In this video, I'll explain to you how injuries heal and how you can use the body's natural
healing process combined with a little bit of rest and careful strengthening exercise
to make the best recovery possible. Welcome! My name is Maryke, and I'm the physiotherapist at
sports-injury-physio.com. If this is your first time here and you would like to learn how to stay
injury-free, make sure to subscribe and hit the little bell so that you don't miss any of the
updates. How do injuries heal? Now this may sound a bit weird coming from a physiotherapist, but you
don't actually need to be massaged or manipulated or receive acupuncture or anything like that for
your injury to heal. Those type of techniques can all make the symptoms feel better; it can take
pain away or it can decrease pain for a little bit; it can take muscle spasm away. But the fact
is that all of these symptoms will return again if the injury doesn't heal correctly. And your
body is pretty good at healing itself, as long as you give it the right circumstances to do so. So,
what do bodies need? Basically, they need a combination of rest and exercise. Now, rest alone
is not useful, because our bodies are programmed to survive, and to survive, it is forever trying
to conserve energy. So if you just rest something and you don't actually use that body part for a
long period of time, the brain just thinks that you don't need it and it doesn't see a reason to
make it stronger. That's why often, the pain will settle, but you go back to sports and then you
re-injure yourself quite quickly. Now on the flip side, if you try and strengthen it too quickly and
it's not ready for it, you will also tear the new cells that's formed, because they're not strong
enough for it. So it's quite important to get that combination of rest and exercise right to get the
injury stronger. And the essential part to getting that right is actually understanding the healing
process. Now, it's not difficult; it's got three components. The first is the inflammatory phase,
second is the proliferation phase, and the third is a remodelling phase. So, let's look at what
these phases mean. The first one, the inflammatory phase, is pretty much just what it says. It lasts
for about … it starts immediately when you get injured, and then it lasts for about the first
five to seven days. So, let's have a look at what happens when you sustain an injury. I'm going to
use a calf muscle strain as an example, because it's quite a common injury that people get. So,
a muscle strain happens when some of the muscle fibres tear, and you often also tear a few blood
vessels, and if you do a proper job of it, you may even involve the tendon or ligaments around that
area as well. Now, if you get a lot of swelling and bruising, it means that you've likely torn
quite a few blood vessels, and that's the reason for all the swelling and the bruising. Depending
on how badly you've injured the body part, the inflammatory phase can last for anything between
three to seven days, as I've said. And what happens during this phase is, all of the damaged
cells need to be removed. So, a clot forms inside, kind of like … You know when you fall or you graze
your skin and you get a scab on your skin? It's the same thing that happens inside the body,
except it's a soft clot that forms. And this clot also will act as the scaffolding for the new cells
to come and attach to. But the inflammatory phase is quite important, because that's the way that
the cell … the body gets rid of the broken cells. So, you have these specific cells that come in and
they eat the broken cells up. So, inflammation has been given a bad name throughout the years
because everybody grabs anti-inflammatories and things and try to get the inflammation down when
they're injured. But actually, we now understand that the inflammatory phase is a very important
part of the healing process, so they are now discouraging people to take anti-inflammatories
within the first five days of sustaining injuries unless you have excessive swelling and excessive
inflammation; so if you can get away with just using ice instead of anti-inflammatories, that's
much better. The other thing that you should really stay away from is any corticosteroids,
like cortisone injections, within that period, because that really stops the healing process
from happening. The other important thing: Now, I'm hoping if you're going to the gym that you're
not a smoker, but if you do smoke, just know that nicotine actually also stops the healing process;
that's why you see smokers often look a lot older - their skin and things - later in life,
because it doesn't regenerate that quickly. So, what do you do during the first five to seven days
of an injury? Well, the first thing is to protect that injury site. So, if you feel your calf muscle
go while you're exercising, then stop what you're doing, because if you keep on exercising at that
moment, that calf muscle is now weaker than what it used to be, so you will actually … it will take
less force to injure it further. Also, if you keep on running on it or keep on doing exercise on it,
you will cause more swelling and more bleeding and the pressure from that can actually injure other
cells, because it can cause them to not get the blood supply that they need to recover or to just
survive, to be honest. So, it's the old acronym of RICE, which is Rest, Immobilise, so that you
protect it, Compress … Now when I say compression, it's basically to stop the initial bleeding and
to help a little bit with the swelling, so the initial compression within the first ten minutes
can be quite firm, but after that, be careful, because if you put too much compression onto an
injury, you can actually stop the blood supply and make it worse again. So it's quite … it's
more … think of it as firmness rather than strong compression. Then also, as I said, Ice. So, the
ice is quite useful, because that can limit the swelling, because it stops bleeding, but it can
also act as a slight anti-inflammatory function so that you don't get quite excessive inflammation,
but you don't stop the whole process either. Then, the important bit that's missing from RICE is the
M at the end that physios have started putting in these days, which stands for Movement. Now,
when I say movement, it's not trying to do your full movement; it's just keeping the
body part gently active within limits of pain. The research has actually shown that if you do that,
your recovery time is quicker. So, don't be overprotective. Yes of course, if it's painful,
just keep it still for a while; but as soon as you can, try to just gently move the body part. So,
that's your first five days after an injury. So, you'll agree to exercise that specific injury site
at that point would be a little bit stupid, because you'll just re-tear or you'll just
further injure that site. Now the next phase is the proliferation phase, which can last between
14 and 21 days. Now, these phases aren't set, that this one stops, that one starts; they all
overlap a little bit. During the proliferation phase, you get new cells, you build new cells,
the body produces more collagen, more muscle cells, depending on what you've injured. The
problem is that all of these new cells kind of just get put there like spaghetti on a plate; so,
they're not aligned as they should be in the muscle, they are all tangled and they're not
strong cells yet, they’re quite fine cells. So, during this phase, although the wound is getting
a little bit stronger, it's still quite weak, because these fibres aren't quite functional
yet. And that's why I'm going to jump onto the remodelling phase immediately, because I feel that
they interact a little bit. So, the remodelling phase is the third phase, and that overlaps quite
a lot with the proliferation phase, because during this phase, the body now realises that it has to
align these cells in the direction that you need them to be aligned in and make them stronger. So,
let me explain how this happens. So, the new cells form, they're in a total wrong position.
