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Old habits are hard to change


This section is probably the most important one. I see this everyday in my physical therapy practice, as well as when I am on the courts interacting with people. Rehabilitation concepts have changed dramatically in the past 5, 10, 15, 20, and 30 years. The concepts back in the day may no longer be the best course of treatment for your injury. I always hear people giving advice to others based on personal experience, or based on something they heard somewhere. Everyone thinks they have the answer, but a lot of times, the knowledge you are passing on to someone may be detrimental to their recovery.

I will attempt to capture some of what I hear most often, in order to help you and others on the courts avoid delaying your recovery. Once again, if you are injured and unsure, please consult a healthcare professional instead of your buddy who's uncle told him the solution to everything is Icy-Hot...

ICING injuries:

Paying the PRICE: most people are familiar with the P.R.I.C.E. concept (or at least the R.I.C.E. concept): Protect, Rest, Ice, Compress, Elevate (or Rest, Ice, Compress, Elevate).

The person who came up with this famous R.I.C.E is Dr. Gabe Mirkin who published a famous Sports medicine book in 1978, and coined the term RICE. This was an easy mnemonic to remember what to do after injuries, and it has stuck ever since. However, recent evidence shows that icing may not be the best solution after an acute injury, as it might actually delay the healing process. Dr. Mirkin himself is no longer in favor of icing after an injury to control inflammation and he reports that ice is only beneficial to help control pain. He notes that the process of icing actually delays and prevents proper healing from taking place (as discussed in this study:

This makes sense from a physiological standpoint. What is inflammation? It is our body's reaction to trauma and injury, increasing the blood flow to the area, and in the process bringing healing substances to the injured area to start the recovery process. Just like a fever is the body's response to a virus to try to kill the virus, inflammation is the response to injury to try to heal it. 

Instead of Icing and delaying healing, focusing on gentle movement, light resistance exercises, and heat can make a world of difference following an acute injury. Early movement is key in any type of recovery these days: people with hip and knee replacements are on their feet the same day of their surgery to encourage movement, blood flow, and faster recovery. This has been the trend in the past 10 years, and it clearly produces results that can no longer be ignored.

Using Braces: I often hear people recommend certain types of braces following an injury. Don't get me wrong in this section: braces have their place, and should be used in certain situations, but becoming dependent on a brace is not a good idea in the long run. Our bodies have specific structures in place such as ligaments and muscles that play an important part in providing stability to our joints during movement. Using a brace over a long period of time leads to decreased usage and activation of key stabilizing muscles, and should be avoided. 

Here is my view on it: if you are so injured that you cannot perform your activity without the use of a brace, you probably should be resting your body and performing the appropriate rehabilitation in order to get back to playing. Wearing a brace in order to play through pain is probably not a good idea in the long run, but if you have to for some reason, then go for it. Otherwise, I would recommend consulting a Rehab Specialist, and designing an individual plan for you to address your mobility, flexibility, stability, strength, and conditioning in order to return to playing.

Lifting weights and using machines at the gym: Once again, this might upset some people, but unfortunately, feathers need to be ruffled sometimes in order to implement change.

I see patients all the time who come in for an injury, and when I ask what they do in terms of strengthening they tell me that they go the gym and use machines and lift weights. They use the knee extension machine, hamstring curl machine, chest press machine, back machine, and on and on and on... Then I usually ask them if they perform any strengthening that includes any functional movements: and they usually have no idea what I'm talking about. 

So here it is: performing exercises at the gym that follow a set pattern designed by a machine will only get you stronger and more efficient at performing that specific movement. If you do not incorporate strengthening in a way that is functional (meaning that it relates to movements you perform during your activities or sport), it will not be beneficial to you when playing. For example, you might be able to do the knee extension machine with 200 lbs on it, thinking that you have super strong quads, but all you are doing is getting very good at straightening your knee against resistance. This will help very little when playing your sport. However, performing squats (for example) with correct form, mechanics, and motor control, focusing on the eccentric portion to emphasize deceleration, and training explosiveness during the concentric portion will help you be more stable and generate more power during athletic activities, and will transfer into better performance over time, while getting your quads stronger. 

Getting stronger is not just about getting stronger, but it is about getting stronger in a way that is functional and beneficial to the activity for which you are training. This is called specificity of training and is very important in athletic performance and rehabilitation.

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