How Can You Recover Effectively From Injuries

If you're a Sunday league weekend warrior like thousands of others are in the UK ( Pre-COVID-19 of course) then during a game you may see an opportunity to; 1) win the ball from an opponent, or 2) retrieve it in open play. A rival player in close proximity harbors similar intentions and you size each other up before committing what is known in football parlance as a 50/50 challenge.  Instinct and adrenaline kick in as you brace for physical impact. Either you successfully recover the ball or lose possession whilst being on the receiving end of a hefty challenge with a sustained injury.  You momentarily leave the pitch but if the pain subsides you rejoin the action.  After the match however, and for the following weeks, the discomfort remains. 

You stop playing, take time off work, visit the GP.  Doctors request an X-ray of the limb and prescribe painkillers. If broken, the affected area may be put in a cast for a period until the bone has healed.  Otherwise, you're given more pills, advised to stop playing and rest until the pain goes. When it finally subsides we’re ecstatic; eager to re-join our team and play. So the moment you attempt to sprint or make a tackle, what causes the injury flare up again? The simple answer:  Ineffective recovery.

The beginning stages of recovery of injury 

Injury will occur in two ways. Firstly through sudden impact, and secondly as a result of long term body imbalance, miss-alignment and repetitive strain ( this can also come from numerous micro-traumas, a build up of little injuries left ignored).  Whether a fracture has taken place or not - scar tissue built up from injury requires ICE to control swelling, and heat to encourage fresh blood supply to visit the damaged site with nutrients and oxygen; thus stimulating the rebuilding phase to begin post trauma.  ICE needs to be applied for 20 mins on the hour for the first 48 hours of an injury. The ICE needs to be compressed, but not applied directly to the skin. The limb in question needs to be elevated to allow fluid and blood with unwanted cells to “drain off” away from the damaged site.  Dead/damaged cells of ligaments, tendons, old broken blood vessel scar tissue from muscles need to be effectively removed from the trauma site. Imobilising the area to prevent further structural damage is important - more so with fractures, as bone needs to fit back into its pre-injury state and can’t be dislodged as it re-models itself.  

Replacing of old cells and breaking down of scar tissue 

As fresh cells are encouraged to replenish a new site - it is important that they do not rebuild over damaged old cells.  Whilst ICE plays an important role in the first 48 hrs injury to control ( not prevent/restrain swelling as previously thought. Research has shown that swelling is a necessary part of the repair and recovery phase of trauma, and only needs to be regulated) heat is more important in the days after initial injury. Strapping and bandaging the area can also be used to regulate swelling.  As the injury progressively begins to heal, heat and ICE can be alternated from 20 mins at a time, with a slight 1 minute break in between.  Eventually heat alone can be applied to promote healing.  It should be noted that the application of commercial creams such as “voltarol” and “deep heat” have been shown through research to be no more effective than a hot water bottle - and are unnecessary.  Also soft tissue therapy (sports massage) is crucial for encouraging the damaged and dead cells that are clumped together (especially muscle cells) to be released and broken down to make way for fresh new cells.  Cupping is also used to draw away toxins from dead/damaged cells as well as built up carbon dioxide that needs to be flushed out of the injured site to make room for fresh cells.

Re-modelling and proprioception

Once the damaged bone remoulds itself as well fresh muscle cells, ligament, tendon and blood vessels are being replenished, they need to take on the characteristics from the once dead and damaged cells they are replacing so the person can perform the sporting activities as effectively as they did prior to injury.  Muscle memory is a term used often - to describe the characteristics of certain muscle tissue fibres.  It is  usually referred to in terms of the overall strength of a muscle, or how strong a muscle was prior to injury.  What is not often discussed is muscle memory with reference to movement and distinct patterns.  In football and other skill related sports its the effective knitting together of sequential movements to produce things dribbling, step-overs, and accurate passing and delivery from dead-ball situations which is much more complex than muscular strength. 

Training and rehabilitation that encourages re-modeling and muscle memory

Good recovery from injury is underpinned by flexibility work.  Muscles, with fresh cells, replacing the old ones need to be able to be extended to the same need to range as the old cells so they can carry out the old workload.  Core stability work using a swiss ball, and rubber band activation work must also be used to get different muscles to switch on and distribute workload throughout training.  Damaged muscles that are inactive will lose mass and overall strength.  However, whilst resistance training is a key part of recovery we need to make sure we are encouraging balancing work and proprioception (static balancing work whilst eyes are closed to enhance and develop spatial awareness) and repeating patterns, and sequences will get muscles to undergo the complex tasks necessary that simple resistance training simply cannot do.

In summary, taking painkillers and “resting” damaged, or injured body parts will allow for recovery from trauma, but is not enough to get the body part to do what it had previously been doing.  “Active” and not “Passive” recovery is required to get a limb or muscle back into the shape it was in.  

1. The importance of ICE and imobilisation and rest in the initial stages of injury is crucial - in particular the first 48hrs.
2. After which, heat applied from a hot water bottle along with soft tissue techniques such as sports massage and cupping to allow old injured and dead cells to make way for new fresh cells.  
3. The remodelling stage of recovery is key to get muscles to re-learn sequential patterns so the limb can function as it previously was able to. This is done by balance work, core training, activation work via resistance bands.  Also stretching to maintain full range of movement and resistance to build up injured muscle which has been temporarily inactive, is equally important.