“The wound is the place where the Light enters you.” – Rumi
Taking some time off from training to care for ourselves, either to recover from injury, illness or a surgery, will at some point surely become a necessary (but hopefully infrequent) aspect of leading an active lifestyle. With the foreknowledge that catabolism (muscle breakdown), insulin resistance and elevated cortisol levels will be an inevitable part of the healing process, can we hope to somehow manage the losses and expedite the return to an even better tomorrow? The short answer is a resounding “Yes!”
Movement is life, and moving well is living well. Leading an adventurous lifestyle of any kind does, unfortunately, involve the risk having to set aside time for healing occasionally; planned or unplanned. In order to give oneself the best chance of an expedient and successful recovery from the setback of an athletic injury or to recover from a necessary surgery, it’s a good idea to prioritize two things; strength training and community.
It might seem obvious that getting as strong as possible before having to undergo such an ordeal and getting moving again as quickly as possible afterwards would speed up recovery time but when faced with the actual challenge “in the flesh,” so to speak, even the most hearty among us can feel daunted. When we’re hurt, we tend to get really scared of being more hurt, and unfortunately that fear holds us back from getting better faster. Understanding the biological processes associated with the phases of healing can help us take heart, and with a strong community to support us we need not fear the pitfalls on the road to recovery.
“Reject your sense of injury and the injury itself disappears.” – Marcus Aurelius
Research suggests that we can lose up to about 10% of our muscle tissue and experience a reduction of 30% of muscle protein synthesis for every two weeks we are immobilized by an enforced rest or something like a surgical recovery. This means that the stronger we are and the more lean muscle we carry before going into a surgery or having to take time off due to an injury, the less this inevitable period of immobilization will impact us. Think of it this way, if a body has a very low proportion of lean muscle tissue before being laid up, then the loss of even a small amount is going to mean a lot; effectively taking a body from already weak to downright feeble. But if that body carries a high proportion of muscle mass, it can more easily afford to lose a little without being seriously compromised; going from very strong to maybe just somewhat strong. Sounds a lot better, doesn’t it? Pre-habilitation can make a recovery hole that we may find ourselves having to climb out of a lot less deep. In a sense, recovery actually begins before an injury or a surgery takes place by making sure the body is as strong as possible beforehand.
Even assuming that we’re feeling strong going into an ordeal, it can be very tempting during a recuperation period to eschew all forms of exercise. Especially considering that while tissues are in the first two phases of healing, we can experience a lot of pain and discomfort. First we have to get through an Inflammatory Phase, where there can be lots of swelling and any dead tissues are actually being consumed by our own bodies. Then there’s a Proliferation Phase, where those recycled resources are used to form new immature tissues with type III collagen. This process can take… a good long while. Avoiding all forms of movement training for that entire period of convalescence might amount to months of straight muscle loss while all of the body’s joints just stiffen up because they are given the clear message that they don’t need to maintain their full functional work spaces!
Recent medical research indicates that early mobilization after surgery lowers the risk of complications, swelling and loss of cardiovascular endurance. As such, getting moving again as soon as possible after an injury, even while feeling sore, sluggish, doing modified programming and possibly even wearing a cast or a brace, is crucial to minimize the rehabilitation time. But how does one avoid getting it all wrong, taking too many risks with resistance training and sabotaging one’s own recovery? This is where community really comes in.
“We don’t heal in isolation, but in community.” S. Kelley Harrell
Although challenging, adaptive training during a recovery period can be an experience filled with failsafes, encouragement and just the right dose of accountability. Going it alone just isn’t as successful. A solid support system of family, friends, therapists, coaches and training partners makes all the difference. Of course, it does help to have a basic understanding of the phases of healing that our tissues have to go through in order to take confident ownership of the process and not put all the responsibility on the rest of our support team. As described above, the first two phases, Inflammatory and Proliferative, can be fairly delicate and unpleasant. Gentle mobility work, with a minimum of pain and discomfort, will help to facilitate blood flow, reduce stiffness and allow the weaker type III collagen layers to form. During this phase of recovery we can maximize progress by putting the non-injured body parts through some fairly normal looking, even vigorous, bodyweight-only or appropriately loaded drills while keeping the movement in the injured area barely perceptible. Injury recovery, and not training recovery, must remain the priority for the body’s limited adaptive resources throughout this period.
When we enter the Maturation or Remodeling phase (which starts about six weeks following the initial trauma and can last for up to two years) the immature type III collagen layers start converting into more robust type I’s. This is the phase where a return to full function begins to take shape because of, and not in spite of, closely monitored optimal loading and controlled manipulation of the injured area. An appropriate level of stress, applied in a creeping, incremental, progression must be diligently followed throughout this long period of healing in order to get as close as possible to our prior level of performance. Unfortunately, this is often the time when we have exhausted our available physical therapy sessions or we just become scared, bored and disillusioned with the whole process; settling for a level of recuperation which is far from our true potential! Consistency over time (much longer than we think) is the only sure method to maximize results.
With several months of properly periodized corrective exercise and resistance training adapted to suit the given circumstances, plus the support of a strong community, recovering athletes are able to achieve results that might have seemed impossible when they were side-lined. A new version of “full function” is not an unreasonable goal in more cases than we often think when we’re alone with our thoughts and trying to figure things out by ourselves. So if you happen to be a fellow traveller out there on the long comeback trail, consider becoming a strong member of a strong community, if you aren’t already. Coaching and training with a group of powerful people might be the closest thing to a panacea that one could hope for.
“Strength isn’t what keeps you from breaking. It’s what lets you put yourself back together without pretending the break didn’t happen” — Annie Wright