"It Depends".... Considerations with pain and biomechanics of injury
“It Depends”, when treating pain and biomechanics in athletes.
When teaching and treating, I often preface a response with “It depends…” much to the frustration of the audience. However, as I will touch upon here, so much of quality training and rehabilitation does depend on the multifactorial elements associated with the athlete.
To really appreciate this further, both pain and running form need to be evaluated in greater detail.
First when touching on pain (I will do a separate blog on this topic), I honestly believe this topic has been one of the most misunderstood areas for athletes/clients in the past. Recently, we are seeing more and more exposure to our better understanding of pain. Specifically, that the brain produces pain in response to what is perceives the threat to be. Pause for a moment to process that. Whether experiencing acute or chronic pain, the brain produces the pain that you feel. Pain is a very real thing, there is no question about it, but acuity and mechanism of pain is so important to understand in order to properly address it.
Similarly, analyzing biomechanics is only the tip of the iceberg when treating an athlete. You only have to look at some of the fastest long distance runners to see that biomechanical efficiency is not a stand-alone key factor. For example, one could refer to traditional running analysis and highlight multiple areas of inefficiencies for Tiki Gelana (London Olympic Gold in women’s marathon), but really, as the best in the world and without injury, are her ‘inefficiencies’ costing her? That said, I am a big believer in improving efficiency when training and treating athletes. The main point I am making is that like pain, gait biomechanics need to be used as a piece to the jigsaw when understanding the root cause of an athletes injury, not necessarily the be all and end all. With every month, more and more literature is supporting these views.
The million-dollar question for every athlete going through rehabilitation is “how do I get back to my full training as quick as possible?”
As a physiotherapist, the challenge is picking out the relevant issues that impede this return and crucially, what stressors are/were responsible for causing the issue in the first place. Assessing this allows us to treat strategically in our effort to ensure the athlete adapts to the strain placed upon them, and therefore avoids further injury.
To sum up my “it depends” blog entry, we have to consider pain and injury as multi-factorial if we intend to treat it effectively. The identification and understanding of the cause is paramount to selecting the most efficient management. This is why I truly believe that physiotherapists have such a key role in treating injuries, but perhaps more importantly, preventing them.