the skin surface, penetrating deeper and more specifically into the muscles than can be accomplished through manual therapy. I frequently receive and refer clients for dry needling to treat stubborn sore muscles and specific trigger points that I can not entirely release through manual therapy. I have found the best dry needling results for shoulder and low back injuries.
Why? Well, in simple terms, muscles in the shoulder such as the posterior deltoid, upper traps, infraspinatus, teres minor, latissimuus dorsi, rhomboid and levator scapula, among others, are notorious for getting trigger points. By getting deep into the muscle and making the muscle twitch in response to the needle, the muscle ‘re-sets’, so to speak. The trigger point releases, toxins exit the tissue into the blood, oxygen flow improves to the muscle and tight muscles are able to relax.
For the low back, there are many muscles and other soft tissues that are often involved, including those on the lateral hip, hip flexors, gluteal muscles, low back muscles and lower leg muscles such as the calves (gastroch and soleus). Breaking up the trigger points and adhesions in these areas takes pressure off of the lower back and can reduce pain and tightness.
Keep in mind that dry needling can be very uncomfortable and can result in muscle soreness for days following a treatment. But the results can make it worth the pain.
Chiropractic
There are different types of chiropractors and each provider often incorporates a combination of modalities such as joint tractioning, Cox technique, joint mobilization (cracking), manual therapies such as Active Release (ART), Graston (deep tissue technique using tools), electrical stim therapy, ultrasound, ice and heat. As with a lot of rehabilitation therapies, chiropractic care is an art form and some are much better at their craft than others.
Chiropractors are spine specialists. So whether it is neck, low back or rib pain, chiropractic care can be a very effective course of treatment on its own or in combination with other injury recovery therapies. Here are two examples:
Rib subluxation: This can be a painful injury in which a rib head moves out of position, mildly displacing from its joint (facet joint). It can affect breathing and cause acute pain during certain movements. One of my chiropractors was able to move, or ‘crack’ it, back into place in two sessions. Problem solved!
Neck Pain: On several occasions I have pinched a nerve and/or disc in my neck, causing sharp pain. Sometimes I’ll go for manual therapy and sometimes for a neck mobilization/adjustment by my chiropractor. I have found it to be very helpful to me and my clients in certain situations. Just make sure your chiropracotr really knows what she is doing because an overly aggressive adjustment can make things worse.
For more on injury therapy, try a free health consultation.
When an injury becomes serious, a combination of treatments and longer term therapy may be required.
Physical Therapy
There are so many different modalities and approaches within this area of injury rehabilitation. As in any field, there is a wide spectrum of bad to great PTs. If your PT is primarily doing 5 minutes of manual therapy, giving you a few generic exercises overseen by an assistant and having you spend half the treatment time with ice or heat on your back while receiving electrical stim therapy, my recommendation is that you stop wasting your time and money, and find someone else.
Sports medicine doctors often rely on physical therapy as the first go-to treatment for many non-surgical injuries and as the primary treatment for post-surgical rehabilitation.
For example, Physical Therapy is the primary treatment course for post-surgical ACL recovery. The ACL is an important knee ligament commonly torn by football players and almost always requires surgery. Physical Therapists are injury therapy specialists who are rigorously trained to handle these types of rehab treatments. Early on in the recovery process, the goal is to control inflammation, prevent scar tissue formation, prevent muscle atrophy (severe weakening) and maintain joint mobility through gentle movement, electrical stimulation therapy, massage therapy, very basic strength exercises and gentle stretching to the surrounding muscles.
By using a well-established timeline and treatment blueprint that includes an appropriate sequencing of joint mobilization, stretching and stability/strength exercises, PTs help get these patients standing and functioning pain-free.
Upon ‘graduation’ from physical therapy, it is important for the patient to safely transition back to general fitness and sport-specific training. This is where highly-skilled personal trainers, corrective exercise specialists and athletic trainers may take over.
When the injury in question develops into a severe case, medications, injections and surgery may be necessary.
Anti-inflammatory, Muscle Relaxer and Pain Medication: Unless these medications are used as a complement to other therapies and as just one component of the healing and rehab process, it has been my experience that their benefits are short-lived and limited.
What these medications can do primarily is provide a window of opportunity to try the rehabilitation therapies described above. This is because the medicaitons can reduce the pain and inflammatory cycles that often prevent movement and recovery from taking place, allowing you to address the root causes without pain and inflammation getting in the way. If you just take pills, the chances are that, when you stop, the pain will resurface.
Injections: Whether it’s powerful medications such as cortisone or other substances, these treatments can solve a problem completely but as with oral medications, their benefits are often temporary. In addition, having repeated cortisone injections into the same area over a short period of time can cause serious damage to tissues.
Surgery: In some cases surgery is required for optimal healing and full recovery. This is especially true for injuries such as a torn ACL in the knee, a serious bone fracture, hip replacement or third degree rotator cuff tears. In other situations, it should be your last resort, especially for the spine, because it may not be necessary or helpful and in reality it may make things worse. Also keep in mind that if you rush nto surgery too soon because you think it will help you avoid going through non-surgical treatment therapies (see above), in all likelihood you'll end up having to do those same therapies after surgery anyway.
The take home message is to stay patient, persistent and positive, even on the bad days. When you do have a bad day, keep in mind whether you are progressing in the right direction overall. If you are, then stick with what is working. If you aren’t seeing progress, keep trying different things, switch providers and listen to your body.