“How long will this take?” “When will I be back to my normal activities?” As a physical therapist these are questions we hear on a daily basis. Patients want to know exactly how long their injury will take to heal. While this is a valid question and patients have the right to wonder, the answer is unfortunately, not always so simple. Injury recovery is influenced by a number of factors including chronicity of injury, ability to commit to a home exercise program and ability to refrain from the irritating activity. In addition factors such as sleep, stress and nutrition can also play a vital role. In general, usually the time it takes to return to full, unrestricted activities, is longer than most patients expect. We’ll break down each of these factors to hopefully give a better idea of what to expect from your injury.
First, the nature and chronicity of the injury will influence healing time. If you seek out care from a physical therapist as soon as possible after an injury or within the first one to two weeks of noticing pain you are going to be more likely to have a faster recovery. There are a few reasons for this. A physical therapist will be able to diagnose abnormal movement patterns and recognize the root cause of the injury, in addition to providing strategies to decrease symptoms. Most over use injuries are due to poor movement patterns that we adopt and load over time. For example, a patient with shoulder pain who has trouble lifting a barbell overhead may have decreased mobility through their thoracic spine, tightness in their latissimus dorsi muscles, and lack of stabilization from their rotator cuff. These deficits are likely going to cause pain, especially if the patient is continuing to overload their shoulders with heavy weight training. Seeing a PT at the first onset of a pain will allow you to be provided with corrective exercises to address these limitations and restore normal movement and stability. If you put off seeing a physical therapist and continue to work through pain in addition to moving in compensated patterns it will take much longer to break these bad habits. The bottom line is if you’ve been having pain for months, recovery is likely going to take at least 8-10 weeks and possibly longer depending on the amount of tissue damage. This mean thats you may need to see a PT 1-2 times a week for 6-8 weeks initially and as you improve this can be tapered down.
The second factor in recovery is the ability to commit to doing a home exercise program. All of us lead busy lives and sometimes just finding 30 minutes to exercise can be challenging. We understand that, however the research has shown that tissue loading is the best way to restore strength and function. This means that performing the movement training and strengthening exercises that your PT prescribes is of utmost importance. Our muscles and tendons respond to load (i.e. strengthening) by building up bigger fibers and remodeling damaged tissue. With most patients my aim is for them to spend 10-15 minutes per day performing their PT exercises at least 5 days per week. If patients are able to spend more time, then great! However, committing some level of consistency is really the key. Without consistent, progressive load the tissues will not be exposed to stimulus that actually creates and enhances healing.
Finally, the ability to refrain from performing irritating activities is also important. I’ve had multiple patients come in who continue to perform activities that irritate their injury. As we know from the previous paragraph, tissues need load but they also can’t be overloaded. This means that id something is causing the pain to be worse, it is not the correct type of loading and needs to be temporarily ceased. Think about a scab. If we continue to pick at a scab it is going to take significantly longer to heal. We need to let our tissues heal while also working on pain free strength and movement. Remember, it is not forever that you need to reduce your activity, only temporarily until movement and strength is restored. I also always encourage patients to find an alternative activity in the mean time so they can continue to stay active. Just because you can’t lift weight overhead doesn’t mean you can’t still go to the gym and find an alternate exercises to perform.
Many patients begin PT with the belief that they will only need between 1-4 visits and that their pain that has been lingering for 3+ months will quickly disappear. While I wish that physical therapists could make patients better that quickly, it is just generally not the case. When dealing with an injury it requires patience and consistency. It is also important to note that recovery will not always be an upward slope. It is very common to improve and then regress slightly. While frustrating, it is a totally normal part of the process and continuing to work through the down slopes will pay of dividends in the end.