Managing Long-Term Injury
Posted on 22nd March 2023 at 12:03
Long term injuries are extremely common and often are more likely to be experienced by those who have previously been more active. As we get older our bodies inevitably become a little bit more fragile there becomes less bounce in our joints and movement becomes more difficult. Although this is an inevitable process of ageing, it does not have to apply to everyone but in my experience applies to well over 90% of the population.
What I want to speak about today is managing specific injuries. I am going to be relating this to two specific cases; one of which is something I personally am managing and another is something that I have come across more often than anything else in my 20 years experience in the health and fitness industry.
The first is managing a degenerative hip condition and this is my personal experience. I am managing a torn hip capsule through a condition called hip dysplasia which is a condition where the hip socket is too shallow and therefore creates much more instability in the hip joint. As a result of this and the activities I have engaged in over the years I have managed to tear the connective tissue that supports my hip joint. I have been told by the specialists that 100% of people with hip dysplasia need a hip replacement (or 2) by the age of 50. I am trying my best to fight this and at present am two years away from disproving this fact but watch this space!
The second condition is long term back pain where an individual has either had a disc fusion or vertebral fusion or has had a disc bulging prolapsed for over 5 or maybe even 10 years. At this point generally speaking under imaging we find that the vertebra has fused. In the vast majority of cases this will occur in the lumbar spine (the lower back) but this can also happen more frequently than one might imagine in the cervical spine (in the neck).
The biggest danger in managing a long term injury is the problem of pain. Pain has many different effects on the body and can lead to many unwanted adaptations. If we look at a long term hip condition the most obvious effect is a disruption to the way somebody walks and once there is a disruption to the walking pattern then other joints in and around the hip joint a will start to take extra load and wear away more quickly than they should.
From the back point of view anybody who has experienced back pain will know just how debilitating that is and will also understand just how draining and how much of an impact that can have on daily life. So staying on top of pain is one of the critical factors in managing any long term injury .
However poor sleep is also a major issue when dealing with a long term injury particularly where pain is concerned. As soon as we start to lose high quality sleep and a regular sleep pattern the body fails to recover on a day-to-day basis. It also affects our focus, our concentration and our decision making. This then impacts on the choices that we make and our ability to stay on track with the lifestyle that we would choose.
Other areas to be concerned about are doing more damage to the injury itself and then the actions and the choices that stem from being either in pain or unable to do things that one wants to do on a long term basis . What I'm talking about here is the very basic things such as comfort eating, making bad choices, doing the wrong things rather than the right things, drinking more, trying to find release from either the injury or the lack of activity that you're able to do. These choices can snowball very quickly if one is not careful.
Although it may seem like a horrible oversimplification the bare truth is that, like most things in life, the way of managing a long term injury comes down to a very straight forward choice. In my experience you can either:
Choose to limit your life, your activities and the things you choose to do down to the level that your injury allows
you can choose to adapt your actions and find new ways to achieve and maintain the level of activity and the lifestyle that you wish to live.
It is very simply a choice of choosing what you can do or choosing what you can't do.
First and foremost, we must accept that every single person is different and every single person’s set of circumstances and attitude towards their injury will be slightly different. Equally there will be certain injuries which are much more difficult to adapt to and will inevitably cause a limitation of lifestyle.
Secondly it is absolutely imperative to understand that people will have days, weeks, months and even perhaps years where their mindset is not able to overcome the challenges that they are facing. That does not make them a bad person, it does not mean they are failing, it is just the reality of life and sometimes a very hard reality.
What I want to give you here is just a very quick list of things that are available to people who may be choosing to try and challenge the level of activity that they are at or the impact of an injury they may be dealing with.
1. Swap Your Workouts. As I am managing my hip condition one thing I've had to be very careful with is the amount of running that I do. I do not like running! However, I know that when I am fit, when I am healthy and when I feel good about myself, I am generally running. So it's almost a necessary evil. But up until this point I have been unable to run consistently due to the level of pain it creates in my hip. What I have done to continue to allow me to train my cardiovascular system is to do a lot of work on the bike and make sure that I'm getting a good solid workout using that on a regular basis. Running is also a challenge for people with long term back pain due to the impact primarily but also often due to an imbalanced running pattern. This is where something like a cross trainer or again a bike or perhaps swimming can become a substitute that gives you the same or a similar benefit without the challenge to the long term injury .
2. Lose Weight. In some respects this is quite a blunt point and may not apply to you if you are not overweight or if you are quite slight of build naturally, but equally I would encourage anybody with a long term health long term injury to ask themselves the question about whether they would be better off with less weight. I would go so far as to say the vast majority of people would experience less discomfort than less pain if they weighed less and by the way I very much include myself in that bracket and it is something that I have worked on over the last few years to make sure that I limit the impact of my hip.
