How to determine the timing of sports injury recovery training

When you meet the three conditions of "the pain is within the safe threshold, there is no structural instability at the injured site, and the basic functions have been restored to more than 70% of the healthy side", you can start restorative training. There is no need to wait until "no pain at all" before moving. This is also the current consensus in the field of sports rehabilitation that has been verified by a large number of clinical trials. Too early will cause secondary injuries, and too late will lead to muscle atrophy and decreased joint mobility, which will prolong the recovery cycle.

Last week, a young man came to my clinic who sprained his foot after running a half-marathon. He lay at home for 10 days, tiptoed even when he went downstairs to buy food. He made sure that walking did not hurt at all before coming for an evaluation. The result was that the calf circumference of the affected side was 1.2cm smaller than the unaffected side. The recovery that was supposed to be completed in two weeks had to take an extra three weeks of muscle strengthening classes. I have encountered more than 20 cases of similar situations in the past six months.

Interestingly, in the development of sports rehabilitation, there has been debate about the timing of recovery for decades. In the early years, the traditional orthopedics school was basically a fan of the "complete rest school". It was believed that as long as there is still pain, it means that the inflammation has not gone away and absolute immobilization is necessary. This view is still applicable to serious injuries such as fractures and complete ligament rupture. Many retired old team doctors I know still strictly require lying down for a long enough time when treating injuries of young players. There is no problem. However, with the development of sports medicine in the past ten years, the "early activist" group has gradually become the mainstream. This is the POLICE principle that everyone often hears now, which requires isometric contraction to begin after the acute phase (usually 48-72 hours after injury) to avoid muscle disuse atrophy. This logic also holds true, but the premise is that you must first confirm that the injury has no structural problems.

First, let’s talk about the pain threshold that is easiest for everyone to judge. I usually give patients a standard of 0-3 pain points which is safe - out of 10 points, 3 points is probably the degree of slight itching and pain after being bitten by a mosquito. You can’t help but hide when you press it. There is only muscle soreness when moving, without sharp stinging, pulling pain or numbness. There used to be a girl who played badminton with a mild rotator cuff injury. She followed online rehabilitation videos at home and felt a stinging pain every time she raised her arm to a certain angle. She thought it was "normal adhesion pain" and gritted her teeth and practiced for two months. The injury that was supposed to be healed in three weeks turned into a chronic inflammation, and she struggled to even comb her hair. You must know that "stop when it hurts" and "break through the pain limit" are both extremes. Soreness and swelling are signals of muscle activation, and tingling is the body's alarm.

The pain is easy to judge, but the structural stability is difficult for ordinary people to determine by themselves. For example, after an ankle joint is sprained, many people think that it will be fine if they can walk. However, if they can feel the ligaments loosening when they sway sideways, it means that they have not grown properly. At this time, running and jumping in a hurry can easily turn into a habitual sprain. Last year, I met a young man who played basketball. His anterior cruciate ligament was partially torn. He rested at home for two weeks and felt that walking no longer hurt. He secretly ran to play basketball, but a sudden change of direction completely severed the ligament. He eventually underwent reconstructive surgery and he didn’t touch a ball for half a year. Don’t skip this step. Either ask a rehabilitation practitioner to do a stress test or take an MRI to confirm that the continuity of the injured area has been restored. Don’t gamble on your joints.

If the first two are satisfied, the basic functions will be tested at the end. There is no need to buy any complicated equipment. The grip strength of the upper limbs will be tested to see if it can reach 70% of the uninjured side. The lower limbs will be tested to stand on one leg. Can you stand with your eyes open for 30 seconds without shaking, and squat to 90 degrees without any obvious limitation of force production. There used to be a cross-country running enthusiast who sprained his ankle and was able to walk without much pain. However, he could only stand on one leg for 10 seconds. He refused to listen and insisted on climbing the mountain. As a result, he sprained it again when going downhill. He repeated it three times. Now he has to be careful when wearing high heels. If you're not sure about this step, I usually have a wild method: do the movement that caused the injury in slow motion. For example, if you jumped up and landed on the ground and twisted your foot, then slowly do the movement of landing on one leg. If there is no pain and no jamming during the whole process, then there is basically no problem.

There are a lot of opinions on the Internet about the timing of recovery. Some people say that you must wait until there is no pain before moving, and some say that you must practice the next day after the injury. In fact, they are only half right. For serious structural injuries such as fractures and ligament rupture, you really have to wait until the doctor says you can move again. If it is just a mild muscle strain or ligament sprain, there is no need to lie down until it doesn't hurt at all. As long as those three conditions are met, recovery will be faster if you start it earlier.

To be honest, there has never been a unified timetable for recovery time. Some people are young and have good metabolism, and can return to the court after a week after spraining their ankles. Some people usually do little exercise and may need to rest for a month before they can move. Don't compare your progress with others. If you are really not sure, find a professional rehabilitation therapist for evaluation and spend dozens of dollars to register. It is better than messing around until you get injured twice and lie down for three months, right?