What happens after an injury?
During last week’s MHR podcast, JohnnyB asked if there is an effect from an injury that decreases local flexibility, and if that ever ‘cascades’, in essence, creating a propensity for additional injury. For the sake of brevity, the answer is ‘yes’. For those who would like a little more knowledge, take a trip inside with me into the wondrous functions of the human physiology and the muscular-skeletal system.
Every injury of the muscle, tendon or ligament, or of the covering of such tissues known as the ‘fascia’, involves the tearing of small fibers. This is true when you are sore after a workout, and it’s true when that soreness goes over the line into injury, small or major. When those fibers tear, they repair via a process known as the ‘inflammatory process’. Inflammation is necessary to healing – it signals the body to bring nutrients, proteins and other needed substances to the site of the injury. That process creates scar tissue.
This can be helpful in small amounts. The process of getting stronger is the process of tearing small amounts of tissue and replacing it with stronger tissue as the muscle enlarges. Yet, scar tissue is, by its nature, less elastic than the tissues that it repairs. At this point, two issues arise.
In the first issue, that of the scar tissue itself, you will have potentially less ROM (range of motion) within that portion of the muscle, tendon or ligament that was injured, depending on the amount of tearing. For this reason, most people who have sustained and recovered from such injuries will carry some degree of compensation in their ‘postural equation’. If that happens and you move very fast or experience a collision, your likelihood of injury is raised in proportion to the severity of the first injury, or by where it was located (lower body injuries affect everything above them, so they throw the body’s balance off more dramatically).
Let’s deal with the issues of scar tissue. Here, after an injury, you have a tissue that ‘patches’ the injured tissue. Scar tissue is very strong stuff. That’s its great advantage. It’s like patching a rubber tire with a high-tech carbon/steel fiber material. It will even be stronger than the original tissue. But it’s not, by its nature, extremely flexible, and that creates the second problem in recovery.
Pro sports require speed, power, balance and flexibility. This is necessary on the gross level – starting and stopping, running, tackling, etc. You need the right combinations of slow and fast twitch muscle fibers, a good balance between opposing muscle groups (this is often neglected), strength and substantial flexibility. But it’s also necessary on the smaller level of the local connective tissue.
We’ve all been through it: We take some time off our exercise program, however well organized or haphazard it might be, and when we return, we’re stiff; the muscles and connective tissue have tightened. It’s just part of life for us, but for a pro athlete, having a stiff area in a single muscle, a muscle group or a series of groups is an invitation to injury or reinjury. If you can move quickly to one side with great ROM (range of motion), but have an impediment on the other, you will be far more likely to injure yourself over the course of a game. It's one aspect of postural imbalance.
The third area where injury creates problems is in the phenomena known as ‘muscle memory’. When you have an injury, your body remembers that insult. It doesn’t matter what a stud you are or how well you tolerate pain. It’s not a conscious issue. Via a process that is only superficially understood, our bodies remember injuries and the accompanying pain and try to protect themselves. You can’t really blame them. In pro football, many starting players incur the equivalent of 1 to 5 auto accidents Per Game (That’s why Mike Ditka and others are starting to fight hard for a retirement/recovery program for aging pro football players: Sacrificing your body is more than a coaching phrase. Many of these men are giving up the ability to move comfortably during the last decades of their lives). This is another issue that affects postural balance or imbalance.
Each person is an individual when it comes to recovering from injuries. What decimates one man is easy to another, within reason. Again – it’s not necessarily how ‘tough’ they are. From what little we know of this process, this is, apparently, mostly genetic. But the ability to play through pain and injury is inherent to being a good pro player and yet when you do, your body still recalls, probably on a subconscious level, the injury that you had and may ‘catch’ briefly in self defense when you attempt certain moves. Since you may also have a greater ROM on one side than the other due to the healing process as well, that creates a higher propensity for injury or re-injury. Both scar tissue and muscle memory can account for this.
These three issues –a decrease in local flexibility, the injury's direct effect on postural imbalance and muscle memory and its physical tendency to ‘protect’ one area – create a great susceptibility to injury. The scar tissue, until it has been ‘softened’ by exercise and/or connective tissue work, will decrease flexibility.
Several treatment options present themselves. Working on ROM during healing goes a very long way to solve this and our Broncos training staff is very skilled at this – they understand this process and work to overcome it. I know one of the massage therapists on staff with the Broncos, and he’s top drawer. The trainers are amazingly knowledgeable and hard working. The trainers interact with the conditioning coach and his assistants to balance the players’ posture – in degree.
There are specialists in physical therapy who go far beyond the basics. There are those like Karen C. Thompson in Denver who combine physical therapy with a degree in acupuncture and substantial skills in nutrition. There are exercise physiologists and applied kinesiologists who can analyze the degrees of posture, muscular balance, strength and flexibility with remarkable accuracy. Romo used the best. John Lynch used one trainer outside San Diego and swore by him – I read up on his techniques and was very impressed. I knew several like him, or knew their work, and I have a lot of respect for their abilities to restore or maximize function in the athlete.
There are also those who specialize in clinical sports nutrition – knowing precisely the mechanisms of sports injuries and healing and providing individualized programs for achieving or regaining top performance health. That can greatly speed post-injury healing. Romo is trying to get teams more interested in making this important investment into the players’ maximum potential and health.
So, there it is. Yes, JohnnyB, you lose local flexibility after an injury. That loss can create additional tendencies for injury via recurring muscle tightness or through muscle memory. Right now, it looks like the Broncos could use a specialist or two in that area and perhaps someone like Romo could coordinate that field with that of advanced human nutrition and maximize the potential of our players.
And, last, here’s to the trainers and docs that do help those players day to day. They’re some of the best in the field, they get little attention, and our team scouldn’t function without them.