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Take Control: Injury and Pain Rehab Requires Work

Writer's picture: Bridget FlatenBridget Flaten


In the world of injury and pain rehabilitation, various manual modalities such as massage, chiropractic adjustments, and dry needling are often used to provide relief from pain. While these treatments are effective in reducing symptoms and offering temporary relief, they often do not address the underlying causes of pain. I'll say the quiet part out loud: you'll never get to where you want to with an injury or pain unless YOU put the work in. Where else in life do you get what you want by waiting for someone else to get it for you?


The Benefits and Limitations of Manual Modalities


Massage Therapy Massage therapy involves manipulating the soft tissues of the body to relieve tension and promote relaxation. It can improve circulation, reduce muscle tension, and provide a sense of well-being. There is nothing wrong with a good massage, I fall asleep on the table almost every time! However, massage therapy primarily addresses the symptoms rather than the root cause of pain. 


Chiropractic Adjustments Chiropractic care focuses on the diagnosis and treatment of musculoskeletal disorders, particularly those affecting the spine. Chiropractors use spinal adjustments to restore some degree of function and alleviate pain. These adjustments can be beneficial for temporary pain relief and improved function. However, without addressing the factors contributing to the pain—such as strength deficiencies, poor lifestyle habits, or inadequate movement patterns—patients may experience recurring issues.


Dry Needling Dry needling involves inserting thin needles into trigger points or areas of muscle tightness to reduce pain and improve range of motion. This technique can be effective in deactivating trigger points and relieving muscle tension. However, like other manual modalities, dry needling does not address why the trigger points developed in the first place. Dry needling is integral to the way I practice, and can attest to the relief it provides in the short term. I would be remiss if I did not also attest to the fact that my patients who don’t use the temporary relief to work on what causes the pain never get better. 


Identifying the Root Cause of Pain


To achieve lasting relief, it is essential to identify and address the root causes of pain. This involves a comprehensive assessment and a multifaceted approach to treatment.


Comprehensive Assessment A thorough assessment is crucial for identifying the underlying causes of pain. This includes:


  • Movement and Mobility Analysis: Evaluating how an athlete moves can reveal patterns that contribute to pain. For instance, incomplete movement patterns and compensations can lead to tissue overload and discomfort​​. These are nearly impossible to identify without a trained, professional eye. 

  • Strength Testing: Assessing muscle strength and function helps identify imbalances that may be contributing to pain (see how the NFL spent $4,000,000 to figure this truth out here).

  • Lifestyle and Ergonomic Evaluation: Understanding an athlete's daily activities and work environment can uncover contributing factors to their pain.


Dynamic Treatment Approach Once the root causes of pain are identified, a comprehensive treatment plan can be developed. This plan might include:


  • Corrective Exercises: Tailored exercises can address muscle imbalances and improve strength through full ranges of motion. These corrective exercises should build to match the intensity of your sport or activity. 

  • Education and Ergonomic Adjustments: Teaching patients about proper body mechanics and ergonomically adjusting their workspaces can prevent recurring pain.

  • Movement Retraining: Helping patients learn and adopt proper movement patterns can prevent compensations that lead to pain.

  • Stress, Diet, Hydration, and Sleep Management: Incorporating overall well-being management is the most underrated tool when addressing pain or injury recovery. All of our athletes must fill out a daily health check-in which is reviewed in person. Pain can’t be effectively identified and addressed without a controlled environment. 


Hypothetically Applying the Dynamic Approach


Consider an avid runner with chronic lower back pain who frequently receives chiropractic adjustments for relief. Despite regular treatments, the pain persists. A comprehensive assessment reveals that the patient rarely engages in accessory strength training, resulting in strength imbalances which are exacerbated by being forced to sit at work all day.

The treatment plan includes:


  1. Comprehensive Strength Prehab: A plan is constructed around the athlete’s passion for running. The assigned exercises address strength deficiencies created by a lack of weighted accessory work and an inactive workday. 

  2. Postural Training: The athlete is educated on maintaining a neutral spine position while sitting and providing ergonomic adjustments to their workspace. Ideally, the athlete moves or stands as often as possible.

  3. Movement Retraining: The athlete sees a physical therapist twice weekly for a predetermined amount of time to ensure exercises are performed correctly and the strength gains are translating into the athlete’s running gate. 

  4. Stress, Diet, Hydration, and Sleep Management: The athlete tracks these metrics, what is measured is managed. 


After several weeks of following this comprehensive plan, the patient experiences significant and sustained reduction in lower back pain. This improvement is due to addressing the root causes rather than just the symptoms.


Conclusion


While manual modalities like massage, chiropractic adjustments, and dry needling can provide valuable pain relief, they often do not address the underlying causes of pain. For lasting relief, it is essential to conduct a comprehensive assessment and develop a multifaceted treatment plan that targets the root causes. By focusing on a dynamic approach to pain and rehabilitation, athletes can achieve more sustainable and long-term pain relief.

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