Sustaining an injury is a common problem for athletes. Unfortunately, a number of these injuries become enduring and the player struggles to regain fitness and cannot return to play. There are known reasons why this can happen, including the effectiveness of the early management, accurate diagnosis of the problem and how the player initially responds to the injury. All of these factors are important and often accounted for within the medical team’s preparation and planning. It is within the screening process that the medical team can gather such player information. This usually includes the usual fitness parameters, a history of previous problems and how they were managed and past medical history. Beyond these considerations I am interested in certain behavioural and physiological characteristics of the player that will give me an insight into how they will respond to pain and injury.
The problem has usually been persisting for some time when the player comes to the clinic. Beliefs, expectations and concerns will already be flying around his or her head. These emotions can be stoked by failed treatments and a lack of a diagnosis. Certain fundamental adaptations will have occurred as a result of the injury, such as changes in control of movement, altered perception of the affected area, pain felt with innocuous activities and other physiological goings-on that are not consciously observable. These vital functions involve the immune system, endocrine system and autonomic nervous system, all of which have a wide range of effects across body systems and play a significant role in healing, recovery and protection.
Protection is a key point. When you are in pain the body is protecting itself. You may also be aware of spasm or tightness and these are also part of a survival strategy that is orchestrated by the brain. When we are injured or have a problem we usually focus on the pain–and so we should. Pain is a motivator for us to take action to promote recovery. It grabs our attention to the area at risk so that we can attend to the injury. This is an amazing device that means we can learn and adapt. However, when this device adapts and creates sensitivity that is prolonged, it becomes difficult to progress and return to play.
The device is really a network of nerves that communicates information about the health of the tissues to the brain via the spinal cord. These nerves also play a role in maintaining tissue health by releasing certain factors into the tissues. On receiving information from the tissues via the spinal cord, the brain then scrutinises this data and responds appropriately. On perceiving there to be a threat to the tissues, the brain creates pain via a widespread network of neurons becoming active. It is this widespread network of neurons with a range of roles that is the reason for the many influences upon the pain including past experience, emotional state, fear, anxiety, vision, sound, genetics, gender and significance of the perceived danger to name but a few.
Returning to the enduring sports injury, these processes are underpinning the persisting sensitivity that is evoked with normal activities and amplified when pushed harder, altered motor control and perception, sensorimotor mismatch and continued tightness. These are common reasons for non-progression and require addressing with a modern rehabilitation programme that addresses the tissues, the aforementioned body systems and the brain with specific techniques and strategies that are based on the latest neurosciences.