One of the issues that comes up frequently in an active rehabilitation context is the re-aggravation of an existing injury that often happens during the recovery process.
In our minds, healing and recovery often looks like a straight line graph: The start point is the injury, and the end-point is feeling back to 100% normal. In reality, the graph would look much more like a jagged zig-zag of a line with almost countless small peaks and deep valleys, and the occasional prolonged plateau.
One of the most common comments we get from patients is that they felt great one day, and then the next day they felt like they were right back where they had started. Often, this experience leads to frustration and disappointment, because it makes the individual feel like they are not making any progress and that they will never achieve a better quality of life, improved pain management, or higher level of physical function.
What is hard to understand from inside that experience is the small milestones and achievements that happen throughout the recovery process. It’s hard to celebrate being able to raise your arm over your head for the first time in months, or your first step taken without a limp, when you are focussed on your end goal of being able to wash your hair or go for a run or hike.
What is often missed during this time of frustration is the reason why you are having the “flare up,” which is often BECAUSE you felt better the day before. It’s a basic feature of human nature to do everything you can to the full extent of whatever your abilities are at the time. When abilities are limited due to an injury, you are constantly pushing right to the edge of what you can do on a daily basis. So when you feel better for a day, you are naturally going to do everything you can because for once you feel like you are able to do you! The unfortunate consequence is that you will exhaust your resources and push your physical boundaries, so the next day tends to result in feeling exhausted and sore.
It works on much the same principle as how you would feel if you decided to run a half marathon without training for it. Afterwards you would expect to be sore and exhausted and TEMPORARILY be unable to do a lot of things, because you pushed your body beyond the limits of what you would normally have been able to do. In the same way that your body needs to recover from an intense workout, your body needs to recover when you’ve pushed the boundaries of your 'in-progress' level of function. Just remember you cannot compare to your pre-injury level of function just yet. Wait until you are closer to 90% recovered to start comparing to the end goal. Remember you are in the RECOVERY phase of healing.
That being said, we will often encourage some boundary pushing as part of your active rehabilitation process. If you never push hard enough to find out where your boundaries are, you won’t know when you have made significant progress. The trick is to find a balance of pushing them enough that you continue to see improvement, but not so hard that you have to spend the better part of a week getting back to where you were before you started. Often, especially early in the recovery process, those pushes are much more subtle than you would like, and it’s hard to see where progress is being made. When it comes to that, it is helpful to have objective baseline measurements and the guidance of an experienced therapist to gently point you in an appropriate direction.
A few things we often recommend to our patients and that we will keep track for you are:
Objective, specific details about current abilities, examples:
Range of motion
Functional movements (Eg. squats, getting up off the floor, ability to wash hair)
Perceived pain (0-10 pain scale)
Frequency of headaches/other symptoms
Energy Level on a daily or weekly basis
There are many more, and they will always be selected to be appropriate to each patient’s circumstances. Having a few key items to track allows you to feel some reassurance when from the inside, you don’t feel like you are making any progress. These measures can also help your therapist to determine if the current program is appropriate, or if it needs to be altered to better suit your needs.
The goal of active rehabilitation is always to get you back to as close to 100% as possible; however long it takes, and however many peaks, plateaus, and valleys your individual graph looks like. “Bad Days” or “Flare up” may feel like you’re taking two steps backwards, but often they are an indication that you felt good enough to try something you had previously been unable to do - and that is a clear sign of progress. So try not to let those "bad days' drag you down!!
Think about an active rehabilitation plan supervised by your Physiotherapist or Kinesiologist for your Road to Injury Recovery.