How the Brain Factors Into Recovery?

“How much longer until this heals?” Patience is tough when you’re healing from an injury. It always seems to take longer than you’d like to get back your workouts. Why is this? In part, because there are are two parts to physical injuries:

  1. Tissue damage.
  2. The brain’s response to the injury. This includes compensating (limping, for example) and the natural process of sensitization (the brain gets good at what it practices).

What happens when we injure tissue

There are two types of tissue injury: macrotrauma and microtrauma. In macrotrauma, the tissues start out healthy. You’ll have sudden pain when force–a fall, bad jump, etc.–is too much for the body to handle. In microtrauma, pain can also start suddenly. But, the pain seemingly happens without a triggering event. Some common examples are shoulder tendonitis and the IT Band Syndrome dreaded by runners. Microtrauma injuries result from repetitive stress. They often happen because of faulty mechanics–muscular imbalances and weaknesses, for example–or from not giving the body enough time to recover between trainings.

The three-phase healing process

No matter what the cause, injured muscles and tendons follow a fairly predictable three-phase healing process:

  1. Inflammatory (acute) phase–generally lasts 24-72 hours depending on the severity of the injury. The pain is usually sharp and is accompanied by swelling. (The swelling may not be visible.)
  2. Repair (subacute) phase–lasts up to two months depending on the severity of the injury. There’s less inflammation so the pain isn’t as intense. This is when re-injuries often happen. The tissues are still remodeling (healing) so they’re more prone to re-injury. This phase is especially frustrating for athletes. There’s less pain but if you overdo it, the pain comes back.
  3. Remodeling phase–can last 6-12 months depending on the injury’s severity. You should be able to perform most activities without pain but the injured area won’t be as resilient as it once was. For example, you may run five miles pain-free. But if you run six miles, or five on consecutive days, you’ll feel it.

Treatment goals for each recovery phase

How we treat injured tissue, and the treatment goals, vary in each recovery stage. Here are some examples:

Phase 1: Reduce pain and inflammation. Some inflammation is necessary for the healing process. Inflammation isn’t entirely bad. It does serve a purpose!

Phase 2: Restore pain-free range of motion and begin strengthening if it can be done without pain.

Phase 3: Continue restoring strength and range of motion. Strengthening exercises are generally more intense.

How your brain reacts to an injury

Compensation. We all do it. It isn’t a toughness or pain-tolerance issue. It means that if you have an injury or pain, your body will change how it moves to minimize stress on the area. The body is built for survival, not performance! You can’t override your brain’s tendency to protect the body. It’s true. High-performance athletes usually have a higher pain tolerance. There’s also a theory that what separates them from the rest of us is their ability to compensate. Because they do it so well, they have more options for putting their body into the required position to excel.

Our bodies’ natural protective mechanism can hinder performance, particularly with chronic or recurrent injuries. We can’t hit “reset” on ourselves. If we leave an injury unaddressed for a long time, the way we compensate for it becomes so ingrained that it comes the “new normal.” Our bodies learn poor movement habits and habits can be difficult to break! The good news? Proper movement, practiced regularly can help create better movement. Evaluation tools such as the Functional Movement Screen (FMS) and the Selective Functional Movement Assessment (SFMA) are designed to pick up these compensational patterns.

A perfect example of compensation at work is the correlation of an acute ankle sprain and low back pain. If you sprain your ankle, you’ll limp. Limping alters your hip mechanics and that adds stress to the lower back. Thus, an ankle sprain can often lead to low-back pain. This also shows how injuries can pop up in different areas. Finding the real source of an injury, especially a chronic injury, can feel like a game of whack-a-mole.

Central sensitization is the second part of the brain’s involvement in injury. What it means is that your brain gets good at what it practices. If it’s constantly bombarded with pain, that’s what it gets good at–sensing pain! (This is one theory on how chronic pain syndromes such as fibromyalgia occur.)

Central sensitization is a good argument for addressing injuries earlier rather than later. I’ve found that overcoming unaddressed chronic injuries is often more difficult than addressing the injured tissues!

Muscle weakness–more than just physical

Outside of diseases such as Multiple Sclerosis, there are two primary reasons for muscle weakness in athletes: muscular atrophy and pain inhibition.

Muscular atrophy refers to the shrinking of muscle fibers (the actual muscle size decreases). This is common after injuries such as tendon ruptures. If the injury isn’t addressed, you’ll continue to compensate for it and your body’s pain inhibition will kick in. That’s because it hurts–or is bandaged, in the case of a break–so you use it less. Because you use it less, the muscle shrinks. (A dramatic example–have you seen or felt how weak a limb is after it comes out of a cast?)

Pain inhibition happens because of injury, but the brain drives the weakness. It’s the brain’s attempt to minimize damage to the injured structure. In the context of rehabbing an injury, this can make “pushing it” counterproductive. With each painful repetition, your brain remembers what it can’t do and weakens the injured area to protect it. It’s almost as if your brain fights back. “Still can’t do this. We’re hurt, remember?” That’s why strengthening within a weak range of motion isn’t always the best way to strengthen the injured area. We need to be selective about the exercises.

The Takeaways
  1. Address injuries sooner rather than later. This doesn’t mean you have to see a health care practitioner with the littlest of injuries. But if you have an injury that keeps recurring or never goes away entirely, the right health care professional can make a world of difference.
  2. Find a health care practitioner who knows or participates in your sport. They’ll be in a better position to help you modify your activity. To find one, start by asking your friends at the gym, in your running group, etc., for recommendations.
  3. Avoid the “passive care loop.” You need to be actively involved in your care and recovery. (Home exercises, self massage, icing–for example.) The most effective way to return to your favorite activities or sports is to work with your health care practitioners.

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