“If you always do what you've always done, you'll always get what you've always got.”
This quote has long been debated as to whether it was said by Henry Ford, Albert Einstein or whether it predates both of them, but that’s not what is important. The importance of the quote is the profound meaning behind those words! How many of us consciously or not, repeat the same tasks day in and day out, but expect different results?
The same premise can also be used when speaking about the treatment of soft tissue injuries. Maybe you have an injury that manifests itself as pain, be it lower back, shoulder or knee pain that after you seek treatment the pain goes, only to return a short while later.
There are many reasons as to why an injury might return but it could be to do with the fact that the symptoms are only being treated and the actual cause is never discovered.
When I speak about symptoms I am talking about things like the pain and discomfort that is being felt in a specific area within the body.
The cause is what has actually allowed this pain to manifest. In some cases the symptoms may be felt directly from the cause – examples of this may include impact trauma or extrinsic factors (rolling your ankle in a divot) this type of injury will be felt in the area of impact. However other injuries may produce pain somewhere else in the body through a knock on effect that for example, may be the result of instability at a joint or multiple joints, which has created a weakness in the surrounding muscle and compensatory patterns.
So what happens when the pain we are feeling is just a symptom and is not in fact the cause?
Let’s take the example of rolling your ankle in a divot whilst out running. It’s a nice summer’s day so you decide to go out for your daily run, the weather is beautiful so instead of pounding the concrete you decide to choose the scenic route, across country. You’ve never taken this actual route before, so you don’t know the exact terrain. It starts off across an open meadow where the grass is nearly as tall as you, the ‘path’ meanders here and there and before long you come to the edge of a wood, you enter, as you could now do with the shade. As you’re jogging through the woods, you hear the birds singing to themselves, to the left of you, you hear a rustling in the trees. You turn to look, but as you do this you take your eyes off of the path. Without notice your foot catches a hole in the ground and your ankle ‘rolls’ over. The pain is enough to make you stop and you are unable to continue with your run. You hobble back to your house and you decide that the injury isn’t that bad and that you’ll ‘self treat’ it which includes ice to the area, some rest and painkillers. To start with you can’t walk on your ankle without a limp and you wonder whether a new job in theatre as a pirate is the future, but after a few weeks the pain subsides and you can walk without pain, the limp is still there but it’s not as significant and to be honest, you don’t really notice it. As time goes on you forget about the injury as you’re back to full fitness.....’Let’s go for another run’, you say.
So let’s regress this situation slightly and go back to the moment the injury happened.
When you incur an injury like this, on a basic level your body makes special adaptations to help protect the injured site which may come in different ways, such as the over usage of other muscles to compensate for the debilitated tissue, this in turn will inadvertently change your gait. If this isn’t controlled around the time of the injury this ‘adaptation’ may become a permanent and unconscious one. As fascia lays itself down in lines of stress (the way you move), the result is that your biomechanics will have changed, meaning the way in which you move will be different. Over time we adapt to this new positioning, but because this new positioning can make the body inefficient and put unwanted stresses on it, this can lead to further injury (at the original site or somewhere else) as the body is not functioning as it should. When this happens it may lead us to believe that where we feel the pain (symptoms) is actually the root cause of the problem, so we endeavour to treat this area, but wonder why the injury keeps returning.
Injuries may not be a result of an external force and they may manifest through poor technique and repetition which has happened over a long time or through weak, underactive muscles. It may even be that the injury stems from an accident or injury that happened years ago, that we have long put out of our mind. However, where these injuries are linked is in the way in which they are treated. Every injury has a source and it is up to the practitioner, (physiotherapist, soft tissue therapist, personal trainer etc) to find this. If the symptoms alone are treated, then there is an increased likelihood of reoccurrence. In order for your injury to be treated correctly, you need to understand where it has come from and what has caused it. This may take some ‘detective work’ but the outcome is that you may become pain free indefinitely.
Information is the key to a successful injury rehabilitation process. If you want your injury to be treated in a manner where you understand it and get to the bottom of it, then you need to delve deeper.
Morpheus from the film the Matrix put it well when he said:
“You take the blue pill, the story ends. You wake up in your bed and believe whatever you want to believe. You take the red pill and stay in Wonderland and I show you how deep the rabbit hole goes.”
How do you want your injury to be treated?