Acute pain can usually be easily resolved by correcting a training error, while long-term pain often requires long-term care.
Is it time to go see a physical therapist? Let’s first look at how you go the injury. Many of the injuries athletes sustain fall into two categories: training errors or overuse.
Training errors commonly occur when athletes add mileage, intensity, or speed too quickly or do not allow for enough recovery time—either on a daily/weekly basis or within an overall periodization program.
Overuse injuries are those nagging but consistent pains that we put off, sometimes for years. The pain may be minimal or it may stop you in your tracks. Overuse injury is often like the constant companion—and ignored until it is too late. While many argue that overuse injuries are caused by overtraining, I look at things a bit differently. Overuse injuries are indicators of a more global systemic problem, muscular balance issues, poor biomechanics, or poor sport-specific mechanics. Overtraining is often an isolated (or very sporatic) episode of pain caused more directly by a training error.
The pain that comes from training errors is usually a surprise. You have been training well, likely gaining fitness and speed, and you have been feeling good. Then you go out for that one swim, bike, or run and come home in pain. This can be a frustrating and scary moment. The good news is that if treated quickly and appropriately, these injuries will usually resolve in short order. In times like these the best course of action is to reduce the inflammation as quickly as possible. We have all heard it: Rest, Ice, Compression, and Elevation. This is the time to think of your long-term training and racing plans, then truly take a break to recover from the injury.
Often this means taking 1–3 days completely off; however, active recovery can be a part of this equation as well. Use caution with active recovery because pushing into or through pain will only delay or prevent healing.
Extremities do well in 10-minute ice baths. Use ice packs for generalized areas up to 20 minutes or perform 5-minute ice massages for localized areas. Icing several times daily is important, but wait a minimum of two hours between treatments so tissues may warm and blood flow increases to the area.
Compression is not just for swollen ankles anymore, and a plethora of garments is available to help. Supporting the injured area with compression can help decrease inflammation, decrease the workload of the area, and improve the lymphatic system’s ability to clear waste products. When done correctly, it should never be painful.
Elevation provides relief comparable to compression and helps at day’s end when swelling and inflammation are often highest. During this time, anti-inflammatory medications can also be very helpful.
By helping to reduce inflammation with proper care, injuries from training errors may heal within 7–10 days. If after 10 days a return to the inciting activity is still painful, I recommend seeking medical advice to ensure no underlying biomechanical issue exists.
Overuse pain is something athletes often chalk up to being ‘in training.’ Often they have sought tests, had massage, chiropractic, or physical therapy, but the pain continues. The key to changing overuse pain is persistence. Find a physical therapist who understands your goals and will work with you to reach those goals. I have treated people who have had knee pain for 20+ years and just want surgery to ‘fix it.’ These types of injuries are frustrating and often prevent athletes from returning to their chosen sport. I believe the vast majority of overuse injuries can be helped by physical therapy.
The most difficult aspect of treating this type of injury is the time it takes to make a difference. In the case of the patient with 20+ years of knee pain, walking down a flight of stairs without pain was an issue. We treated twice a week for three months. Yes, that’s a long time and a lot of treatment … but this person climbed Denali with no pain one year after ending treatment. Changes in muscular balance, joint mechanics and motor control take time. Long-term complaints of pain can require long-term care and occasionally intermittent check-backs. Having said this, gains should be regular and noticeable.
While I personally enjoy utilizing a variety of body-work professionals, I do believe physical therapists are the movement specialists. They are trained to look at muscular balance, fatigue, neuromuscular control and much more. Changing the way the body moves in order to reduce the chance of injury or improve acute and chronic pain can require multiple aspects of care. Physical therapists are not just for surgical recovery anymore! In many areas your physical therapist can be your first entry point into medical care and help get you back to moving pain-free!