Injury can be a devastating event that puts the end to a sports career or simply leaves you unmotivated to do any kind of physical practice. But depending on how you look at it, it can also be a door into self discovery and a very valuable learning experience. I truly believe it is important to know a bit about the subject even if you are only an amateur. Knowledge is power and possessing at least some sort of correlated information leads to much wiser decisions and better assessments of the situations.
If you are a sane person you will probably not be looking to injure yourself or others on purpose, but if you are involved in any kind of excessive movement practice, at some point it is very likely to happen. When you find yourself in this situation, the most important question to ask is how to deal with it and what to take from this experience. First and foremost we want to minimize the risk as much as possible, the best way to approach it is to think beforehand and to prepare your structure, keeping in mind all possible scenarios of lesion development, depending on your chosen activity. This is why an intelligent process of physical development should be in the big part devoted to the joint prep. Besides, loads and progressions for strength and skill development respectively should be adequately chosen and introduced for each individual. There is a great variety of schemes and protocols that work for most of the population, but a good coach has to keep in mind that sometimes you might come across a special case that needs a totally different approach. To make it work, the best thing one can do before offering coaching services to other people (or even just him/herself) is to educate oneself in related subjects, develop the ability to proceed with proper biomechanical analysis of a given person, to make sure to do his/her own research that is consistently updated and more importantly simply possess a common sense in the time when applying any kind of correlated information to oneself or other people. But if everything mentioned above did not help and the injury happened anyway, a different kind of machinery has to come into play.
Lesions in the human body are a very complex and extensive field of medical study that can't be covered decently in any kind of short format, so i want to make it clear that what I want to achieve with this article is to give those totally unfamiliar with the subject a very basic grasp of physiology of injury in simple terms and in the best case trigger people to go learn about it in detail. I also hope it will encourage everyone who happened to suffer such an event to get the best from it. It will make me really happy if it can help someone to take a step towards developing a different relationship with injury and pain, by taking the path of learning about oneself instead of going into downward spiral of self pity.
Let's touch a bit on physiology: Injuries come in all shapes and grades of severeness. The definitions are not consistent but we can very roughly divide mechanical injuries into 3 large groups: soft tissue injury, skeletal/cartilage injuries and nervous system injuries (internal organs can be injured mechanically too, but it is a totally different subject). Each of them will require a different approach to treatment and each in it's own way will affect your mental state, as there is a direct correlation between the grade of injury and the way it affects motivation of the subject who suffers it (DM Wiese-Bjornstal, AM Smith et al, 1998). In the scope of this article I want to both use as an example and highlight the most common kind of those mentioned above - soft tissue injury. Nerves are also considered soft tissue but the nervous system lesions are the least common in sports, although they are the most complex types that lie in totally different field of study. Bone and cartilage injuries would also need a separate topic, even though in many cases the surrounding soft tissue is affected.
Soft tissue injuries have a large variety of subdivisions. The tissue affected can be a muscle itself, different connective tissue, and skin. The latter is usually caused by mechanical interaction with an external object: The only thing I would like to mention here about it is that the skin is also a metabolic tissue and depending on the practice you are choosing it needs to be conditioned in a certain way, otherwise you just won't be able to step up the level of the game in some fields. (Gymnastic work for example in the beginning causes micro injuries in the skin of the hands that are necessary for further adaptation and more complex work, if you skip it and use gloves many elements will not be available for you in the future.)
There are many ways to classify soft tissue injuries, we won't go into the detail here, but just to name a few of the most common ones: sprains, impingements, injuries related to chronic inflammation (tendonitis, bursitis, etc.), partial or full fiber/tendon/ligament ruptures, loss of elastic qualities in tendons and ligaments, dislocations, fibrosis, etc. Any lesion can be caused by variety of things depending on the activity. The most prevalent cause of injuries in connective tissue and muscle is a repetitive action, in simpler terms - overuse. It can be both a specific movement or lack of it (think office jobs). It is often caused by certain mechanical inefficiencies in the body, that due to monotonous use over time has been compensated for by the surrounding tissue which is not supposed to be involved it this specific motion. When it happens for a long period of time there comes a moment when the structure is not able to handle it anymore, so it first becomes inflamed and then if inflammation is not addressed properly, the tissue suffers degeneration, and eventually, rupture. That is why over specialisation in sports will always send you a bill as the years pass by.
