Quick fix or long-term fix?
Have you ever tried to fix something around the house on your own just to have it break again? Have you had to call in the experts only to find out that the Band-Aid you put on your quick fix cost you a lot more than necessary?
Injury can be much of the same: We can’t just fix it and forget it.
It is understandable that we all want to see results quickly, but the reality of the situation is it takes time and knowledge to repair torn muscles or mend broken bones.
I always say that patience is a virtue and this statement cannot be truer than with the treatment of musculoskeletal injuries.
Most of us lead busy lives and often don’t have time to deal with the interruption that comes with injury. Many will seek out “do it yourself” or quick-fix treatment options like medications, self-stretches or injections.
Often these fixes don’t address the root of the problem. While they can be a part of the solution, they often are not the entire answer. Sometimes, we think that “it will get better on its own” and, after several months of pain and disability, we realize that we need to call in the experts of physical therapy to overcome injury.
But, how long?
The question always remains: How long does it take to get better, and how fast can I expect see results?
Of course there are many variables that influence the outcome of physical therapy, including prior level of function, genetics, exercise prescription, exercise compliance, length of pain or disability, and age, to name a few, but there are some expectations to understand when it comes to results.
Let’s take strengthening, for example.
At the start of therapy, most people are surprised at how weak they have actually become from injury. In most cases, it is very apparent that strengthening is a necessary component of fixing the problem.
When we are injured, the body has an incredible way of self-protecting and self-immobilizing.
Why would a muscle that hurts want to work? Why would your muscles work to place your joint in a position of pain? Our body avoids pain at all costs.
Immobilization can have a profound effect on muscle, and I have read that muscle fiber size can be reduced by 14-17 percent after only 72 hours of immobilization. The effect on muscle weakness is profound.
Through the years, I have noted that it usually takes a good six to eight weeks for a patient to experience more of a lasting improvement in strength and pain. I do expect, however, to see change within the first few weeks and we should see the pain become less intense and occur less often. This is a good sign that the patient will respond to therapy and that we are on the right track with treatment.
Don’t give up
Therapy is much like a diet in that those first 5 pounds come off quickly. This is similar to how many patients experience a noticeable difference in strength within a week or two. Often this is due to direct changes within the neuromuscular system.
When we first start a program, there are all types of reactions occurring in the body and early gains in strength are not due to a change in muscle mass, but rather due to changes within the nervous system.
Early in rehabilitation, the brain and muscles learn to communicate more efficiently. The system increases the rate of motor-unit recruitment, the endurance of the motor unit, its ability to recruit different muscle types, and its ability to fire motor-units at the same time versus staggered.
All these factors contribute to those early signs of strength gain and can have a positive effect on pain.
Despite this, it is not the first few weeks that matter the most in this long-term battle. It is a marathon, not a sprint.
With exercise in therapy, we also have to realize that in order to make long-term changes, consistency is important.
With less insurance coverage, higher co-payments, and busier lifestyles, patient participation at home has become more and more important.
If you expect to get results, you have to put the work in. It may take several months to ensure that we have addressed the mechanical issues, but you can never underestimate the negative long-term effects of taking shortcuts. When you take the shortcut, chances are you won’t be able to fix it and forget it.