The Science of Physio

REHABING A BROKEN PHYSIO

If you've ever wondered how a physio goes about rehabing their injuries, this is your chance. Here’s a glimpse into my recovery process after busting my ankle at the start of the climbing season:

Week 1 (May 17th)

I busted my ankle on Super Dyke. For those of you familiar with the climb, you'll guess exactly where: between the boulder and the tree. My foot blew off the slab quite unexpectedly (I was feeling invincible that night!) and went crashing down onto the tree root below me. My left foot landed flat and my knee proceeded to continue moving forward. For you anatomy buffs, I hyperdorsiflexed my ankle. I did a couple of quick tests which told me I should get an x-ray to rule out a fracture…

 

No fractures!

 

The next day I woke up with a very swollen ankle, unable to put very much weight through my foot. It was clear this wouldn't exactly be a quick recovery.

Swollen ankle

At this point most people would think about RICE. Ever hear of it?

REST.

ICE.

COMPRESS.

ELEVATE.

DID I REST?  

I sure did! I avoided anything that was painful. In fact it's the only thing I could do. That's the beauty of pain and inflammation - it stops you from causing further harm when the system is weak and trying to repair itself.

DID I ICE?

I did NOT. Here's why:

Ice is thought to help slow or even prevent the effects of inflammation. It turns out the inflammatory process plays a very important role in healing. In fact this is exactly what HEALS your injuries, so why would you want to take it away? You shouldn’t take it away. Trust your body to heal itself - it does a great job!

To add insult to injury, when we look at the research, it turns out ice probably doesn’t even penetrate deep enough to have an effect on the inflammatory process. There is no strong evidence to suggest that icing an injury will accelerate your healing time.

Some will say we should use ice to help manage pain. While ice may help reduce your pain, I would argue that pain is very useful and a natural part of the healing process, especially in the acute phase. It tells you to back off! I chose not to use ice for pain management mostly because I could adequately control my pain by resting and protecting my ankle. If you push through the pain and use ice as a management strategy you’re not doing yourself or your injury a favour. In fact pushing through your injury at an early stage may in fact prolong your recovery period.

DID I COMPRESS?

This one isn't as clear cut as icing. Some studies have shown positive results on healing time and pain, while others have shown it to be ineffective. So what did I do? I wore tight ski socks and wrapped it with a tensor for a couple of hours here and there. I could visibly see a decrease in swelling with aggressive wrapping but it's questionable as to whether it had an effect. Just because the swelling is temporarily reduced, doesn't mean this accelerates healing time.

As far as pain goes, I experienced more pain immediately after removing the dressing. This would lead me to think that compression is helpful in controlling pain. What's more likely is that I experienced a temporary increase in pain as the ankle returned to its more natural swollen state. In other words, the ankle wants to be swollen because of damaged blood vessels and permeable cell membranes. The body will repair this over time and swelling will come down naturally with a little help from specific exercises.

DID I ELEVATE?

Surprisingly, this is the least studied of the RICE recommendations. Intuitively, it makes sense to elevate for swelling control, especially if it helps with pain.

Did I elevate it? Yes! I elevated it whenever it was throbbing or aching. Having it high above my heart was the most comfortable position. If it wasn't bothering me, I had it resting on the coffee table or planted on the ground. This is arguably the equivalent of resting my ankle.

What did I do?

If I didn't ice, or do much compressing, and wasn't religious about elevating it, it doesn't sound like I did much, does it? To the contrary, I did quite a bit.

 

Protection and Optimal Loading

I moved my ankle and toes as much as I could through it's available pain free range. I did so in non-weight bearing positions, but also with my foot planted on the ground. I used the help of a belt to move it around, but also did so actively with my ankle and foot muscles. I let pain be my guide. I would avoid anything that brought on an increase in pain, trusting that when I felt pain it was more so a warning sign as opposed to an indication that I was causing more harm (see video below).

I practiced walking as normally as I could using crutches. I also started moving my left knee, hip and back to help avoid the effects of disuse. I used my physio stool to load my left hip, which helped a lot with work! I was even able to get into the pool and tread water lightly. In essence, I tried to be as active as possible without aggravating my ankle.

 

WEEK 2:

 

It turns out my ankle was in fact broken... and I needed surgery.

 


 

To be continued...

 

A Question for my Colleagues

Pain is an incredibly complex phenomenon, and as health professionals we often have a limited understanding of why or how people may experience it (believe it or not!). This article is for my colleagues in the health world - are we doing more harm than good? Lorimer Moseley is a leading researcher and physiotherapist on pain science. In his article First, do no Harmhe explores whether the knowledge we impart on clients causes more harm than good. Have a gander and share your thoughts! 

http://www.bodyinmind.org/clinicians-do-no-harm-pain-management/

Acupuncture: Does it Work?

Acupuncture has picked up a fair bit of fanfare in the rehab world. Many health professionals have started using it as a means of managing a client's pain. Is it effective? I'm not so sure. Check out this article by Dr. Colquhoun and Dr. Novella for their take on accupuncture and it's use in managing pain. 

https://www.sciencebasedmedicine.org/acupuncture-doesnt-work/

MRIs: The Gold Standard?

There's been a number of studies looking at whether imaging effectively demonstrates cause and effect for various pain conditions. In other words, can the bulging disk in your MRI effectively explain the pain you're experiencing? In a recent study, researchers have shown that the majority of healthy people (even young adults) show signs of disc bulging. It's a fascinating read! These studies are changing the way we think about pathology and pain. Have a read! 

http://www.ncbi.nlm.nih.gov/pubmed/25584950/

Explain Pain by Lorimer Moseley and David Butler

Pain is an incredibly complex phenomenon that deserves explaining. Hence Explain Pain, by Lorimer Moseley and David Butler. This book helps clarify the who, what, where, why, when and how of pain in an easy to understand and interactive format. If you're a chronic pain sufferer this resource should be your bible. Have a gander!

http://www.noigroup.com/en/Category/EP

By William Bateman