22/05/2024
I had a patient come in this Sunday who had been experiencing ongoing shoulder issues for the last 20 weeks. He mentioned he was in the best shape of his life, training extremely hard, and he woke up the day after one of his training sessions with some stiffness in his left shoulder.
He booked a private session with a physiotherapist who suggested he may have a rotator cuff issue and advised him to rest until it gets better before resuming training. Unfortunately, after 3 weeks of resting, his problem not only did not go away, but it also began to get worse. He mentioned the pain increased from 3-4 to 7-8, and his shoulder mobility started to significantly reduce.
When an injury or symptoms are present, the receptors in the affected area become sensitized. The brain’s natural reaction is to stop or reduce putting load or force through it, as it perceives that things can get worse in the affected area. However, when it comes to pain, it’s important to understand that pain reflects the “perceived” need for protection, not necessarily the “actual” need. This concept is known as predictive processing.
As therapists, trainers, or coaches, we have to respect this higher centre adaptation, but we also have to acknowledge that the longer the individual spends time in this adaptation, the more likely it is to become their future reality, meaning they are going to have serious limitations for a long period, as the brain is always perceiving or predicting a problem is going to occur when they load or move it.
The brain’s command/message was predicting protection in the given area, and unfortunately, this was starting to become his reality, causing him more pain and making the problem more complex.
Rehabilitation is essentially training when injury or pain is present. It may be less intense than what one is used to and more technically demanding. However, it is essential to gradually expose the affected area to different movements, loads, speed of movement, etc., as this is what helps regain the trust of the nervous system and reduces the predictive processing of the brain. As the saying goes, USE IT OR LOSE IT.
Be sensible, be cautious, but DO NOT be afraid.