We’re in Austin, which means we have a lot of clients who like to play hard. Whether biking, running, or enjoying the miles of greenbelts throughout our fair city, people like to be outside. This means we see our share of injuries at Efficient Exercise. What follows is NOT a guide as to how to be recover or repair an injury; rather, this is a discussion of the physiological and structural events at play following on an injury. With this information, I hope you’ll be better equipped to do just ONE thing: not reinjure yourself before you’re actually healed. You’ll see what I mean in a few minutes.
So when we’re talking about injury, we’re talking about trauma, specifically macrotrauma. This is defined as a sudden episode of tissue overload, far exceeding the integrity of the tissue structure. Depending on the tissue, this manifests as things like dislocation (complete displacement of joint surfaces), subluxation (partial displacement of joint surfaces), sprain (tearing of ligaments), or strains (tearing of muscle tissue). Now it’s important to make the distinction between macrotrauma and microtrauma, which is actually the stimulation that results in overcompensation and stronger tissues from training. This is an important point, so I’m going to internet yell at you about it: TRAINING IS NOT LIKE BUILDING A BRICK WALL! MORE IS NOT BETTER! IT IS LIKE A FLU SHOT: THE BODY GROWS STRONGER IN RESPONSE TO EXPOSURE. TRAIN TOO OFTEN AND YOU’LL TURN MICROTRAUMA INTO MACROTRAUMA, JUST LIKE GETTING TOO MANY FLU SHOTS RESULTS IN THE FLU!
… Whew, maybe I should wait for my coffee to kick in so I’m less grouchy.
So if you should be in the unfortunate position of injury, there is a pattern that the body will go through with all tissues. Take a look:
Collagen is, despite what the women at the mall have told you, not just the stuff of plump lips and cellulite. These Collagen Type-I fibers are the major protein of bone, tendon, and ligament. Let’s expand just a bit on the phases above.
- Inflammation: So in addition to what you’re reading above about inflammation, it’s important to note that there is actually a mechanical reason for the swelling. That is if the tissue is swollen, the muscles,tendons, ligaments and joints all suffer a significant mechanical disadvantage, discouraging active use of the area. And that’s what you should be doing: no active use of the area during this phase. This phase lasts two or three days, generally. Longer and you should get it checked out by a PT.
- Repair: In an attempt to improve tissue integrity, new tissue is generated and scar tissue is formed. In addition, new capillaries are formed to help bring in more of the needed components of tissue repair. Also at this point collagen fibers are being laid down in a haphazard fashion, like a poor latticework patch. These fibers need time to align themselves. At this point heat, balance work of the affected limb, and even manual gentle massage of the area, are prudent owing to the nature of tissue: blood brings the building blocks of tissue repair in but the nasty junky garbage from the repair leaves in the lymph. There is no central pump for the lymph; your muscular contractions ARE that pump. This phase can last up to 2 months.
- Remodeling phase: By now your tissue is in the slow process of reorganizing the fibers in the appropriate direction to maximize strength. This is also where pain is basically gone, meaning this is actually the most dangerous time for a trainee: you’re weak and you don’t know it because you don’t feel it. In addition this phase can last 2 to 4 months(!) depending on the injury.
Here’s a graph of the general timeline for the visual learners out there:
Notice that at about the halfway point, the pain is basically gone but the tissue is still super weak. This is the critical point where we as trainers have to keep riding clients to NOT go back to the same level of effort as they’ll likely re-injure themselves. They can’t feel anything wrong, so who are we to say they should do X activity? Here’s my first response if I get push back:
My second response after a good laugh is to remind them how far they’ve come and how frustrating it would be to be injured again. Tempering people who really want to be active is hard: we’ve mostly the opposite problem in America. But as a trainer we’ve been hired to bring perspective to the situation. I hope this can help you if you’re a trainer and, if you’re just an athlete, help you to pause when things are feeling good and NOT go run that ultramarathon (or whatever) just yet.
Finally, you can see this in action to some degree. The next time you get a decent cut, pay attention to it. You’ll see the inflammation response around the wound bed, and then after a few days you can see the rough latticework around the wound site as new collagen is being laid down. After a couple months all of the fibers leading to the scar are aligned in the same direction. I was going to post a photo of a wound on my leg to demonstrate this but it’s already Monday morning and I didn’t want it to be anymore traumatizing than it already is.
Skyler Tanner is an Efficient Exercise Master Trainer and holds his MS in Exercise Science. He enjoys teaching others about the power of proper exercise and how it positively affects functional mobility and the biomarkers of aging.