5 Steps to Navigating an Injury

One theme in my work, sad to say, is figuring out how to navigate injuries that my clients and I have in our athletics and recreation passions.

I’ve come to accept that injury is part of the journey. It’s nice to fantasize about a world in which active outdoor folks don’t get injured, but it just happens as we are out playing and exploring our world. And we’re not staying home on the couch. The benefits (physical, mental, social and spiritual) of physical exercise so far outweigh the downsides of injury that it’s just something we need to learn how to mitigate and work with when it happens.

So that brings us to how to navigate it. For the purposes of this article, we are talking about what you might call sports injuries— muscular, tendon, ligament, joint, and sometimes bone. Sprains strains, possible tears. This is where you describe a tweaky shoulder, a knee thing, or your back hurting or “going out”. These are things that may have happened as a result of a workout, or during your sport or recreational activity. But it could have just been a mishap in your day, or even come on gradually with no clear when, why or how.

Questions arise! Do you use the injured area or rest it? Would stretching help, or does it need strengthening? How about getting a massage or acupuncture? Heat or cold? And where to start when it comes to which doctor to see? Do you have to go to your primary care doctor first? And if you see a specialist, should it be an orthopedic doc, or  physical therapist, a sports med person or physiatrist? (And what even is a physiatrist anyway??)

In the face of such an injury, the impulse can be to shut down mentally and physically. Physically for fear of doing more damage. Mentally due to denial or to decision paralysis about how to get the right treatment or medical advice. So easy to see Dr Internet and decide for yourself what is going on! So easy to listen to your co-workers telling you what you absolutely should or shouldn’t do! Don’t do those things, kids. Be an advocate for yourself and take care of yourself. Here’s how you’re going to do that.

Before we get to the steps, let’s just put it out there that for suspected serious injuries, just get to the urgent care or ER. I am not a doctor of any sort, and this post should not be considered a substitute for the advice of a physician. These are simply my observations over twenty years and speaking with specialists as I and many of my clients make our way through mild to moderate musculoskeletal injuries.

Your Acute Response – Keep Track and Take Care

If the injury has just happened and you can pinpoint the cause, make note of any information you can about it. When, where, how did it happen? What’s the pain like and how bad on a scale of 1-10. Keep a daily diary of pain and sensations so you can track how they change. In the acute (3 days) following an injury, you may notice limited function in the area since your body may protectively close down. That doesn’t mean something is terribly wrong, though. Things can seem more serious than they are in that acute time frame. During the acute period, as you wait to see a practitioner, you can explore different injury care modalities to see what helps. Research is mixed on both heat and ice, but why not experiment? Compression and elevating the area above the heart may also help. If you suspect that massage, acupuncture or an epsom salt bath might help during this acute phase, explore those as you await your appointment.

To Move It or Not, and How?

If you are able to move without much pain 1-4 on a scale of 1 to 10, you may continue to move/use it. Pain level may even reduce with movement. But if it’s painful above ~4, then you may be better off resting it instead. Note that that doesn’t have to mean no activity. Depending on what is injured, how can you still manage to move? If you hurt your shoulder, you can likely still walk, maybe even run or do a number of strength exercises. A trainer or fitness coach can help you methodically explore what exercises you may still be able to do safely.

Who You Gonna Call?

If an injury feels significant, or if it persists more than a couple of weeks, my first step is always to a physical therapist. The reason is that these doctors (almost all PTs are doctors) are skilled at assessing injuries and determining if you can repair this yourself (with their help) or if you need to see someone else. While it’s important to keep your primary care doctor informed, seeing them first is likely going to result in your being told to see a physical therapist. As a general rule, in the US, you don’t need a referral to see a PT. We have direct access laws that allow you to self-refer for at least a first visit. Check with your insurance, but this is usually the case. A PT can also advise you if an orthopedic doctor is called for, but that generally doesn’t make sense unless it’s suspected to be a more serious injury. A physiatrist, by the way, is a non-surgically oriented physical medicine doctor, who also may refer to themselves as a sports medicine or sports rehab doctor. I love having one who oversees all my physical care and sometimes for diagnoses, but he often just tells me to get myself to a physical therapist.

Do Your Homework

At the PT visit, you will likely get instructions for home care, as well as for possible stretches and (more likely and more importantly!) strength exercises. Most injuries I come across are due to inadequate stability and strength, not from tight muscles. And many soft tissue injuries are healed with load, meaning they need to be worked with progressive resistance in order to return to their pre-injury level of function.

• Once you have your PT homework, make note of the specifics —how many reps, how many sets, frequency per day and week. Follow this, okay? This is your power! Also important to get clarity about:
• When do you return for a re-check?
• What is the timeframe for assessing improvement and deciding on a different course of action?
• Should you be getting the opinion of another practitioner (an orthopedic doctor for example) as you continue your PT treatment?
• When will you be able to get more complex imaging if it’s warranted? Some imaging won’t be advised or covered until you’ve devoted about 6 weeks to conservative care (PT exercises and the like), so be diligent about doing your exercises and following the timeline so you can progress to the next stage if you don’t see improvement.
• What other treatments are out there if conservative care doesn’t produce results?

Make Rehab Your New Self-Care Practice

Explore other complementary modalities to support your rehab. Any home remedy care you’ve discovered, as well as on-going bodywork and acupuncture, and keeping moving in ways that don’t hurt can all help your body in the journey back to full function.

It helps to have a community who understands. The Unstill Life gang is here and we can relate. I have a strong network of healing professionals who I consult for my own and my clients’ injuries. You can find many of them on my Resources Page, or just drop me a note. And above all, try to be patient, open-minded and hopeful as you make your way along your injury rehab. Things take the time they need to heal, and we come through that time learning great self-care skills that serve us the rest of our lives. 

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