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The Two Options You Have When You Are Injured…
The options are simple, but the process is complex. You can either decrease your activity or increase your capacity.
Person: “Doctor, my back started to hurt this earlier this week, and hasn’t gotten better. It hurts every time I bend forward.”
Doctor: “Ok, stop bending forward then. I want you to take the next few days off and just relax at home.”
Hmm… that IS one way to go about it. But what if there is a better way? What do you think the downside is of stopping your activities?
When you are injured, the activities you were doing before can be painful, whether it is deadlifting or washing the dishes doesn’t really matter.
To manage your injury, you essentially have two options….
Option 1: Decrease your activity level
The idea here is that you decrease your activities to a level that doesn’t cause pain.
This is a viable option for some injuries, but it is never a permanent solution. If you decrease your activity too much for too long, you will end up deconditioned, and then you live in a feedback loop where you keep getting worse… Just like this picture:
I recommend that MOST of my patients decrease their stressors for a period of time (but this is only for a few days). Then we get into Option 2…
Option 2: increase your capacity
With this strategy, you work to increase your strength, endurance, and recovery to improve your overall capacity to a level that can handle the stresses of your activity.
Personally, Option 2 sounds like a better solution to me.
The more we can increase your capacity, the larger buffer you have between your demands and your threshold.
In order to use Option 2 though, you need to have a plan. We need a structured, progressive and intentional exercise plan in order to build up this buffer. It can’t be done in a day, and it doesn’t work to just use random exercises with no intention.
Option 2 is a 3 step process.
Step 1: Calm Stuff Down
This often still consists of a period of decreased activity, but it is NOT a permanent strategy. It is only long enough to give us a window to build upon. We also use things like stretching, foam rolling, mobilization, and hands-on therapy during this phase to decrease your pain.
Step 2: Build Back Up
During this phase, the focus is on building strength and endurance around the body parts and systems involved in your activity. This means strength and mobility exercises, with less emphasis on mobility or hands-on treatment.
Step 3: Bridge the Gap
This is the fun part. After your symptoms are under control, we start to work on speed, strength and re-integrating your favourite activities. You like to run? Your rehab plan involved running. You like to ski? Yup, that’s part of the plan. Mountain Biking? You bet we include that.
Here are a couple of the components of Bridging the Gap:
Movement Quality and Capacity: how well do you move in relation to your sport/activity, and do you have enough range of motion for your task
Sport/Activity Specific Cardiovascular and Muscular Endurance: even though you are out of pain doing a simple single-leg squat in the clinic, doesn’t mean you maintain that same quality when you are out of breath
Rate of Force Development: can you generate force quickly enough, as you need it, during your activity?
Recovery: making sure you have the strategies and skills in place you need to recover from the demands of your activity.
This is also one of the most IMPORTANT parts. If all you do is get out of pain, but you don’t continue to improve your movement quality, recovery strategies, and overall capacity, it is extremely common to start sliding backwards, right back to where you started.
The reason I use this framework is that it is not only the most effective method that I have found, it also helps YOU develop the tools you need to keep your pain from coming back.
If you are ready to take control of your pain and get back to doing the things you love, I can help you.
Author: Dr Mark Murdoch, Chiropractor and Co-Founder at Base Camp Chiropractic and Sports Rehab in Vernon, BC.
Mark Murdoch is a Doctor of Chiropractic with a Master’s Degree in Sports Medicine.
Contact: drmurdoch@basecampclinic.com
Instagram: Base.Camp.Doc
What to do when you get hurt
Gone are the days of bedrest, ice and ibuprofen
What is the FIRST thing you should do when you get hurt?
Most people are familiar with the 'RICE' acronym, of Rest, Ice, Compress, Elevate... but what if I told you that RICE was outdated and could even hinder your healing ability?
Whether it is a new knee sprain, back injury, or shoulder strain, you can use these simple principles to speed up your recovery. Gone are the days of bed rest, ice, and immobilization.
Don't believe me?
Let me make my case.
RICE is based on out-of-date research and does some of the exact OPPOSITE things we need for healing. In order to heal, our body needs stress and inflammation. Rest and Ice actually decrease the body's ability to heal, if used for an extended period of time.
Healing occurs in 3 phases:
Phase 1) Inflammatory Phase (a few days)
Phase 2) Repair Phase (1-2 weeks)
Phase 3) Remodelling Phase (Months)
If you want to optimize your healing during all of these phases, you need to follow the PEACE and LOVE protocols. The goal of the PEACE phase is to calm everything down. Let the inflammatory phase run its' course. The LOVE phase is to start building things back up.
Here is the summary of PEACE and LOVE:
Day ~1-3: PEACE
Protect: avoid excessively painful and aggravating activities
Elevate: when at rest, try and keep the injured limb above your heart
Avoid anti-inflammatories: avoid ice, ibuprofen, and other anti-inflammatories whenever possible
Compression: use a tensor wrap, compression wrap or other compression tools to clear swelling
Education: learn about your injury and the typical healing times (that is where we come in)
Day 3+: LOVE
Load: start injury specific exercises as early as possible to promote proper healing
Optimism: stay positive. Injuries suck, but you will get back to it.
Vascularization: keep training cardio as often as you can to maintain your cardiovascular fitness and
Exercise: start reintroducing normal activities and get back to regular exercise as tolerated without a significant increase in pain
How long does it take to heal?
This depends on the body part injured, the severity of your injury, and your overall health.