Your brain realises which way to align these cells through gentle movement; so, we call it
mechanical strain, basically because ... If you can imagine my bicep muscle; say, for instance,
I've given it a slight muscle strain or a tear there. Now, imagine the muscle fibres all aligned
in funny positions; I want them to be in this ... aligned in this direction. So, if I gently move my
arm up and down, I'm tugging on the sides of the muscle fibres and I'm telling them, “I want you to
be aligned in this direction.” Now, you will agree that at this point, where I've got new muscle
fibres, they're not thick yet, they’re still quite fine; you can't go and do heavy weights like the
ones you've done before they were injured, because you will just re-tear them. So, you've got to cut
it back to the point where you can do the full range of movement without pain before you can even
think about starting to load it up with weight. And that's where I'm quite excited about the e-gym
system that CHANGE has in the gym. Now, you guys who may have used that system, you'll know that
you can set it perfectly for your joint range of movement; you can limit your range of movement.
So, say for instance, my arm hurts when it gets there, but it's okay to train up until there,
you can actually set that equipment that it doesn't allow you to go below that point, and
you can also set the resistance that it's so low that it is just enough to strengthen it up. So,
how does the body know to strengthen things up? Okay, so what happens is, if you strain the new
muscle fibres just enough that it's a little bit hard but not hard enough to tear them, the brain
realises that, “Oh, okay. That was quite hard. I think we need stronger muscle fibres there,”
and it rebuilds them a bit stronger; so, the next time you train it, you can do a little bit more,
and then that acts as a signal again to the brain that, “Oh, okay. That was good,
but it was still hard. So, we need to make it a little bit stronger.” The key lies in not
overstepping that mark and understanding that you need enough rest periods in between. Now,
I'm a big … What's the word that I'm looking for? I love the concept of relative rest. Relative rest
means that you rest from the activities that cause you discomfort or strain that injury in
the wrong way while you carry on with the things that are safe. And the reason I like this is, one,
it stops you from losing all your fitness, and two, it also actually keeps the blood supply …
I've lost my words now … gives you a better blood supply; and blood and circulation are needed for
better nutrients, so you actually help your injury heal quicker. So again, let's come back to the
example of a calf strain. So yes, you may not be able to run and yes, you may not be able to jump,
but you may still … you can still do everything from the knees up, basically. So you can do
squats, you can do knee extension exercises, you can do anything for the core, you can do anything
for the upper body. You may even be able to start back cycling gently, long before you can run. And
the gentle action of the bike can improve the circulation in the calf muscle and help
to strengthen the injury again. So, it's all about being clever about it. Another example of relative
rest – again, let's think of the calf muscle – is if you go running in the swimming pool rather than
running outside. If we think of upper body; say, for instance, you've strained your shoulder. Now,
nothing stops you from exercising the other side or the positions that don't actually use that
painful bit. So, coming back to the example of bicep strain. Yes, you won't be able to do bicep
curls, you won't likely be able to do overhead pulling things, but you may be able to do flies,
or you may be able to do … What's another example? So, biceps works in this position;
so, you may be able to do triceps extensions with the arms with a pulley system. It's all just about
identifying the movements that you can do and making sure that you don't do the things too hard,
that they actually affect the other body parts. And again, that's where I find that it works quite
well when I work closely together with personal trainers, because I can identify the things that
you can do and I can identify the limits to where you should be working, and personal trainers are
really usually very good at then sticking to these limits and being creative, thinking of
other exercises that you can do with the rest of the body so that you don't get bored. Of course,
the big thing with an injury is also that it can often derail your habit of exercise and it's quite
heart-breaking when you've managed to do … put all the hard work in for a good six months and you're
really enjoying exercise just to be injured, then take a prolonged period of time off,
and then you find you actually just don't have the mojo to get back to training. So, it's always
better to try and keep something going rather than stop altogether. Okay, so let's recap: The phases
of healing are your inflammatory phase, during which you've got to be really nice to the injury
and protect it a little bit, give a gentle range of movement exercises, but nothing into pain,
and you can use ice to help with the swelling and inflammation, and that lasts for roughly five to
seven days. Then you've got your proliferation phase, where your new cells form, but remember,
these cells are still lying around in the wrong direction, and you need gentle movement to
start telling in which direction it needs to lie into or realign itself into. And then you need,
during the remodelling phase, you need gentle, careful strengthening, so that you get it stronger
but without actually breaking it back down. Thank you for watching! If you would like to learn more
about preventing sports injuries, make sure you hit the Subscribe button. See you next time!