Well yes, the whole reason injuries are accompanied by inflammation is that increased blood flow speeds healing. But in my case, the worry was that inflammation was causing me to cause more damage when I did PT exercises, which then leads to more inflammation and more damage and more inflammation... etc. So I had to stop that cycle by forcing the inflammation down. Now I'm easing off of the ice and NSAIDs to allow more blood flow and faster healing.
Just a few hundred years ago they burned witches in Salem, Mass and many thought the world was flat. Dr. Hauser has cleared up for us all what inflammation is, its really the laying down of new collagen, anti-inflammatories keep football players playing for the fans at the cost of future arthritis.............cadavers have been found with unhealed soft tissues from a cortisone shot 30 years prior............still think you got it right?
I think what Ryan is saying, is that inflammation can be a good thing, but under these circumstances, perhaps it is too much of a good thing. I'm sure we all agree it can be a difficult balancing act to train or condition injured tissue without making it worse. The question is not really about the value of inflammation - which has already been established, but about the relative benefits of suppressing it versus allowing it to get out of hand while he trains.
In my business, laying down of new collagen is not necessarily a good thing. In fact, we spend a lot of time trying to break up the adhesions formed by these natural processes, because they can lead to permanent dysfunction if left unchecked. Think of a horrible looking scar, only an internal one in this case. Preventing or removing such internal scarring is the concept behind deep tissue techniques such as Graston, ASTYM, ART, etc., which do in fact produce an inflammatory response, but one whose results are being managed.
May I suggest that once said inflammation has begun, the exercises meant to prevent ITBFS may be counterproductive, if they are resulting in too much movement-related inflammation and/or muscle tightening. What Ryan is trying to do, with the help of his PT, is to regain or maintain the kind of muscle tone that will prevent the stability problems that led to his condition in the first place. This late in the game, it appears to be making his condition worse, which happens a lot in advanced cases. Movement should probably be limited to preventing adhesions and joint fixation at this point. Inflammation should run its course without further damage if a gentler exercise strategy is employed. Care must be taken to avoid aggravating the condition, without hiding the symptoms, or letting the injury congeal into a dysfunctional mess.
Something that should not be lost in the conversation on remedial interventions, is the importance of running form to your original complaint. While the timing may be suspect, any conscious effort to reduce the tendency to produce this inflammatory condition (if indeed that is what it is) has a place in your recovery. As Damien Howell, PT has made plain in his posts, form cannot be left to chance. There must be a conscious effort to improve the way our running muscles are used, in order to mimimize the initial occurance, or recurrence of injuries. The "chicken or egg" question that often comes up, is whether soft tissue dysfunction leads to errors in form or vice-versa. Of course, it is true both ways, but our strategies are often aimed only in one of these directions, or timed incorrectly. As the saying goes, to someone with a hammer, the whole world looks like a nail. Make sure you involve every skill in the rebuilding of your body.
While you are being rebuilt, expect it to sometimes be painful. The important point of all these posts is that rebuilding of tissue often involves growing pains of some sort, and can even be considered a part of being healthy, when properly informed. Rare is that individual who can grow into a superb athlete without pain. The trick is to know what pain is constructive versus being merely instructive, and what pain directs us to cause or to symptom. This is the direction we depend on professionals for, but each of us must still be well-informed. Keep reading, the answers are legion. While our bodies haven't fundamentally changed much in recent years, our understanding of how it works most certainly has.
The now traditional - but until relatively recent times untested - advice to repress the inflammatory symptoms, has come under increased scrutiny. However, the current science indicates that, though all inflammation is not bad, too much ongoing inflammation is not good either, as it can affect blood and cellular chemistry in a negative way. The resulting stress has its own consequences. Decisions are now made by assigning a different weight, to either suppression of symptoms by interfering with the natural process, or by delaying overly-aggressive treatment until the inflammation has run its course. There must still be an eye on what is healing and how. This can take not only effort, but time. Rome wasn't built in a day, but it was built well. The fact that quality trumps quantity is why much of it still stands.
If we ourselves haven't been told by our doctors not to run, we've all heard of other runners being so advised. Now we know why. It is an unpopular position for a physician to take, but I think the average practitioner would rather see us stop creating problems, rather than simply medicate them. Be careful about deciding who the good guys really are. With respect to the example of professional athletes, it may not be us, either.
Running can be quite addictive.. the pride of accomplishment even more so. If we lose the ability to listen to our own bodies, who will speak up for them? As I have often recounted in this forum, I once took an entire 6 months off of running to let my body heal. I remained mildly active, and not immobile, which I think together are the best course of treatment for many of the running-related inflammatory conditions we discuss here. I think there is enough evidence that the extremes of bed rest and targeted exercise can both do harm, and there is a happy medium for all of us that is unique to each individual case. In my case, I not only recovered, but after a year or two, came back to set PRs at many distances. The old problems have not returned.
