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17
03
2016

Why didn’t my physiotherapy work?

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What kind of injury did you sustain? Email me (https://ryanbooth.ca/contact.html) ! Let’s fix that sucker!

I’m regularly asked, “Ryan, what is post-rehab?”

Well, thank you for asking! Post rehab refers to the time that it takes to get you back to your optimal performance after you have sustained an injury and had that injury rehabilitated by a physiotherapist, athletic therapist, sports medicine doctor, or voodoo dude.

Very often in the rehabilitation process, only the area of pain is looked at. This can be effective for a certain amount of time. However, the site of the injury is very often not where the problem lies. This is why (sometimes) those nagging injuries seem to come back, or never really go away in the first place.

“Ryan, why is that?”

Thanks for asking!

There are two mechanisms by which an overload injury can occur. The first is pretty straightforward; the second may just be the reason why that nagging pain never really seems to go away.

Injury Type One:

The load was too great for the muscle or structure’s load tolerance and there’s a sudden injury. For instance, you wipe out skiing and dislocate your shoulder. In such a case, we can see there is a pretty specific cause and effect. You hit the ground hard with your arm abducted it goes into external rotation and a sudden force behind your shoulder (the ground or your rib cage) dislocate your glenohumeral joint. Painful as heck, but you can see the cause-and-effect. 10 weeks later you are back to Aerials and moguls.

However sometimes the culprit is much more sinister. Sometimes, the simple act of bending over to pick up an envelope or to brush your teeth in the morning or stepping off the curb causes sudden acute lower back pain. Sometimes, that pain just comes out of nowhere – or seems too.

So what happened in these cases? Certainly, brushing your teeth or stepping off of a curb does not present enough of an insult to damage spinal structure or musculature? It should not. So, we have to look for something else. This leads to the second reason that you could be in pain:

Low Back Disorders- Stuart McGill
Low Back Disorders- Evidence-Based Prevention and Rehabilitation Second Edition by Stuart McGill
Injury Type Two:

An inappropriate load overtime brought your load tolerance down and created a sudden injury. This one is tough because it can seemingly happen for no reason. Poor posture, movement dynamics, a muscle imbalance and general weakness can contribute to driving load tolerance down over time.

I remember in my rugby days having extremely dainty hamstrings. I didn’t know this the time but it was due to poor hip kinesis. And it seemed as though my hamstrings were always in pain if not torn.

I had to correct my hip dyskinesis so that (over time) the load tolerance of my hamstrings would eventually go back up. That was a frustrating lesson to learn! Took a lot of time.

Identifying the specific reason for chronic or acute pain is very delicate work. It requires a little bit more patience than just getting someone to go back to work. Very often, once the pain is gone, that’s when the trouble begins. The reason for this is that you have a false confidence that you’re ready to return to play. Then old habits return, and lead to re-injury.

Hopefully this was helpful! If you’d like to come in (https://ryanbooth.ca/index.html) and chat about any of those old nagging issues you may have, I’d love to help!

See you next time,

The trainer (https://ryanbooth.ca/index.html) 🙂

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author: ryanbooth