Tips for safely returning to activity after injury

After an injury, it can be confusing to know how much activity you can do and what you should avoid doing. As a physical therapist that works predominantly with active individuals, it is important to keep my clients doing the activities that they love in any capacity that I can. Regardless of the injury sustained, there are always ways to incorporate your sport or activity into your rehab program.

One of the first questions I typically receive when seeing a new client is, “can I continue *insert activity or sport here*?” This is a hard question to generalize an answer for. But I will explain the principles to consider when returning to your activity in this blog.

This is a general framework for the progression of any activity. It could be adapted to fit running, swimming, hiking, skiing, lacrosse, hockey, softball, tennis, or golf just to name a few! You can also use these principals for injury to any body part.

Gradual activity progression

As a physical therapist, part of my job is to help guide your tissues tolerance, and work on building it up to meet your individual goals. A large component of my approach is education about tissue healing, and teaching my clients how to listen to their body.

Easing back into activity allows you to determine the amount of stress your body can handle. That gives you a starting point to progress from. This is what we call your body’s tissue capacity. Tissue capacity is the amount of stress the tissue can take. 

A gradual progression back to activity allows you to identify your body’s load tolerance (another way to say tissue capacity). That is the starting point you can build from to progress activity. An activity can be progressed by intensity, frequency, or duration. In the earlier stages of returning to activity I recommend only progressing one of these things at a time. As you progress these different aspects of activity, your tissue’s load capacity increases and you can start to be more aggressive with progressing more than one aspect of intensity at a time. 

After an injury, the body's tissue capacity will likely look different than it did prior to injury. This is due to the body's healing response. There are three phases to injury healing: The inflammatory phase, the proliferation phase, and the remodeling phase. 

Pain is present during the acute, inflammatory phase to protect the body’s tissue as it produces initial scar tissue. That pain can be a guide for you to determine your tissue capacity initially after an injury. 

Let pain be your guide

It is important to load your muscles and tissue enough to make them stronger, but not too much to break things down. There is a fine balance, and everyone is different! That is why having an individualized approach to recovery is so important. I always say, “push to the pain, not through it.” 

Here is where it gets hard to generalize things. Bones, muscles, tendons, and ligaments have different healing timelines. So depending on the injury, the amount of pain that is okay to push through is different. That is why an evaluation by a physical therapist is important to understand your individual circumstance.

If pain gets higher than the mild range, your body is telling you to slow down. That could mean to decrease speed or weight, or it could mean to shut your activity down completely- it just depends on what you are feeling and how long it lasts. 

This is what the saying, “listen to your body” means. But understanding what you need to listen for is helpful. Once you have determined the tissue affected in your injury, you and your physical therapist can create a progression for activity. In knowing the tissue involved, that will give you an outline for what kind of pain and the intensity you can work through.

Your body needs recovery

Regardless of symptoms, you should allow for more recovery time early on so you can build muscle faster and not just wear yourself down. If you work past the body’s tissue capacity, you may start to irritate or break down tissue, working against your recovery. As you are building back up to your pre-injury capacity, you may need more rest days.

You should also spend time cross training to decrease repetitive stress with your activity. Cross training can mean more mobility work, strength training, or a different mode of cardio than is required for your sport. It is important to build up stability with accessory movement to support your performance. 

In addition to active recovery techniques, you may need bodywork to help your muscles recover during injury. Some techniques that I implement with my clients are, soft tissue mobilization, dry needling, cupping, and muscle scraping.

My approach to guiding clients through return to activity progressions:

• Start by doing your activity on non-consecutive days. That means every other day at the most. This allows for more recovery time between activity specific repetitive movements. 

• Once tissue capacity is determined, gradually increase intensity only after 3 successful sessions at determined capacity.

• Do not allow pain to get above a mild pain level (~4/10 on the Visual Analog Scale). If pain rises above that level, decrease intensity or stop the activity. 

• If pain doesn’t go away after stopping, allow for a 48 hour recovery period. 

• If pain occurs up to 48 hours after stopping activity, bump down in intensity for the next training session. 

Components of progression

Return to activity progressions can be used for any sport but I will use running and lacrosse as examples of a non contact, and contact sport. 

For running, it is important to build tolerance to jogging and endurance to the desired time before progressing intensity. Once tolerance is built up, integrating runs that include speed intervals or hills are appropriate. 

For a contact sports, like lacrosse, tolerance to jogging and cutting needs, or throwing to be built up first. Then the athlete can progress to skills and non contact drills. Once the athlete can tolerate those activities without symptoms, contact play can be progressed. The body must be strong enough and reactive enough to tolerate unexpected perturbations to tolerate contact. 

Want your own progression?

If you would like an individualized return to activity progression built by me, schedule a free discovery call to get started!

*This blog does not include consider progression after surgical intervention and a different approach is indicated in that circumstance.

**The information provided on this blog is intended for general wellness education purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physical therapist, physician, or other qualified health provider with any questions you may have regarding a medical condition.