Another common cause of injuries is that the tissue has not been adapted enough for a given load - so called acute injuries. Those who are racing for higher numbers in weights or aiming for skills too advanced for their current physical condition will sooner or later encounter this problem. Injuries caused by extreme abrupt overloads are usually the most severe ones. It doesn’t only happen to people who overestimate themselves but is also common in all kinds of contact sports, where unexpected situations can happen. The reason is still that the structure is not fit enough to handle the load, but it happens in chaotic scenarios. Whether it is martial arts or team games - awkward positions on unprepared joints you are forced into by a lock in jiu jitsu, or bumping into your opponent at full speed in a basketball match are just a couple of possible situations.
Everything listed in the last two paragraphs is very important to keep in mind and respect while constructing programming for specific work. It doesn't matter if it is aimed at strength, mobility, skill etc. Be very thoughtful of how you apply overloads within a training regimen and make sure to introduce progressions for development gradually to avoid accidents and lesions that can kick you out of the game and discourage you for a long period of time. It takes a lot of effort both physically and psychologically to recover from an injury and if you are involved in competitive sports or making a living out of scenic arts this can be a very significant event that can upset the whole course of your life. But in case it happens, there are various ways to approach this, and the wisest one would be to try to understand the nature the of event and learn from it.
Here is a piece of very important information that can help to relate to pain differently, for those readers who are currently recovering from injury or suffering chronic pain: it had been shown by a variety of researchers that pain is not always directly correlated with tissue damage. The pain exists in your body maps inside your brain, not at the exact spot where you feel it. To explain it in a simpler way - when you have a chronic pain it does not necessarily mean that the tissue in this area is affected, it might be just the memory of this pain. Also the fact that you have had tissue damage in some part of your body will not necessary cause you pain, but must nevertheless be addressed to avoid further harm. Series of research opened up a whole new view on how we treat injury and there is more and more evidence surfacing, that the soft tissue lesions can and should be treated through the central nervous system. (DL Morton, JS Sandhu et al, 2016)
When recovering from injury, non operative treatment should be the first choice, as it results in the best outcome and if failed, the consequences are not as dramatic. Overall, movement is the best healer. If you have to go to a specialist to help you go through recovery, be aware of those who totally restrict movement of the injured part of the body and don't prescribe you any exercise at all. The information that total immobilization of the injured part is necessary for healing is out of date, as the more blood flow damaged tissue receives, the faster recovery will occur. Depending on the severity of the injury, certain restrictions might indeed be needed, especially within first 3-5 days, but it had been shown by numerous pieces of research that when the proper movement therapy is involved, recovery is much faster and full motor function of the affected area is much more likely to be regained (JA Buckwater, 1995). The main problem with this is that the most conventional hospitals will offer you a 3 week treatment regimen and let you go with whatever function they can possibly recover in this short period of time, when in some severe cases it can take up to several years. You must be patient and you must find a suitable person who will be able and willing to truly help and work with you on a proper recovery program. Sometimes it takes serious casting to find the right therapist, but don't let it discourage you, it was never easy to find a needle in a stack of hay.
It is also important to mention that all kinds of injuries are very closely connected with inflammation, so in order to maximize healing potential, I would highly recommend looking into dietary and supplementation modifications to minimize the general inflammation of the body. To give you a few examples - the most effective anti-inflammatory supplements are shown to be Omega-3 (EPA) and concentrated Curcumin. (PC Calder, 2010. N Chainani-Wu, et al, 2003) It is not a panacea for healing, but it can be a significant help. If you are not willing to go for supplementation, at least there should be some dietary restrictions on pro-inflammatory foods.
The severity of an injury varies greatly, but so does the perception of the person who experiences it. Some may not be able to handle a simple sprain while others go through the recovery process from full tendon or ligament ruptures with no pain killers. This aside as with most things in life there can only really be two options: you can choose to be a victim or you can choose to be a hero. The first one will use the injury as an excuse for all sort of things, the second will take it as an opportunity for reflection and will go through a healing process, that depending on the seriousness of the injury, can be a conscious decision to pass through hell. I can't think of a more sophisticated way to train character nor a better opportunity to develop a different relationship with pain. The latter alone can be a very useful skill for many things.
Injury is a very challenging event but can definitely be taken from a philosophical point of view, and while having correct information about it you might be able to make conclusions applicable to many others fields of human existence. So if you look at it from the right perspective, it becomes a very valuable lesson in life.