Pushing the Injury Boundary 19/11/2020

Treating & assessing patients (Online / Face-to-Face) during and post-lockdown; I’ve seen and heard different perspectives, opinions and behaviours in dealing with injury and pain and I completely understand all of them, because there are different variables on our lives during the pandemic which are probably different/more intense.

Despite the changes in our lifestyles and circumstances during the pandemic, I feel that some behaviours with pain and injury are changing particularly with pain management. More of us are living with and accepting pain as part of our lives, but at what point do you say, ‘This is not right, I shouldn’t be in this much pain’, or ‘I can’t push through the pain and ignore it anymore’? Is it when you’re:

  • Sitting down for 5 mins during a Zoom meeting?
  • Picking up your child? Running 10 minutes?
  • Standing up for 2 mins?
  • Or something simple like washing your hair?

When you reach this point, what are your next steps? It may be; a Google search for the best exercise/stretch, trying something new like Yoga or Pilates, completely avoiding the aggravating factor, or seeking professional help.

Whichever option you take, you will eventually have to learn how to manage pain and try to understand how much is too much. The image at the top of this page will help you understand this, it shows how some of the current jobs, activities or sports we do can cause more pain, and it’s the reason why I’ve created this post.

The Injury Boundary

Some of the icons are overlapping the circle or the, ‘Injury Boundary’, which represents our own individual pain thresholds which becomes excessive and makes us to stop. I’ve added some icons representing many different sports, exercise and daily tasks because they can all contribute towards pain. This will be very different to each person and activity/sports.

The Injury Boundary represents the loads/activities that are inside or outside our current capability to deal with the physical demands. The activities or sports that are inside the lines are what we can deal with, in terms of pain. If they are outside, they can cause us pain.

I’ve added a couple on the boundary i.e, the football, computer screen and office chair. This means that they either just within our capabilities depending on how much we can do. For example, playing 45 mins of football, staring at a computer screen for 60 mins or sitting down (on a sofa or driving) for 30 mins before we can notice symptoms.

It’s a good way to allow us to understand what we are capable of doing, and when. If you have a shoulder injury, swimming might be too much, however, carrying your food shopping might be ok. This gives you a goal to improve your health of the shoulder to deal with the demands of swimming.

You can refine this even more. Using swimming as an example again, you might be more comfortable with; the backstroke compared to the front crawl, swimming for 20 lengths rather than 50, or using a float for every other length. As you do this, you can build and progress as you adapt and recover. Sometimes it’s good to know what we are capable of doing without an adverse reaction.

Envelope of Function

This has been inspired by Scott Dye, MD (2005), and in particular the phrase ‘Envelope of Function’ (1) which is described as; ‘That torque which can be safely withstood and transmitted by the system without damage’, the torque envelope of that system. A human knee is a very different system to a car, but both can be described as able to accept, transfer and dissipate respective forces, (mechanical in the car and biomechanical in the knee), both describing its ‘Envelope of Function’.

Essentially, we can improve what and how much we can do by allowing the injured site/tissue to respond and adapt to progressive loads. Considering this, we have to appreciate the demands of certain tasks of our everyday lives, and our exercise or sport.

So…does this change or help the way you think about pain management, and injury rehab? Sometimes it’s good to know the pain/injury boundary. As long as you meet it, and don’t push past it, you can allow tissues to adapt rather than crumble…well not literally! I like to use the phrase, ‘Don’t poke the bruise and keep poking it to see if it is not painful’.

  1. Dye, S. (2005). The Pathophysiology of Patellofemoral Pain; A Tissue Homeostasis Perspective, Clinical Orthopaedics and Related Research, 436, 100-110. https://pubmed.ncbi.nlm.nih.gov/15995427/

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