Are you stuck in the GAP?

 Have you ever wondered why a professional athlete can return so fast from an injury to a high level of competition while the average person with the same injury can barely get back to walking in that amount of rehab time?

You might just chalk it up to the “pro” being a finely tuned machine.  They are, of course, but a ligament is a ligament whether you are “pro” or not. 

Look at the comeback story of UFC Fighter Dominick Cruz.  He had 3 ACL repairs (two on one knee and one on the other knee) and a groin tear injury in the last 4 years.  He only fought 61 seconds (won by a knockout) in 4 years and this past January came back to win his UFC Bantamweight Championship Belt! 

Just one of those injuries could have ended an athletic career.  He is an extreme example but wow it’s impressive and shows you what is possible with the right mindset and training.  You would have never known he had been through all those obstacles based on his performance in January.

How can an athlete do something like Dominick did but the average person only reach about 80-90% of their pre-surgery functional level after just one knee surgery?

I think it’s due to a GAP between how far traditional rehab can take you and getting back to 100%. 

Have you or someone you’ve known given up on activities like running, jumping or sports because of an injury?  Are you one of the people that still doesn’t trust the leg they had surgery on even though it’s been several years or more?  Or do you have pain on the other leg now? 

These are all examples of someone that didn’t fully rehab the injury.  It is very common.  I see it all the time. 

I watched this with my brother’s leg injury his senior year in high school.  He had a compound fracture of his lower leg during a freak accident in his Varsity football game that led to not one but two ACL knee repairs after his bones healed.  He did the normal rehab course after two knee surgeries with an excellent surgeon and therapist and at 20 years old, he told me he couldn’t run without pain. 

He was young, healthy, athletic and did everything he was told to do to rehab his injuries.  It made no sense to me that he couldn’t run. 

Unfortunately, that GAP between rehab and return to real life activities is typically dictated by your health insurance because they decide the amount of therapy you get after a surgery/injury.  Everyone’s benefits are different which impacts the amount of rehab you receive. 

Your insurance company doesn’t care if you were a runner prior to your injury.  In their mind, if you are walking without crutches and have had 20 PT sessions then you are good to go!  

Here’s the deal.  If you want to have the best outcome after injury, you need to take control of your recovery and fill in that GAP with good daily self-care and some help from other resources.

In regards to the “pro”, sure it’s their job to return back to 100% but you can do it too.  A “pro” does have the edge – their career is at stake, they have an incredible work ethic, they came into the injury in amazing shape, and they usually have a cutting edge rehab team behind them.

But here is the secret… if they don’t do the work, then it won’t happen.  If they don’t listen to their physician and health practitioners and push too hard, too fast, it won’t work.  Most of the time, they have to be proactive about their recovery and seek out help from practitioners outside of their coaches and team.

So let’s talk about how you can GO PRO by taking control of any injury you’ve experienced whether recent or one from the past (I’m referring a lot to knee or ACL rehab but this applies to all injuries). 

Three MISTAKES to AVOID when you decide to GO PRO with your Recovery:

1.  DON’T GIVE UP when traditional therapy ends if you are not where you want to be in terms of function, your goals or pain issues.
 
Let’ go back to my brother’s rehab.  What did we do?  I started him on a daily exercise program to build strength, power and agility using Pilates rehab and sports rehab/conditioning concepts.
 
We did flexibility therapy and addressed all of his scars, adhesions, inflammation, and range of motion issues.
 
What was the result?  He got back to running and has even done some half marathons and a tri-athalon.  He just needed more time and to progress his rehab beyond what insurance would pay for to train toward his goal of running.
 
2.  DON’T IGNORE PAIN.  I still have trouble with this one even after years of working with clients that have injuries and chronic pain and dealing with my own injuries. 
 
Last summer I had neck pain that I ignored and waited too long to get help so it took much longer to heal.  I also re-injured it while I was going through rehab because I returned to my normal activities and workouts too fast.
 
It’s best to address the pain as soon as it starts nagging at you and give it the time it needs to heal fully.  I’ll share some ways to do that in the next section.
 
3.  DON’T LIMIT YOURSELF TO ONE OPINION.  If you are considering surgery, you have a right to get as many opinions as you need to feel comfortable with your decision (I recommend minimum 2-3 sometimes 4 when making important decisions about your health). 
 
I had a client who was a retired, avid golfer and was told by 3 orthopedic surgeons that he needed a 4 level fusion of his spine due to narrowing (spinal stenosis) and he would have to give up golf!  For my client, that would be completely disabling to never play again.  Luckily, he had a friend in Houston that gave him the name of a neurosurgeon to get another opinion.
 
As it turned out, the neurosurgeon told my client that he could do the surgery without fusing him and that he could play golf as long as the client promised to stay away from golf for at least 6 months after surgery.  He also had to agree to begin Pilates Rehab after his outpatient physical therapy ended.
 
How could this surgeon’s procedure provide such a different outcome than the other surgeons?  His explanation was that he does 1000’s of these procedures a year with a team who has been with him for years and he is able to take his time and goes in from a different angle/approach.
 
Who do you think my client went with?  Of course, the neurosurgeon!  He did wonderful.  I saw him for his Pilates Rehab and he did return to golf 6-7 months after his surgery.  As a bonus for following his post-op recommendations, he learned a lot of new tools to take care of his body so he could continue to play golf as he aged.
 
What’s the take away? Do your research and get several opinions when making important decisions like this one.  Also follow the recovery recommendations of the practitioner you have decided to work with. Seek out someone near a Medical Center or has experience working in one whenever possible.  The cutting edge techniques and complex injuries and illnesses professionals are exposed to in those environments is on another level.
 
