Our focus at Reboot has always been exercise rehabilitation but why do we predominantly focus on this area and what are the benefits for injury treatment?
Pain is a protective signal to prevent us being injured – exercise rehabilitation can expose the body to movements and positions that may have previously resulted in a pain response. The body almost wants to avoid these positions and produces pain as a fear response. Rehabilitation allows for a gradually increased exposure to previously painful actions and improves strength to support a previously injured area. We aim to create greater tolerance to load and increase the capacity of the body to deal with demands we place upon it.
The majority of the time, pain is a result of an inability to cope with the load applied. This is true for both contact and non-contact injuries. For example, if you take a significant impact to the outside of the knee, forcing the knee inwards and stressing the medial collateral ligament (MCL) on the inside of the knee, the ligament is injured. The MCL was unable to cope with the load applied to it causing it to length, stretch and tear. However, load can also apply to how much we demand from a tissue. If we think of the Achilles tendon in runners then our force is relatively consistent with each ground contact. Load in this case applies to the frequency that we run (how often), the intensity (the speed) and the duration (or distance). If we increase the demands on this tissue too quickly it responds poorly as it has not had the opportunity to gradually build tolerance to new load. Rehabilitation is used to increase the ability to manage load. This is protective against further injury or damage and aims to prevent recurrence.
Mechanotransduction and mechanotherapy
Mechanotransduction is how physical force can encourage cellular activity. Cells within the body can sense and respond to mechanical loads. This process can be utilised to encourage healing from injury by specifically and appropriately applying loads to the tissue to encourage recovery while not causing further tissue damage.
Mechanotherapy, the application of load as a therapeutic modality turning movement in to tissue healing, can be applied to promote repair and remodelling of tendon, muscle, articular cartilage and bone injuries. Therefore, utilising exercise rehabilitation can provide sufficient force to encourage the healing process to take place. With loading, tissues remodel, become stronger and therefore more resilient to injury.
What about pain?
Exercise is known to release endorphins, an opioid hormone that can relive stress, increase feelings of happiness and importantly for us working with injured patients, reduce pain. Endorphins can block pain signals from reaching the brain and therefore influence the intensity of pain that is felt, particularly in more ongoing, chronic conditions. Our management of injuries focusing on the use of exercise rehabilitation can therefore have this benefit. For an individual who is relatively immobile due to pain and restrictions in range of motion caused by their injury, the endorphin release is essential. Injuries can be tough to manage mentally! Introducing an exercise programme that not only reduces their pain, facilitates the healing process to take place and improves function but also makes you feel better and relieves stress!
Muscle contractions also work as pain killers. Both isometric contractions (muscle contractions where there is no change in length of the muscle) and isotonic contractions (muscle contractions where the muscle length changes) have demonstrated the ability to reduce pain. An immediate analgesic effect from contracting a muscle will allow for greater pain free movement and therefore improve function. Both types of contractions will also stimulate the physical force on cells required to stimulate the benefits of mechanotherapy and begin to restore normal use of an injured joint. A reduction in pain will also likely result in an increase in activity, reducing fear of exercise and movement, while providing an individual the ability to reduce their own pain rather than relying on a therapist.
With so many benefits of exercise rehabilitation, is there really a need for hands on treatment?Return to blog