In any active recovery program, there is always the point where you wonder if you are ready to try and do something, or whether you should really rest and not venture back into the fray. This point is one of great conjecture amongst many people who are attempting to make a return to the active, sporting field. Many questions determine whether you are 'fit' to take the field again or whether you should be sitting at home with your feet up and having a cup of tea.
Personality is a major driver of this conundrum. When looking at recovery from an injury, one of the main aspects to take into account is 'personality'. Are you an active recovery person, or are you happy to take the path of least resistance when it comes to re-engaging in physical activity. Both aspects can be your own worst nightmare if you are are not careful to appraise where you are seated in the 'injury recovery' spectrum.
I often see clients who start back too soon, with too much stress and load and too much 'eagerness' to be back and into the training, that they damage themselves and don't allow the necessary healing to take place. This is the 'athlete' mind set. It's like a dog, all they want is to get back on the field and run. In this case, you sometimes have to exercise a little caution and restraint and pull hard back on those reins. The active individual needs to allow the muscles/tendons/joint to heal and then to monitor a 'gradual return' to loading that will assist with recovery and make the area stronger than it was before. Too much action or stress too early in the healing process can lead to much more damaging issues later on.
Then there is the other extreme, where 'fear' becomes a major issue and does not allow someone to go out and really 'stress' the area concerned or 'test it' with any real resilience. The memory of the original injury or pain is too much to warrant a complete, all out blast at an action. Sometimes, you need to give a joint space or tendon a good stressing so that you know it is going to heal strong, or even to make it heal stronger! It is not uncommon after knee surgery for example that the attending physician will have you up and about the next day, weight bearing and putting pressure on the operated area to ensure that is stressed sufficiently to warrant a strong healing process. It's a little bit like the immunisation debate. A small dosage of resistance may actually make the area become more resilient to a major strain!
Basically the best advice is to let 'pain be your guide'. If you can imagine Jiminy Cricket 0n your shoulder telling you so, "Ache is great but shooting ain't soothing". A dull ache of a muscle 'usually' can indicate that you are working a muscle and 're-conditioning' an area that has been under-utilised or underdeveloped previously. A sharp, shooting pain is an indicator that you are doing yourself further damage. Acute pain like this indicates that the fibres/filaments/tendons are still not quite over the initial damage and that you may be encouraging more bleeding/tearing of an already weakened structure.
To stretch or not to stretch is often a great quandry for people who are returning from injury. The basic premise is, that if you can't use it, don't stretch it. Any soft tissue structure that is unable to be contracted or stressed for any period, will not benefit from being stretched or strained. Like a piece of cotton, the fibres will more easily pull apart if the unit as a whole, is not solid and strong. Stretching in this period of healing is 'contradictory to healing'. You are only pulling the fibres apart further by continuing to stretch in this manner.
So to is the issue of icing. ICE whilst beneficial at the immediate stages of injury, may be a contraindication to healing. Effectively freezing the fibres so that they are inflexible and unable to repair or allow movement from occuring. If there is no internal bleeding then the use of ice is to be administered sparingly or not at all. You require blood flow and heat to ensure cells are delivered to the area as required. For more on this read my previous article on cryotherapy
To be certain of what stage of recovery you are at, trust your therapist. Understanding when to 'push' or stress a 'joint' can be most beneficial in a solid return to full form. However, be mindful that any sharp pain indicates you are not quite ready to return to 'full load'. Listen to your body. It will let you know if it is ready or not. Mimic the movement that you need to do and if that still hurts, you may need further treatment or more stability. If you can't do your full training schedule pain free, you aren't ready to 'perform' on the field or court.
Working with therapists who understand your needs and goals is primary to any recovery. Trusting them with your recovery and having an outside perspective is beneficial to knowing when to 'get off the crutches and give it a go'. Both extremes are there to be mindful of and if you aren't sure, then ask. We are here to work 'with' you to get you back on track.