My friends and family often refer to me as “Dr. Beth”. Obviously I’m not a medical doctor, but as a Certified Athletic Trainer I’ve had plenty of experience evaluating injuries over the past 20 years, and many come to me to figure out what’s wrong with them when other attempts are healing have failed. Now, the acute sports injuries are always the most exciting – the broken bones, dislocated shoulders, head injuries. Not that I wish it upon anyone, but that adrenaline rush you get when putting an elbow back into it’s joint or stabilizing a scared football player until the EMS can get there is a bit addicting. It’s a good feeling to know that you play an essential role in a critical time of need, but really those aren’t the injuries that I most like to work with.
Instead, I prefer the chronic and recurring injuries. That hip pain that won’t go away, or the knee that continues to give out and flare up. Figuring out the “why” of these injuries is much more challenging, and therefore rewarding, in the long run. And it happens to be what I’m good at, and why my close friends often come to me with questions first.
Here’s a secret that many don’t realize. The reason that the pain continues to return and keeps you from making progress in your training is usually because the true cause hasn’t been corrected. Here’s what I see from most of the athletes who come to me.
They’ve gone to a doctor for a knee injury and are sent home with a quad strengthening rehab sheet, instructions to keep it easy on training, and a prescription for pain med (either just OTC or true prescription). They take the meds and rest. They might do some of the rehab, but the meds and rest make them feel well enough to give training a go. The first time or two out feel pretty good, but then the pain returns. And the swelling. And now more time off of training as a result. If they do go back to the doctor, usually an MRI is ordered and possible “exploratory surgery” to see if there a rascal hiding in there that’s causing all of this chaos. Usually there’s not… or is there?
In these case there probably is a rascal hiding in there, but the docs just weren’t looking in the right spot. You see, when we have pain in our knees, it’s often a symptom that there is an issue elsewhere in the chain, and 90% of the time it comes down to our core strength and how we move. If our bodies aren’t in proper alignment to position the muscles and joints in a way where they have their full capabilities to support our skeleton, then 2 things happen. First, we’re not able to harvest the true function of our muscles which leads to less structural support and reduced performance. Second, are bones are shifted enough to start creating wear patterns that aren’t mean to be there. Similar to when the alignment in your car is off. The wear begins in one area, but usually the “break” happens somewhere else.
To truly heal this condition we have to break everything down to find that rascal hidden in our bodies that’s causing this bad movement pattern. We need to identify the weaknesses and start fixing them. Once we find that rascal, we need to turn the habits around to become beneficial to us. When we step back from our training and relearn the correct movement patterns, we start encouraging those pesky areas to start working with us instead of against us. Although it can take time, stepping back to address alignment, biomechanics/movement, and Vital Core strength will keep us training pain free for the long haul. So let’s look at another case.
My athlete has been coming in before and after practice for stim and ice, and sometimes rolling and massage, for hip issues. She just assumes it’s a result of her training and has been told by her chiropractor to do this. She gets adjusted once a week because a rib is out of place and her legs are not even, which is believed to be the cause of the pain. There is no adjust ment to the training plan and no rehab given by the chiropractor. Simply adjust, train as tolerated, and treat with modalities (pain meds, ice, heat, stim/TENS, rolling, etc). This has been going on for months. It gets slightly better during the off-season, but then resumes once training load increase.
Anyone else see that red flag?
So, #1 thing – modalities help us tolerate pain but do nothing to help heal us. Plain and simple. Ice can sometimes help reduce inflammation during the very acute stages of healing, but even this is becoming a debatable topic. The rest are simply a mind trick to your brain. You see, your nervous system is efficient and can only deliver one sensation message to your brain at a time. So we use things like ice, heat, stim, and even analgesic rubs (Biofreeze, Icy Hot, Deep Blue, Tiger Balm, etc) to try to override the pain signal. Instead of feeling pain, our bodies with feel the sensation of whatever medium we’ve put there. It’s a great benefit for the time that the modality is being applied, but it’s not healing anything. Check out the “Gate Control Theory” for more on this.
On a side note – if you’re pregnant, I highly suggested buying or renting an OB TENS unit for your labor. HUGE help.
Now let’s move on to #2. I’m not here to bad mouth any medical profession. As you all know, I’m a huge fan of collaboration in treating conditions, and with that said, in my opinion, chiropractic adjustments are not a miracle pill. Here’s why. It’s true that our muscles get tight and can pull our bones and joints out of alignment, and adjustment are extremely useful to getting these back into good position. But the reason we have to continue to get adjusted it because those muscles remain shortened and continue to pull our skeleton out of alignment. The purpose of the adjustments in to “train” our muscles to return to their optimal length and keep us aligned. And all of this is spot-on and great, but here’s my beef. Where is the rehab? Where is the discussion on habit and biomechanical changes that are root of us being out of alignment? Because, if we don’t change those, then we’re never going to train our muscles to stay at their optimal length. The forces of our movement patterns are greater than an adjustment simply because we put our bodies through them 17-24 hours a day! We have to offset these movement patterns and retrain the function of the muscle if we really want to it behave and not pull structures out of alignment. The combination of the adjustments and stripping our training and daily habits down to expose the flaws and then retraining how our muscles move is what will start making the biggest changes – both in our pain levels and our performance.
I am always ecstatic when I meet a chiropractor who gets what I’m going and will work with me, unfortunately this doesn’t happen as much as I’d like it to. But when it does, amazing things happen because I can take the physical diagnosis and devise restoratives, rehab, and a progressive training plan that actually resolves the condition and keeps my athlete training in some capacity. It’s a truly lovely thing – works well with Physical Therapist (ortho or women’s health) and Massage Therapists too.
So what’s my point in all of this? It’s basically that if you’re frustrated in your recurring pain and/or injury and inability to train and play as you’d like to because of it, then there’s a pretty good change that there’s an underlying cause that’s not being addressed. Yes, you might need to step back from your intensity of training to resolve the underlying issue, but your ability to do so will improve both your mental and physical game. You have to find the balance of finding rehab to truly fix the issue cause pain, but also allow you to continue training in a way that maintains your level of conditioning during this RE-Boot of your movement system.
The athlete mindset makes it so difficult for us to take “time off” from our training, but really that’s the last thing we’re doing when we step back for rehabilitation. Instead, we are making a more dedicated effort in our performance training in our focus of correct movement patterns that are slowing us down – both in injury and in performance. Although the type of training we’re doing shifts, we’re still 100% dedicated in our efforts and to our sport. Our competition timeline might shift a bit into the future, but that just gives us all the time to train correctly to make the comeback of a lifetime. You do your rehab right, and you competition won’t see you coming!
Are you ready to start your own RE-Boot? Download my Daily RE-Boot guide and 30-Day plan to get you on the path for pain free play and performance.