Rebuilding strength after an injury can be incredibly frustrating. Go too fast and you’re likely to re-injure yourself. Too slow and you may not see the gains you’d like to and give up altogether. So how can you help yourself recover with the optimal amount of stimulus to drive tissue growth without overdoing it? Let me drop some science for you…
Tissue repair happens when your body is in the parasympathetic state - meaning, if you're stressed out about work, or life, or your injury, guess what? Your body is not healing. Your stress response means you're in 'fight or flight' mode. What your body cares about in this mode is either getting you away from or ready to fight whatever threat happens to be causing the response. Healing can happen later, once you've survived. But if you happen to just stay in your stress response, well... That's when it becomes detrimental to your health. So first off, please see this post here on how best to switch off your sympathetic mode and switch on your 'rest and digest' parasympathetic mode so tissue repair and healing can optimally occur.
It's important to note that exercise of any form is considered a stressor. It’s important to understand this so you can better life hack the recovery process. If you’re going to add the stress of exercise to your tissue to stimulate growth, try to limit other stressors in your life so your body can focus on the one stress at a time so you don’t accidentally overwhelm the system. Also, try to spend as much time as possible in a parasympathetic ‘recovery’ state post exercise to optimize tissue repair.
So, that said, tissue repair works like this - there’s the initial inflammation stage, which is an important time to maintain pain-free range of motion (assuming you’re not in a cast, of course; if you are, wait until consolidation has occurred before starting to wiggle fingers or toes, which is typically 2 weeks) but you don’t want to actively strengthen the damaged tissue yet. It’s a bit like when you have a cut on your knuckle. Anytime you bend the finger, you reopen the cut and it takes longer to heal. So wait until the signs of inflammation (pain, redness, swelling, heat) have subsided before you begin trying to rebuild strength. The nice part is, you have a handy, built-in warning system to let you know if you’re further damaging anything - pain. Pain is the signal that tissue damage is likely to occur, if not currently occurring. This is why it’s important to stay within the ‘pain-free’ limits during recovery. If you overdo it, your body will let you know. Don’t push it, otherwise, you delay healing, like reopening the cut on your knuckle. So think of your pain signal as your helpful friend. Just stay away from that and you’re good. The inflammation stage lasts anywhere from a few days to a few weeks, depending on how bad the injury is.
Typically between 2-8 weeks is when folks are at most risk of re-injury. This is when the repair phase has mostly occurred and you no longer have an active wound, but the tissue is still fragile as remodeling happens, which is the stage where the new tissue fibers strengthen. This is a wonderful time to start making slow strength gains, but still within the pain-free range. The reasons for slowly increasing activity during this phase are two-fold - 1) the increase in activity helps the re-coordination of your muscles, joints, fascia, and nervous system that has likely been immobile for a while which 2) feeds back to your brain that healing has occurred and the body is no longer injured. So the more you move in that pain-free range, the more your body and brain will begin to believe that it’s healed. But that’s only true as long as you don’t push it. Because if you do then your brain and body basically get into an argument over which one is the liar and you have a flair up of symptoms. This means your tissue will be less likely to trust that it’s actually healed, so when you start re-introducing activity after the flare up, it will be much more hesitant to trust that it is healed, more reactive to over stretch stimuli and more likely to go into protective spasm sooner. This can set you up for a chronic injury that just never seems to get better despite tissue healing, or what we call a ‘hyper-sensitization reaction’. This is a miscoordination of the nervous system where it becomes more sensitive to previously neutral stimuli. Basically, your body begins to see everything as a threat because it can no longer trust the signals it’s receiving. And that will lead to a much longer and in-depth rehabilitation to retrain that.
So what are some good guidelines for the re-introduction of pain-free activity? Honestly, it depends on the injury, which is why I usually send patients to one of the physiotherapists I work with to develop an individualized program. But! That’s not why you’re here and reading this post. So here are some handy websites who have already done the work for me:
Remember, go slow. You are not trying to get to fatigue of the muscle. Going to muscle fatigue causes delayed onset muscle soreness, which is your goal if you’re trying to build size. This is about rehabilitation. Okay, hang on, let me explain a bit more for you.
Think about a muscle like strands of uncooked spaghetti that are each wrapped in saran wrap. Then take bundles of ten of those strands and wrap that bundle in saran wrap. Then take a bunch of those bundles, wrap the whole thing in saran wrap and stick it in water and you have a basic muscle. The individual spaghetti strands are what we call muscle filaments. A bundle of filaments is called a muscle fiber. A bunch of fibers together makes up a muscle. These guys do a pretty good job of explaining the relationship of fascia (the saran wrap) and muscles (the bundles of spaghetti and saran wrap together). They also have really great injury recovery exercises if you want to play around on their site.
So the goal when exercising is to break a few of the filaments. This is what causes delayed onset muscle soreness and is the signal to your body that the muscle wasn’t strong enough to lift the load. So then the body will replace those broken filaments plus add a few more for good measure so that the next time it comes up against a similar weight, it will be better prepared. You do not want to tear a muscle fiber because fibers replace with scar tissue, and a muscle with a scar is only at best 80% as effective as muscle without one. Plus, scar tissue is sticky and takes longer to heal. Filaments take about 48 hours to replace. A torn fiber takes two weeks. This is why it’s so important to give yourself adequate rest time between workouts - if your muscle wasn’t strong enough to lift the load originally, now you’re working with fewer filaments. If it wasn’t strong enough before, it definitely isn’t now, which means you are that much more likely to tear a fiber, which takes two weeks to heal. This is what sets people up for tendonitis. That scar tissue, during those two weeks, is sticky and fragile and likely to re-tear if you go back to your normal routine, which, as we’ve already established, you weren't strong enough to handle the first time around. So you re-tear those fragile fibers, and that requires more scar tissue, which you will re-tear the next time you work out… see where I’m going with this?
You’re already dealing with fragile tissue. You DO NOT want to go to muscle fatigue while re-strengthening when the injury is still fresh. Wait until it has fully healed before you go to muscle fatigue with your work outs. Now, that said - you don’t want to go to fatigue of THAT specific injured muscle. But you’ve got lots of other muscles you can focus on. They’re all fair game.
So for all of you thinking ‘no pain no gain’ or that you can tough out that sprain - just don’t. Why not be kind to your body instead so it doesn’t develop trust issues?
Food for thought…
Till next time, dear Readers!