The Vicious Cycle: Injury, Rest, Atrophy, Re-injury – or – How to Avoid Resetting the Clock – By William P. Rix, MD
Muscle and ligament strains are common orthopedic complaints. The pain from these injuries can be disabling, and proper rehabilitation is essential to ensure a full recovery.
Resting a sprain is natural and appropriate, but it comes at a cost. When muscles are not used they become weak and lose bulk (atrophy) in response to their diminished role. With this loss in strength the injured muscles, as well as the joints and ligaments they support, are now more vulnerable to another injury.
As the pain from our original injury subsides, we assume we have returned to “normal” and, typically, resume our regular activities. The injured limb or spine, however, now deconditioned or “out of shape”, is not normal, and re-injury occurs. This is followed again by pain, protection, atrophy and an even lower threshold for re-injury. This is the Vicious Cycle.
How do we balance our need for rest and protection with our need to minimize risk of re-injury? This is accomplished by rehabilitation of the whole limb or spine before returning to full activities. Therapy begins soon after injury and focuses on strengthening the surrounding uninjured muscles while protecting the injured one(s). Included in this therapy are the muscle groups distant from the injury but also affected by lack of use.
As the pain subsides, the strained muscles are slowly introduced to a controlled set of progressive, non-impact, strengthening exercises. The limb or spine must be fully reconditioned to at least its pre-injury status before regular activity levels can be resumed.
Rehabilitation from an injury is complex, and we must walk a fine line between doing too much and doing too little. A certified physical therapist or trainer can be invaluable in this process. It is very discouraging to fall into the vicious cycle, and extrication can be long and difficult. Full fitness and conditioning after injury is our “ounce of prevention” against this debilitating condition.