I see a lot of people who’ve had specific, traumatic incidents which have caused their pain: fractures from traffic accidents, ligament ruptures from skiing accidents, joint replacements and other major surgery. But we also see an awful lot of people whose injuries would traditionally be termed “overuse” injuries: tennis elbow, shoulder impingement syndrome, tendinitis of the Achilles or patellar tendons, acute low back pain…
The problem with labelling these injuries as “overuse” is that people naturally assume that they can be cured with less use — also known as rest. So they stop doing the activity that brings on the pain — running, playing tennis, ironing — under the misguided belief that once they’ve “healed”, or once the “inflammation has subsided” that they’ll be able to go back to doing exactly what they want to do.
Unfortunately, this approach is just like being a yo-yo dieter (if you aren’t one of these yourself, I’m sure you know a few!) Yes, if you give up cakes or wine for a few weeks, your tummy will get flatter. But once you come off the diet and return to your old habits, you’ll put the weight right back on again — and probably a bit more too! Similarly, people on the the exercise-injury-rest-exercise pattern tend to find that each new injury is slightly more painful or takes a bit longer to recover from than the last.
The thing that we as physios don’t shout loudly enough is that the cause of these “overuse” injuries isn’t “overuse” nearly as often as it is “misuse” — bad movement habits or poor exercise technique, which may have a multitude of different roots.
As one example last year, a surgeon referred me a delightful middle Eastern woman who’d had chronic pain in both knees for 12 years. There was nothing structurally wrong with her knees: as I assessed her, it quickly became obvious that she wasn’t using her gluteal (buttock) muscles as she walked and ran — a vital factor in knee control, because the glutes keep your femur (thigh bone) from excessive inward rotation as you step onto your foot, which would stress the structures around the knee. When I asked her about this, she told me she had deliberately stopped using her glutes because of sexual harassment she’d been subject to, when walking around her home town! Once we’d realised this and retrained her glutes, her knee pain resolved within 2 months.
Another example I saw was a stock market trader who has 3 large computer screens constantly on the go over his desk. Over time, he developed severe back pain and came to me to work out why. We realised that his habit of sitting in a twisted position for long hours, staring at the screen to his left, had caused uneven pressure concentrations on his spinal discs, leading initially to backache and stiffness — and then, when he ignored it for long enough, to an acute locked back. Unfortunately for him, restoring disc metabolism is a slow business, but again, once the cause of his issue was unearthed, we were able to help him to retrain his sitting posture and then go through a course of hands-on treatment and exercises to give him not just pain relief, but normal movement patterns.
In my view, the most important thing we do as physiotherapists is to coach you in retraining your habits and movement patterns.
When a poor movement pattern is ingrained — for example, if you twist every time you put weight through one foot, or every time you sit down — it can lead to compensatory habits: dysfunctional patterns of excessively high and low muscle tone, which in turn leads to even worse movement patterns and eventually to pain.
Our first job is to work out where it all started — and then to coach you to change your bad habits for good ones, much like a tennis coach trains you to transfer your weight, rotate your torso and swing your arm properly until you can hit a great backhand even under pressure. But much like learning a backhand, good patterns don’t come overnight, and that’s why we only work with people who are prepared to sign up to a course of treatment, and who are prepared to put the work in. Retraining physical habits takes time, effort and consistency — but the reward is getting out of that cycle of exercise/injury/rest/exercise/worse injury and achieving long term results.
Are you using your body optimally, or are you stuck in the injury/rest/injury cycle? If you’re not sure, why not give my team a call on 0207 175 0150 and arrange an assessment…