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The Stepping Stones of Injury Rehabilitation

“I just bent down to tie my shoe lace and bang… another episode of back pain”!

This is a very common sentence to hear from patients with back pain seeking rehabilitation for their pain. These episodes seem to come right out of the blue, no warning just a sudden searing pain. In fact these situations are often the result of the accumulation of a number of stresses and strains over time, lack of sleep, longer working hours, stressful commutes, arguments at home. That might sound crazy but actually the recent science strongly suggests that all of these factors have an important role in the occurrence of such episodes. It might seem like the pain came right out of the blue but if you consider all these other factors it might be less surprisingly than it originally appeared to be. In these situations detailed assessment by a professional is needed followed by appropriate rehabilitation.

Reducing pain and increasing movement

So how do we start people on the road to recovery? Initially we want to make sure you have adequate mobility and flexibility to get back to normal life. This can involve some hands on treatment just to calm down the muscle tightness and get joints moving again to help make the area less sensitized. During the current Coronavirus pandemic this area of treatment may not be possible. Tissue densensitization can happen quite quickly, but proper rehabilitation does take some time and patience and it’s our job to guide you through this process.

Hurt does not equal Harm

Specific rehabilitation exercises are a key part of recovery and are best done little and often (at least once or twice a day for 10 minutes or so). They may cause some mild pain, that’s ok, hurt does not equal harm! In other words just because you feel some pain does NOT mean that you are doing damage to your body. A traffic light system can be a useful analogy here, so if you think of a pain scale from 0-10 (0- being no pain and 10 very severe pain) anywhere from 0-3 is a green light, just continue doing the exercises and movements, 3-6 you can carry on but you need to be a little bit more careful and gradual, 7-10 level pain means you should stop what you are doing.

We shouldn’t completely ignore “warning signs” in terms or aggravation of symptoms like pain for hours or days after exercise or activity, or more stiffness or swelling but equally wee shouldn’t be worried about stiffness and soreness in the recovery phase. It’s also worth remembering that aching and soreness is a normal part of any new exercise or rehabilitation programme. If soreness persists for more than a few days or recurs significantly after another one or two exercise sessions we are probably doing too much too soon. We have to allow healing to take its course. Taking a few days relative rest to let the symptoms settle is wise and then starting again with less resistance and fewer repetitions.

Daily over strain can lead to pain

We must remember that other postures and activities in day-to-day life are likely to have contributed to the occurrence of the injury in the first place (assuming it was non traumatic in origin i.e. it wasn’t a fall or a car accident). Most muscle and joint injuries are a result of cumulative postural strain or overuse. Day to day stresses and strains on muscle and joints will slow down recovery and reduce our capacity to play sport or do our rehabilitation exercises.
We need to think about your sitting or driving posture, your lifting technique (even for lighter objects like shopping bags) the length of time you spend in a bent or twisted position (e.g at work, when doing DIY or gardening). We should limit the time in these postures to a few minutes and then straighten up, walk around and try to vary or tasks to avoid prolonged periods in such positions. Poor or awkward postures are likely to aggravate symptoms and slow down healing and recovery. It’s very important to consider your working postures and for many people this means us assessing their workstation set up. Your chair, screen height mouse position and working routines are all important factors to consider.

Building functional resilience

As rehabilitation develops we introduce more technical exercises that require good balance coordination and movement control. They may involve more resistance and carry a slightly higher risk of injury than exercises in if not done correctly or done to excess so good technique is essential for these exercises. The benefit of them is that if done correctly they make our bodies fitter, stronger and more resilient. These exercises are a vital step for those returning to sport, but guidelines now advice everyone should be doing at least 30 minutes of exercise a day and 2 strength training sessions per week (this doesn’t have to mean throwing lumps 100kg over your head though) it’s all about what is appropriate to you at that point in time.
Returning to normal life and sport
As you return to normal activities again you may find it useful to keep a log or brief diary of the rehabilitation programme you are doing as well as any sports or other exercise your participating in. It makes sense to also include other events in the week that take a lot of time or cause stresses and strains (both physical and psychological). Over the course of each week we have might log extra travel, DIY, gardening etc. Making note of all of these elements will help you chart your improvement over time but it will also help you to understand why any future minor flare ups or injuries have might occur. You can keep as brief or as detailed a record as you wish, but it will help you to understand how your rehabilitation develops over time.
Once you understand these stepping stones of rehabilitation and recovery, you can walk walk the walk and talk the talk. You are then more in control, you are empowered. Does this approach prevent all muscle or joint pain? No of course not! However this strategy will make us far more resilient and far more aware and all the science says this approach really does give us personal power over pain.

To Find out more about specific rehabilitation and exercise for your own problems or to help you achieve your sporting goals and improve physical performance visit our website:
To read many other interesting blogs in this field including Professor Stuart McGill visit: