Why isn't my injury healing?

Here are two stories of injuries that seemingly wouldn't heal and how we overcame them.

One client of mine had dealt with Achilles and ankle pain for years. She wanted to get back to cycling and other sports, but her foot was holding her back.

She would rest it at the recommendation of her physio, and it would feel better, but anytime she challenged it, her foot flared up, and she would be limping again.

Another client was dealing with a nagging hamstring injury that stuck around for months. It would show up if she sat too long and felt it at random times while moving about during her day.

Her hamstring felt brutally tight all the time, and it wasn't making any progress.

What goes on in these cases?

We're told that rest is needed for injuries to give the body a chance to recover, which is true. However, in the case of the Achilles injury and many other tendon injuries, loading the area is just as important to healing.

A 2012 study found that "mechanical cues affect tendon healing." And that "loss of muscle force delays tendon development." In other words, complete removal of load is detrimental to injury healing because tendons need movement. It prevents adhesion formation, and it better prepares the tendon for future loading capacity.

A 2022 study found that "strain plays a fundamental role in the enhancement of healthy tendons." In practical terms, too little stress on tendons results in muscle and strength loss, which interferes with healing. Too much can also be a problem, meaning finding the sweet spot of applying enough stress to cause positive adaptation is key.

In this client's case, once we challenged her Achilles in a tolerable way and built her up (to the point where she was able to tolerate single-leg calf raises), her pain began to fade. How this is done will depend on the person, but the process remains the same.

For the other client dealing with the hamstring injury, things were different. Because it lasted so long, she decided to get it looked at with imaging, and the results shocked her. There were no signs of degeneration or inflammation. Her hamstring was physically and structurally fine.

You'd be surprised how often this is the case for chronic pain and injury, and I describe it to clients as thus: "your rehab isn't finished until your brain stops protecting what's already healed."

Our brains are built to protect us, and signals of pain are designed to do the same. Records of pain are inscribed in our central nervous system long after the tissue is healed. That's why movements can be flagged as dangerous, resulting in tension and pain, even when nothing is truly wrong.

Processing this old threat means giving your brain proof that the movement is safe again which you do by, you guessed it, gradually loading the tissue in a tolerable way.

For this client, we started with bodyweight hamstring curls and light Romanian deadlifts. We built up to machine lying hamstring curls and beyond. She no longer thinks about her hamstring anymore.

Both of these situations illustrate why you can't always "rest" an injury away, and how movement and loading can help you overcome pesky injuries that don't seem to go away.

It's all about retraining our brains and building up our capacity, both physically and mentally, to handle what's in front of us.

To your good health,

Coach Stephen

---

Thanks for reading.

P.S.

Whenever you’re ready, here are a few additional ways that I may be able to help you.

Free:

Instagram: @CoachStrumos

*I share tons of bite-sized lessons and tips here

Paid:

1-on-1 Pain Management and Strength Coaching: Apply here