3. Increase Flexibility. This point is absolutely vital for people with long term back pain. There are people in the population who have too much flexibility but of the hundreds of long-term back pain clients that I have worked with in 20 years, I think I have met only a handful that have had too much flexibility. Immobility/inflexibility significantly increases the work that is expected to be done by the lower back and the more work you are asking a lower back to do the more likely you are to flare up an old injury or worse still create another injury in the same vicinity as the previous one.
Nobody chooses to HAVE a long-term injury.
But EVERYBODY has a choice in HOW they manage their long-term injury!
4. Stay Strong. We all lose 2% of our muscle mass each and every year over the age of 35 unless we do something to counter it. If you are managing a long-term injury the muscles that surround the injury become even more important than they were before hand and the likelihood is that the muscles that surround that injury were not strong enough in the first place (because otherwise they wouldn't have got injured in the first place). Muscles that stop being used or are inhibited through pain will wither even faster.
5. Improve Posture. Posture is a position from which movement begins and ends. Posture is also the position in which our joints spend the most time. Poor posture creates increased load on joints in a position where they are not designed to take that load. Most people will have heard of cartilage, most people have heard of discs in their back. Discs in your back and cartilage are both located in a position where the loads are supposed to be exerted when you have good posture. They are not put in a place where the loads are exerted when you have poor posture. Therefore, improving posture will put loads through joints in the places where they are designed to take that load and that is good for the longevity of any joint whether it's injured or otherwise. Equally good posture allied with good flexibility and good strength creates healthy human beings that move well. This is also vital for managing long term injuries.
6. Use Medication. Medication can be extremely useful and can even be essential in managing long term injury, particularly where pain is involved. However, there are also side effects to taking medication on a long term basis and this is something that we must be aware of. Medication does not have to be simply that prescribed by your medical professional. There are complementary medicines, there are alternative medicines, there are herbal remedies. There are many different types of medication available on the market at the moment and I would encourage people to do their research and to look into the different possibilities. I would also strongly recommend consulting a licensed expert in the field that you are considering and not just choosing things for yourself.
Personally I have tried ibuprofen of various strengths for my hip, I have also tried anti-inflammatory foods, cannabis oil in both balm and tablet form and as my recent blog post outlined I have also tried cold water therapy. I have stated in other posts that cold water therapy has been the single most effective long term treatment of pain in my hip. What is particularly beneficial about this is that there are no negative side effects to my digestive system, to any part of my body, to my liver or to my kidneys from cold water exposure. Which means I can use this into the future with no side effects whatsoever.
7. Track Changes. Unfortunately a solution that you come up with and seems to be working wonderfully may not last for any length of time. Therefore it is important to keep an eye and monitor your state of health around the injury consistently. This does not mean you should be changing things everyday or every week, but it does mean that if your level of pain changes it is important to look again at the measures that you are taking and ask yourself if they are still effective. In my experience the reasons why they will be less effective is probably because you're doing less of them, however it may also be a case that the impact and the benefit you have experienced from that particular programme or course of action has reduced and you need to look again.
8. Fix It If You Can/When You Can. Fixing a problem properly/permanently is always the best outcome. This applies to both back pain and my personal circumstance of hip pain. However the solution may not be without consequences either here and now or into the future.
As I said at the start I have been advised that I will probably need two hip replacements by the age of 50. A hip replacement is no small thing even though they are relatively common. But they don't last for 40 years as far as we're aware so whilst the solution to my problem could be considered to be hip surgery firstly the surgeon is not willing to do that in it’s current state and secondly it is not something I want rush into. I plan to live for quite a long time yet so would much rather give some very intelligent men and women the chance to develop hip joints that last longer and longer so that hopefully I may only need one hip replacement in my lifetime.
With a back complaint surgery is also possible solution though the solutions are much less black and white but as I said at the start of this, if we are looking at a spine that has already fused then the need for the types of actions I've outlined in this post is even greater because there is no surgical solution to unfused that disc. I would also stress that with long term back injuries, 90% are caused by the actions of the individual over a period of time so whilst surgery may be a part of the solution, unless you stop the actions that caused the injury in the first place, you will simply create the same injury one level up or one level down from the previous injury site.
Managing a long-term injury is challenging. It is also not linear and needs consistent evaluation and adaptation. Every person’s experience of managing their pain and their injury will also be different and we must not assume that just because something isn’t working that it is because we haven't tried hard enough or we're not doing things properly. Plans will need to be changed, approaches will need to be adapted and you may need to look at things that you think you have already ruled out. But you absolutely have to choose to manage the injury and achieve the highest level of health vitality and therefore lifestyle that you can. That is something only you are in control of and something that must remain as constant as you possibly can.
I hope you have found this post interesting? If you are suffering with a long term injury and would like to discuss your circumstances in more detail please do drop me an e-mail via the link here and I would be happy to talk to you more specifically about your own personal situation.
Tagged as: Back Pain, Back Rehab Exercises, Chek, Emotional health, Exercise, Flexibility, Habits, Holistic Health, Lifestyle, Long Term Back Pain, Rehabilitation, sleep, Strength training, weight loss
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