For example, a Grade 1 Ankle Sprain? Typically resolved within 2 weeks.
A Grade 2+ Hamstring Strain? Can take MONTHS to fully resolve, or longer without proper rehab.
Anxious and afraid of your pain? Fearful or every little twinge? That will slow your rehab and prolong your recovery.
There ARE a few things you can do to speed up your recovery:
Move OFTEN: keep moving within pain-free range (or tolerable increases in pain)
Manage SWELLING: swelling can limit your activity and cause considerable discomfort
Stay OPTIMISTIC: a positive outlook is extremely valuable and can actually speed up your recovery
Not sure where to start?
That is where a qualified Chiropractor or Physiotherapist in Vernon, BC can help. A good Chiro or Physio will put you through a thorough assessment and help identify the extent of your injury and your pain triggers. Then, they will help you put together a rehab plan to get you back in action.
Author: Dr Mark Murdoch, Chiropractor and Co-Founder at Base Camp Sport and Spine in Vernon, BC.
Mark Murdoch is a Doctor of Chiropractic with a Master’s Degree in Sports Medicine.
Contact: drmurdoch@basecampclinic.com
Book an Appointment with Dr Murdoch: book here
Instagram: Base.Camp.Doc
You Are Not Fragile
You are not fragile. Our bodies are designed to keep us moving forward and that is basically a super power.
Good news! Most injuries do not have to become lifelong struggles. Our bones rebuild, our cells regrow, our neurons learn new pathways. Human bodies are designed to be highly adaptable.
Our softness is sometimes purely mental. Driven by the fear of re-injury, an internal dialogue we tell ourselves plays on repeat based on our Dr. Google searches or incomplete conversations with our doctors.
Repeat after me: I am not a chocolate souffle’. You have order, structure and the ability to move forward. This is why it’s important to have a conversation with your doctor about your injury and the healing process.
We all have our dings and dents.
We are surrounded by stories of strength and adaptivity. A man jumped over the Great Wall of China on a skateboard with two broken ankles. A woman runs ultra marathons after being told she had arthritic knees and should restrict herself to walking. A man moved a 1000 pounds off the ground after a disc injury to his back years before. Ask any person who has been pregnant and given birth about adaptivity and they will no doubt have a good chuckle.
How do injuries happen?
Injuries are the body's response to overload. There are 2 types of overload: acute and chronic.
Acute load is when you take a tumble on your skis and reach out to break the fall, thus breaking your wrist. It’s a quick insult to the tissues that pushes past the threshold of structural integrity rebuilding.
Chronic load is when you spend 8 hours a day sitting like a banana in your desk chair. This is multiple insults to the tissue that will eventually cause pain because the body can’t keep up.
What does healing tissue look like?
Healing time is based on 4 main things:
Age
Degree of injury
Amount of load to tissues
Overall health of person
Younger people tend to heal faster. The degree or grade of injury may require more time to heal. For example: An athlete with a Grade 1 (ligament irritation) ankle sprain will take less time to heal than a person of similar age and lifestyle who has a Grade 3 (full ligament rupture) ankle sprain.
Ligamentous injuries like sprained ankles take as little as 6 weeks to heal. Muscular injuries like groin strains take as little as 3 weeks to heal. Bone injuries like stress fractures take approximately 6 to 12 weeks to heal. Neuromuscular injuries like disc herniations take approximately 12 weeks to heal.
But my doctor said my scoliosis will always give me back pain.
Injuries are not the only thing that can make us feel fragile. Sometimes we are told that our anatomy or structure predisposes us to further injury down the line. Many people are told that things like scoliosis, spinal alignment and osteoarthritis may make life more difficult for them down the road. This is not often the case. Structure does not dictate function. I plant my flag firmly in this ground.
One study of 230 knees on 115 pain-free adults (mean age of 44 years old) showed abnormalities (meniscus tearing, cartilage damage or bone marrow legions) in at least one knee in every patient.
It’s important to have a conversion with your doctor or chiropractor or physiotherapist about your concerns around your injury.
Things to ask your doc:
How long will it take for this injury to fully heal?
What can I do to ensure this process doesn’t take longer?
Is there any reason I should believe this may be a long term struggle for me in my activities I enjoy doing?
How do I build strength around this injury?
Bottom line: You are not merely a meat bag moving in three planes. Your injury should not make you feel fragile. We all get ego checks but it shouldn’t keep us from doing what we love. Have a conversation with your doc today about how you can feel stronger around your injuries.
Author: Dr Sam Krieg, Chiropractor and Co-Founder at Base Camp Sport and Spine in Vernon, BC.
Contact: drkrieg@basecampclinic.com
Disclaimer: This blog is intended for general informational purposes only and is not intended for the delivery of medical advice. No doctor/patient relationship is formed. The use of information on this blog or materials linked from this blog is at the user's own risk. The content of this blog and website is not intended to be a substitute for medical advice.
References:
Horga LM, Hirschmann AC, Henckel J, Fotiadou A, Di Laura A, Torlasco C, D'Silva A, Sharma S, Moon JC, Hart AJ. Prevalence of abnormal findings in 230 knees of asymptomatic adults using 3.0 T MRI. Skeletal Radiol. 2020 Jul;49(7):1099-1107. doi: 10.1007/s00256-020-03394-z. Epub 2020 Feb 14. PMID: 32060622; PMCID: PMC7237395.
Written by: Sam Krieg DC in Vernon, British Columbia at Base Camp Sport and Spine
How running injuries happen