Injury – The nemesis of training (Part 2)
In Part 1 we discussed the healing cascade and the commonly recommended solution to address strains and sprains. The R.I.C.E + anti-inflammatory method of treatment, depending on severity of injury, usually allows one to return function within days or weeks and minimizes the pain during this period of recovery.
The healing cascade clearly shows the importance of mobilizing materials (ie damaged tissue, various cell types and nutrients etc to perform the actual healing). The R.I.C.E + anti-inflammatory treatment protocol shows that its primary function is to inhibit the inflammatory phase for increased comfort while healing. However, doing so has the negative consequence of hindering movement of all the materials needed for healing.
Once again, I have to ask, why on earth would we want to willingly inhibit the movement of materials that are critical for healing and if we do employ such methods what’s at risk?
To answer that question, let’s take a closer look at tendons/ligaments and the role they play in the body.
Tendons are tough, collagen based, inelastic structures. Tendons attach muscle to bone and transfer the muscles tension and contraction into movement.
Ligaments are also tough and collagen based but do have some flexibility and attach bones to other bones.
These tissues are incredibly strong. They are able to take massive loads and transfer incredible amounts of contractile force into movement. Their shortfall however is in their ability to heal. Every cell in the human body has a life span. A given cells lifespan varies greatly depending on the type of cell. For example, red blood cells have a life span of approx. 115 days. Skin cells have a lifespan of a couple weeks. The cells that make up tendons and ligaments have a life span ranging from 300-500 days and these tissues lack the vascularity of many other tissues in the body. This all lends itself to very slow healing.
Most medical professionals will claim that wounds generally only heal to approx. 80% of their original structural integrity and claim that applies to tendons and ligaments as well. There are many published medical papers on the process of tendon/ligament healing that validate this claim.
Once again, I can’t help but to look back at the healing cascade, the chain of events that occur and the complete reliance on materials from each phase that go into a complete injury repair and I have to ask, why on earth would anyone want to intentionally interfere with the healing process and even more importantly what can happen if we do?
Each phase of the healing cascade relies heavily on actions from the previous phase. If one of these phases is interrupted or shunted the end result is that the healing process is suboptimal and, in some cases, nearly halted altogether.
If you’re the average couch potato, sacrificing healing for pain remediation may seem like a fair trade but the long-term effects can be devastating. If it’s a tendon injury you will be more susceptible to reinjury during muscle contractions. Once again if you’re a couch potato this may not seem important because you don’t exercise or lift weights. However, the body has remarkable, built-in safety mechanisms. Have you ever had a small slip? Perhaps misjudged a small grade change and stumbled? Have you ever pulled a muscle when this happened or even suffered some post slip muscle soreness? In an effort to avoid falling to the ground during a slip or stumble the body can and will automatically contract various muscles in an effort to prevent a face plant. In some cases, this violent contraction can be so severe it tears muscle tissue or worse and on occasion where unhealed or improperly healed tendon injuries exist can actually cause a tendon to rapture, tearing it free from the bone. Similar things can happen during accidents or physical collisions with other people or objects. The bodies natural flinch response can be quite violent and having tendons in a weakened, partially healed state, simply means you are more likely to suffer a catastrophic injury.
Unhealed ligaments pose a more insidious problem known as joint laxity. Since the role of ligaments is to attach bones to other bones and support our skeleton, weakened or damaged ligaments can pose some serious, permanent, long-term damage if not addressed.
To highlight this scenario, let’s use the back as an example. The injury could have been from lifting something heavy or even a car accident but suffice it to say there was some trauma that damaged the ligaments that attach to and support the spine. In a perfect world, the various ligaments that support the spine are applying equal force and tension from the various directions. Between our vertebra, we have discs that act as shock absorbers isolating the vertebra from each other and through the vertebra is our spinal cord. We have root nerves that also reach out from our spinal cord between the vertebra and spread out to control the various tissues of our body. When the ligaments are in good health they keep the spine in alignment and the pressure distributed evenly on the discs between them. When a ligament sustains an injury it can result in a loss of tensile strength and flexibility. Much like a rubber band that you have stretched dozens of times to near its limit. When this occurs, you end up with uneven tension and support of a given joint. This, in turn, leads to uneven pressure on the various tissues designed to isolate bones (ie cartilage, discs etc) from their neighboring bones.
Over time, this uneven pressure on the joint tissue leads to uneven and premature wear and degradation. In an attempt to remediate these uneven forces, the muscles attached to the damaged area will exert contractual force in an effort to support the injured area by assisting the injured ligament. In the case of the spine, this often manifests itself as muscle tightness and spasms because the muscles are in a constant state of contraction to support the injured area. While the muscles can do a pretty good job of supporting an area in the short term they are no substitute for healthy ligaments and invariably this results in uneven pressure on the disc that separate the vertebra.
Over time this uneven pressure on the disc begins to cause excess fatigue on portions of the disc which eventually lead to failure, often in the form of a bulge or rupture. This, in turn, can apply pressure to nerves leading to a whole slew of additional issues.
Keep checking back as we continue the discussion in Part 3.