How to Recover from a Serious Injury

Everyone on a Sunday afternoon from the cheering dads on the sideline to the star quarterback is aware of the constantly looming threat of muscle tears and sprains. They happen, and there is no fail-safe way of ensuring you never receive one. Even the iced bathed and well-oil superstars with the best coaching and physiotherapy in the world cannot avoid the wrath of torn muscles – and it’s nothing to be ashamed of – even Achilles was eventually thwarted by a tear in his ankle. Maybe he should have subscribed to our blog.

Last week, we outlined PRICE – Protect, Rest, Ice, Compression, Elevate - which is the immediate response you or a physio should have a sprain or tear. The sooner after the injury you attend to the area the better effect it will have. Your physio will be able to advise you on the level of the tear (graded from 1-3) and help draft a bespoke plan as to how you should implement the routine.

In most cases, the subsequent procedure should see you through most of the recovery. For more serious damage, consulting a physiotherapist on a regular basis for sports massages may be necessary. During your first visit, your physiotherapist will likely ask you about the activity that led to this damage and conduct a thorough physical examination to determine how severe the tear is. This is especially important if there was no on-site physio after the initial damage. Your comprehensive plan could include:

·        Ice or heat to reduce swelling

·        Electrotherapeutic modalities which use sound waves to heat up and repair deeper tissue

·        Soft tissue mobilization to relieve muscle spasms or tight muscles

Your physio will include self-stretching routines to mobilize muscles and reduce long-term damage. Stretching the damaged area will allow it to regain flexibility as weakness tends to occur when you do not move or contract a limb for a long period of time. It can also affect your ability to move a joint at full range. Stretching can help loosen tight muscles and increase the range of motion after sustaining a sprain or tear. These can either be done with your physiotherapist or at the gym/home. Stretch programmes work best alongside sports massages – however, if you do not have access to these – then foam rollers (which you can find by typing “buy foam roller” into Google) are fantastic at self-massaging.

The final step to recovery is strength training. This doesn’t mean an Arnold Schwarzenegger Boot Camp but a progressive exercise routine that will gradually build up the damaged area. After a muscle is damaged but before it is fully recovered the area will still be significantly weaker than it was before. The job now is to build up to your “normal” amount – and exercises should be given according to your level of fitness and specific muscles affected. Strengthening your muscles will help you get back to your previous activities and can help prevent future injuries.

If you have suffered from a tear or strain, please contact us at Mount Sinai Department of Rehabilitative Medicine for a bespoke rehab plan. Contact our switchboard at (212) 241-6321

Relearning the Activities of Daily Living

 For patients who are recovering from a recent stroke, or similar brain injury, one of the struggles they face is the loss of independence in everyday life. The basics of self-care – eating, bathing, dressing, toileting, transferring (walking), and continence – which we usually take for granted, become activities that cannot be done without assistance. These activities of daily living (ADL) are tasks that must be relearned.

Regaining the ability to care for oneself is synonymous with returning to living an independent life. This is achieved through a process of occupational therapy which involves both relearning the muscular movements necessary to carry out tasks as well as increasing confidence levels in one's abilities in order to achieve a full recovery.

Task-specific Training

In order to relearn the processes needed to carry out the ADLs patients must undergo a regimen of exercises to regain coordination and strength, and to improve motor skills. These exercises are task-specific and tailored to the patient depending on which components they are missing. They focus around using repetition to build up muscle strength and memory.

A variety of techniques are used to retrain the muscles. For example, mirror therapy in which a mirror is placed on a table so that it covers the affected arm and reflects the unaffected one. This triggers mirror neurons, which are in the same area of the brain as motor neurons, making the patient think both arms are carrying out the same action. Recovery can also be aided through brain stimulation. Wires are placed on the scalp through which current stimulation is sent to the brain. This excites damaged areas of the brain, helping to increase the chances of them recovering.

The tasks do produce improvements in function and also cortical reorganization, however, these improvements do not generalize and transfer beyond the targeted activity or area. As such a range of exercises is required to improve motor activity in several areas.

Cognitive Strategy Training

While task-specific training is the only way to help patients recover their previous coordination and muscle power, this can be supplemented by cognitive strategy training. This involves utilizing the brain's ability to reorganize and create new pathways to improve cognitive skills such as attention, working memory, logical thinking, reading, and occasionally psychosocial functioning. This can be used in tandem with the physical exercises to increase self-esteem, and problem-solving strategies, as well as regulating training frustration.

Recovery can be a long and discouraging process. In order for the combination of these training techniques to have any lasting effect on motor improvement consistency is crucial. However, with time these exercises can enable stroke rehabilitation patients to live independently again.