The main contribution I try to make here, is that any athlete can learn how to disarm and reverse the neuromuscular patterns that contribute to their injuries in the first place. That being done, everything else can fall into place without major unnatural interventions. Where some may disagree with me, is the method for this reversal. I think there is merit to all interventions discussed, as long as they do not exclude what may be most appropriate at any given time. I trust the body's ability to heal, if damage is not being produced at a greater rate than the rate of recovery. If we consider the relative values of rest, vs exercise, vs stretching, massage, ice, anti-inflammatories, pro-inflammatories, even surgery or other interventions, we can see that all may have their time and place in many cases. We just need to be more discerning about when and where we apply them.
While physicians and therapists, as paid professionals, try to balance your best interests with your aspirations, each of us is the primary diplomat between our bodies and those kind folks who try to help us, and that role should never be surrendered. Pain is natural, and the causes for it are often beneficial, but each of us should know in our hearts when enough is enough, at least for now. Not only can your body heal eventually, but when you aspire to train again, you can improve the same way you improved before. Regardless of whether you have lost fitness in the interim, you can regain it the same way you started, even years later. Patience, along with a healthy lifestyle, is the key.
Just keep in mind that injuries, though we may forget them, are not easily forgotten by the body, and the dysfunctional neuromuscular patterns that result from these injuries can persist for life, if left unaddressed. Your job, and the aim to which all therapies should be directed, should not be to forget, but to re-learn. In my view, you must start by restoring normal function to muscles that make everything else move, and the rest will fall into place. To accomplish this, you must know how muscles respond to injury, how they can store this response indefinitely despite our conscious efforts to control them, and how you can cause them to accept work before the actual workload is introduced. Throughout this process, you must learn how important it is to feel what is going on, and how to avoid repressing or ignoring this feeling, whether by natural or unnatural means. When the pain finally goes away, you want the reason to be removal of cause, rather than merely the loss of symptom.
Although I agreed with just about everything you said, the insight I have gained from prolotherapy is that if you can afford the therapy, there is a chance that you can turn a lemon into lemonade, at the moment I am experiencing some parts of my knee that are now stronger than when I was say 28. I turned money into an investment of strengthened ligaments, tendons and new cartilage. It surely is alot easier for Dr. Hauser to become a triathalete and ironman because he can endlessly administer prolo to himself anytime he wants, his list of injuries and subsequent healings to himself are impressive, he has run up to 60 miles !!!!! He was born with a leg that turns inward (I think) and has more than just adapted or conquered it, he has proven that prolo can create superhuman tissue from what appear to be weak tissue or problematic tissue. I am not in this business and as a poor architectural draftsman just looking to get the word out about my direct 4 1/2 year bank savings draining experience but new chance at life after an accident. Though I am not a therapist, so many parts of my body were mashed that I am wondering where(?) all the scar tissue has caused a problem, no where for me. The body is so efficient that if too much collagen is dumped on anything, the matrix integrates what it needs and the rest atrophries or is eaten by enzymes, a process they call "profiling" 18 months after your last prolo visit. And it has happened just like that for me, my feet became just a tad too tight but low and behold life will tear them out and apart for you, don't worry about too tight, life is tearing things apart naturally, integration and nice and tight structures are what you want and the pain goes away right then and there when you achieve that..........enough said.
re: ITB article by Paul Ingram.. Last I checked, Paul was a massage therapist educated in Canada, where they do take such training very seriously, although his eternal quest for knowledge relevant to our sport appears to have taken on a life of its own in his blogs. Known for his exhaustive research, sense of humor and satiric wit, his "mythbusters" approach is helpful in the field of athletics, where myths grow like moss in a dense forest. Can't say I blame Paul for wanting to make a buck on his elaborate posts, being in a profession that tends not to pay really well if you don't put yourself "out there," but he does give a good bit of information away for free. Whether the complete articles are worth the extra expense depends on how much pain you are in and how many answers you are still looking for. Good luck with your rehabilitation!
nice and tight "structures" means bones and connecting ligaments, which are the slightly flexible form of bones metaphorically in my mind, in that I believe in evolution and in the creation of bones, the evolution of joints, ligaments grew attached to bone as a way to make a joint work. In a nicely taunt structural model, the muscles can relax normally, so my nice and tight structures statement does not include muscles with knots in them or any abnormality in the muscles, I am not including muscles in the structures at all..............by the way.
This is not all just theory.......I am living the results....depending on them, so I can reflect on the truth.
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