Following an injury or illness, we all want to know, “when can I or when should I return to doing the things I was doing before I was injured or sick”. As a rehabilitation professional, there are principles and processes that guide us as we give advice for return to activity:
1) Know the usual progression of injury or illness.
2) Understand what pain means at different stages of the process
a. Initial pain tells you injury may have happened to your tissues
b. The intensity of initial pain isn’t always a good indicator of the magnitude or extent of tissue injury
c. Pain in the first 1-2 weeks after the initial injury reminds you to pay attention to the injury, but doesn’t mean you’ve damage the tissues again
d. Pain with activity during the next 2-4 weeks reminds you that you should work up to your previous activity level incrementally. If the intensity of pain doesn’t increase with more repetitions or load, the activity is appropriate to perform
e. Pain after 6 weeks is reminding you still have some robustness to build back into the tissue through exercises.
f. Pain experienced the morning after performing activity that was strenuous but comfortable the day before, tells you your tissue was not quite ready for that much activity.
3) Take incremental steps back to the desired activity, based on testing rather than guessing. This means decreasing the intensity and duration but still performing the desired activity. Some examples include:
a. If you have had knee surgery this may mean testing what your response is to stepping up a 2-inch step for a day or two. If that goes well, either increasing the height of the step to 4 inches or increasing the amount of repetitions you do.
b. If you’ve had an ankle sprain the testing might include lunging to the side, jumping to the side, hopping to the side, running and cutting at 50% speed, then full speed, then sport specific drills, then practice, then competition.
c. If you have back pain, test would include squatting, bending forward, bending farther forward, lifting in mid-range, lifting heavier in mid-range, and the lifting from low levels, and then lifting heavier from low levels.
By taking incremental steps, you allow your warning system (pain) to react to the injured tissue’s response to the load, rather than basing its warning on what your brain anticipates, based on the initial mechanism of injury. Following these principles gives you a way to take the next step forward in returning to what you want and need to do.