Now that you know what mistakes to avoid, here are 4 things you can do to GO PRO with your Recovery:

1.  GET A TEAM.  Build a group of practitioners that you can go to when you start something new and feel new aches, pains, and imbalances or when pain or issues flare up.  Your “team” should also help you stay out of the GAP so you can return to 100% after an injury or surgery. Here are some resources to consider:

Physical Therapy: PT’s are licensed health care professionals who can help you reduce pain and improve or restore mobility - in many cases without expensive surgery and often reducing the need for long-term use of prescription medications and their side effects. 

• PT’s are movement specialists that will provide a customized exercise program to promote the ability to move, reduce pain, restore function, and prevent disability.
• Treatment techniques to look for: kinesiotape, manual therapy and myofascial relief skills, and dry needling for trigger points in muscles (available in some states).
• Pelvic Floor Physical Therapy:  A specialty of Physical Therapy that uses hands-on physical therapy to stretch, strengthen and relax muscles in the lower pelvis. The physical therapist uses a massage-like technique, known as myofascial release, to help stretch and release the fascia (connective tissue between the skin and underlying muscle and bones). Pelvic floor physical therapy can be used to treat unremitting vaginal or pelvic pain as well as other causes of dyspareunia or urinary incontinence.  Some nurse practitioners also have this training. 

 
Fascial Stretch Therapy:  a form of flexibility training, also called FST that is our favorite tool for improving performance and preventing injury. Nothing gets into the nooks and crannies like FST to unlock range of motion.

We provide this type offlexibility training or you can go to www.stretchtowin.com to find a provider for your area.  All types of health care practitioners have trained in this technique, for fitness or rehab, to improve flexibility, decrease pain and prevent injury in a gentle, painless way.   FYI- for the first time in history, both Super Bowl 50 teams had practitioners providing FST to the players.

Acupuncture: one form of traditional Chinese medicine where the practitioner inserts needles into specific points on the body to alleviate pain and to treat various physical, mental, and emotional conditions.   Studies suggest it can help relieve chronic low back pain, dental pain, migraine headaches, fibromyalgia and osteoarthritis.  It has also been used to treat addiction, anxiety, depression, digestive complaints, and neurological problems. 

Chiropractic care:  is a form of alternative medicine that focuses on diagnosis and treatment of mechanical disorders of the musculoskeletal system, especially the spine, under the belief that these disorders affect general health via the nervous system.  Look for a chiropractor that has done advanced training and possibly provides ART (active release technique), acupuncture or FST.
 
PM&R (Physical Medicine and Rehab Physician) or DO (Doctor of Osteopathic Medicine) Pain Management Specialist.  They typically understand your rehab/therapy options and have various injections that they can offer for pain relief while avoiding the narcotics route.
 
2.  GET OUT OF PAIN.  Don’t try to push through pain.  It is not an effective strategy.  I already shared about avoiding the mistake of ignoring pain. 
 
There are all kinds of pain management strategies available that don’t involve popping pills.  If you don’t have any, then seek out help from your “team”.
 
3.  GET RID OF INFLAMMATION.  There are a lot of DIY strategies you can implement to help with inflammation and swelling.  It’s important to address because it will interfere with muscle function and proper movement when present. 
 
A few strategies to decrease inflammation are proper hydration and rest, ice packs, modifying and slowing your daily activities, anti-inflammatory diet, anti-oxidants, trigger point self-massage, kinesiotape, compression garments, Epsom salt baths and moving more.  Ask your “team” for more ideas and guidance.
 
4.  GET BALANCED.  Improve and balance your strength, flexibility, and coordination on both sides of your body through methods provided by Pilates Rehab, Yoga Therapy or Sports Rehab/Conditioning programs. 
 
Find someone that has a rehab background and possibly works with athletes especially if you want to return to a high level of performance as they will likely have more tools to offer you.

FINAL GO PRO TIPS:

• No practitioner can be with you daily so you need to follow their home exercise program recommendations and guidelines as you heal or progress.  I had to do this with my neck injury.  When I realized what I was doing wasn’t working, I modified my activities as recommended by my chiropractor and acupuncturist.   I made my daily rehab exercise program a priority, limited my work time on the computer, and made a point to move more throughout the day.  I set alarms and scheduled my exercises and rest breaks in my calendar so I wouldn’t forget when I got busy.  I’m a movement specialist and I still had to commit to my home program!

• Don’t forget you are still fragile as you are healing.  Go slow as you get back into normal activities or try new ones even when you start to feel better or have less pain.  Follow your “team’s” advice on how to progress safely.

• Learn to take daily care of your tissue.  Healthy tissue is elastic and free of adhesions and trigger points.  A daily routine of gentle stretching and trigger point self-massage is critical as you age.  The more contact involved in your sport, the more important this becomes.  And yes, running is a contact sport (due to the impact with the ground)!  

 
       My #1 DIY pain management strategy is trigger point self-massage.  I recommend the Trigger Point
       Performance brand.  A Starter Kit is a good place to begin or the Knee kit for runners.

• Remember, if you already went through one course of rehab for your injury, it’s OK to do a tune up to allow your therapist to progress you. 

 
You have to take control of your recovery.  If you are not where you want to be, then it’s up to you to do something about it.  It’s never too late.  ANYTHING is POSSIBLE.
 
Now, I’m curious.   Do you have any GO PRO tips for staying out of the gap after an injury?  If you do, please share in the comments below.  I would love to hear them.
 
 
Avoid the GAP! Go Pro!
Mollie

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