Do you have a bum shoulder? A bad knee? Do you have a pain from an injury that has persisted for months or years? You may have talked to friends or co-workers about it and likely heard “Oh that’s chronic pain and it’s something you just live with” or “Well, what do you expect, you’re getting older”. Many people who develop such pains assume that because their injury was a long time ago, their pain is set in stone and there’s nothing you can do about it. Or, as you get older, it will be more difficult to get rid of it. Well, there is hope! These long-lasting pains don’t have to stay around forever; there are several courses of recovery that can take place depending on the nature of the original injury and the natural repair process that has taken place since.
In scenario 1, let’s assume you have pain from an old shoulder injury. It got better initially but just didn’t seem to fully heal, and now you’re left with some lingering pain. Normally what happens during the first few weeks of soft tissue healing (for example with muscle or ligament) is your body deposits scar tissue to rebuild the injured site. If we looked at the tissue fibres under a microscope at this point we would find them disorganized and unlike the original tissue where the fibres are lined up in parallel. If controlled stress (stretching and/or strengthening) is applied to the injured site at this stage, it would begin to remodel and look more like the original tissue. Depending on the severity of the original injury and assuming no other complications, after several more weeks of recovery and exercise the injured site can become pain-free and function well.
However, some people mistakenly believe that a tissue will heal fully on its own with time, or initially they misinterpret the pain that occurs with stressing the injured site and avoid it. In both cases, the remodelling process is not undertaken, and the scar tissue remains disorganized and tight, causing pain every time it is stressed. The good news is if you understand what is happening and are guided through the remodelling process with the assistance of a physiotherapist, you can make changes to this tissue and achieve a gradual recovery over several weeks or months. Typically this will involve an individualized and structured home exercise program – which can involve strengthening and stretching.
In scenario 2, let’s say you find yourself with pain from an old knee injury and no matter how much you try to remodel it following the principles above, the pain doesn’t go away. Sometimes what can happen at the time of injury is the resting position of the joint is disturbed so now it isn’t “hinging” properly anymore. Again, the positive here is this situation can be reversed quickly with the help of a physiotherapist who can identify the right movements to return it to its proper position. It’s like a floor rug being ruffled up in front of a door – when you try to open the door, it gets blocked by the rug. So what you have to do is find the right way to move the rug and then the door will open smoothly again. There are cases where pain that has persisted for years can respond to simple movements rapidly due to this problem.
The bottom line is this: just because you have had pain for months or years from an old injury that seems to be unchanging, it doesn’t mean you’re doomed to live with it. There’s hope! You can simply start by making an appointment with a physiotherapist. They’ll listen to you and do a thorough assessment to determine the nature of the problem, and design a recovery plan for you. Remember, you don’t need a doctor’s referral to book an appointment with a physiotherapist. As long as you’re willing to put in the effort to recover, the results will likely follow. Wouldn’t it be nice to leave behind that nagging pain you thought would be with you for the rest of your life?
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