Recently I was reading a book written by a fellow Physical Therapist, Jay Dicharry, MPT, SCS, called Anatomy for Runners (highly recommended by the way to any level of runner). The book discusses at great length our bodies and how we can optimize our health, performance and prevent the injuries that so frequently occur in the running community. The book got me thinking about injured workers. The term “Industrial Athlete” is frequently used to describe how we should look at our workers, both pre and post injury. But is this really happening?
In a previous blog we discussed the wait and see approach to Physical Therapy and how this can be detrimental to the outcome of an injured worker. But why is this so?
What is happening at a tissue level with these injured workers when they are prescribed rest versus a more active approach like Physical Therapy?
In another previous blog we discussed the negative biopsychosocial effects from being off of work, but the physical effects are just as detrimental. Both can be avoided by keeping injured workers actively engaged, including an appropriate rehabilitation protocol with Physical Therapy.
Mr. Dicharry doe a great job summarizing what too much rest does to certain tissue types and what needs to be done to help with each issue. Bone’s collagen structure and mineral density becomes weakened with too much rest and need increases in compression and vibration to gain these losses back. Our joint capsules can shrink and become resistant to all planes of movement. It is important to do range of motion exercises as well as receive manual therapy to regain lost motion in the joint capsules. Ligaments in the body decrease in tensile strength and need progressive controlled loading to gain this strength back. Tendons also lose their tensile strength and need progressive eccentric strengthening to help reorganize collagen fibers. Muscle becomes weak by losing its contractile strength and needs exercise in order to induce metabolic adaptations and to recruit additional motor units to fire in order to gain the strength back. And most surprisingly, cartilage gets weak without activity. We would think we would be protecting our all so important cartilage by resting, but cartilage needs consistent moderate loads though our available range of motion to maintain its strength.
So, if we are hurt should we just get out there and exercise as hard as we can? Of course not. Injured tissue needs appropriate time to heal, but that does not mean resting entirely. A skilled manual Physical Therapist can guide patients in appropriate exercises and manual interventions to properly load tissue in ways that will allow it to heal while maintaining its strength. That is why, in addition to the biopsychosocial benefit of keeping our injured workers active, it is important to keep our injured workers active in order to assure proper healing and avoid loss of tissue integrity. The best way to do this is through an appropriate modified duty program and treatment from a highly skilled manual Physical Therapist.
