The Weakest Link
Oftentimes people tend to think of their injury as the result of a specific event, the one time they lifted something wrong for example.
I tend to think of the injury event, the moment “it happened” as the straw that broke the camel’s back. There was something going on in there already, something that predisposed that area to weakness. Then at the point when the injury occurred that area experienced overload.
The chain breaks at its weakest link.
Moshe Feldenkrais, the originator of a method for enhancing quality of life through movement awareness, said, “In short, health is measured by the shock a person can take without his usual way of life being compromised”
In the case of physical, musculoskeletal health, the “shock” is called overload. This is a very important concept in the realm of orthopedic injuries. If we have little resilience in our tissues; muscles, tendons, ligaments, bones, cartilage…then it doesn’t take a lot of shock to overload those tissues to the point of creating a pain reaction, or even a physical lesion (meaning some kind of tear).
Even if we have a lot of resilience in our tissues, we can still become overloaded by a big enough shock.
Throughout our lives we will all accumulate some of the “thousand natural shocks which flesh is heir to” as Hamlet put it. Getting tossed about and overloaded is a normal part of being alive.
Some of those shocks are bound to be disruptive.
They might come too close together, and not give us enough time to heal in between, or they might be single incidences that are much more than we can withstand.
Sometimes we don’t get a lot of choice about that.
But we do get to choose what happens afterward (which is also beforehand, since we know that somewhere, sometime another shock is coming).
After we go through an initial phase of healing, where our tissues knit back together and pain decreases we have the option to continue further and explore our outer limits.
This exploration expands our outer limits.
We also have the option of becoming afraid of hurting ourselves again and deliberately reducing our activities and being more careful. The problem with this approach is that when we reduce our activities we reduce the ongoing load we’re putting through our body. Bodies are dynamic, adaptable, living organisms and they are only ever moving toward or away from health. They never arrive and stay there. Changing to a lifestyle that puts less load through the body means decreasing the strength and resilience of the body. In essence, our limits, our capacities, contract around us.
I recommend exploring the limits of what your shoulder, hip, knee, etc. can do. This is good not only for the tissue, but for the nervous system…but that’s another idea for another time.
With most injuries there is some motion or some position that feels the most dangerous or that creates pain. In order to find the weak link, the site of future injury or aggravation, you can transition through moving the shoulder (or whatever) in all the planes of motion with a challenging load. You would need to do this following the standard principles of progressive overload and specific adaptation to imposed demand. In other words, you would need to keep it challenging, but not too challenging. And you would need to do it often enough to make it part of your life, but not so often that there’s no room for rest and recovery.
Ultimately you would gain enough resilience to practice the most painful and aggravating movements with a challenging load.
This is called practicing the position of failure. If the injury was a typical ankle sprain then you would work toward placing your body weight on your inverted foot, because that was the position where damage occurred.
This is a pretty different tactic than babying the body and trying to avoid the bad position. The idea is that if there is a position where the body is prone to failure, i.e. getting overloaded, then it’s important to load that position in tolerable increments so that when the big shock happens those tissues have built up some strength to withstand it.
Getting back to the ankle. You could load the anterolateral portion of the ankle, which is the most likely part to fail even if you’ve never had an ankle sprain. You can load it to prevent injury, or you can load it to recover from injury and prevent further injury.