Why do I have to go to the physio?

Hi, I'm Adrià, physiotherapist specializing in CrossFit and in this article we will clarify some doubts that may arise when going to the physio.

Throughout my time in CrossFit I have seen several athletes who have not found a way to make progress with their injuries, having to limit their athletic activity and, in some cases, having to drop out of the sport altogether.

What could have gone wrong in most of these cases?

They probably did not receive care commensurate with their needs and, due to lack of knowledge, did not go to the physiotherapist when necessary.

Next, we will mention the main doubts that you usually have when going to the physio as well as the "excuses" that are usually made for not going, and we will try to answer them as simply as possible so that, when the time comes, you will have enough information to be able to decide.

Let's get to it,

What are the most common doubts or "excuses" when going to the physio?

The first most common and most normal doubt that appears is:

How do I know if I should go to a physio?

In general, I would recommend going to the physio if we notice pain or discomfort that does not improve in 2-3 days and that conditions or limits our sporting activity or even day-to-day activities. Other important points that would be reason enough to go to the physio would be:
– Dolor que aumenta o persiste a lo largo del entrenamiento
– Dolor que mejora con el calentamiento pero vuelve al acabar el entreno o al mover cargas altas
– Dolor persistente, nocturno o que dificulta el sueño
– Pérdida de movilidad
– Pérdida de fuerza en determinados rangos del movimiento

On the other hand, we must make it clear that PAIN ≠ INJURY.

This topic can be used for several postsThe pain is a rather complex process. Today we will stay with these points:

Pain is understood as a experience del paciente fruto de la información que recibe de sus tejidos y el procesamiento que realiza (teniendo en cuenta creencias, experiencias, …).
Pain is processed in our brain.
There are several types of pain: The most frequent in sport are usually those caused by a INPUT (nociceptive or peripheral neuropathic).
That INPUT can be a structural injury (rotura muscular, esguince, …), o que los receptores de ciertos tejidos se han estimulado por encima del umbral de activación. El cuerpo lo percibe cómo algo potencialmente peligroso para nuestra integridad, dando cómo respuesta la sensación de dolor.
In this way, we must understand pain as a response of our system to protect us in the event of an injury (or at least our brain interprets it as such) or exposure to danger. What we know as threat perception.
Therefore, we may experience pain in the presence, or not, of injury.

Por todo esto, si nos encontramos en una situación como la descrita anteriormente, el fisioterapeuta será el profesional sanitario que mejor nos podrá valorar, tratar y asesorar.  De este modo, podremos saber si el dolor se debe a una lesión real en alguno de nuestros tejidos (músculo, tendón, ligamento, …) o si se debe a que estamos sometiendo a un estrés demasiado alto alguno de ellos.

In each case the way in which the problem should be approached will vary. If there is a structural lesion we will have to take into account the recovery time of the tissue during treatment. If there is no lesion, we will have to find out what is causing the alarms to go off and solve it in order to to prevent us from ending up injured or decrease the chances of that happening.

Work the force, the mobilityto adapt the charges as well as transmitting to the patient the information necessary to understand the problem and be able to solve it are some of the most powerful tools the physical therapist can use in these cases.

As a piece of advice, I always recommend that you look for a physio who has experience en vuestro deporte, en este caso en CrossFit. Es importante que conozca las exigencias propias de esta disciplina, los gestos, los movimientos, la metodología de entrenamiento, … Así os entenderá mejor, sabrá interpretar qué está sucediendo y como puede ayudaros.

At this point, some of you may be wondering:

I have pain that goes away at the end of exercise or within a couple of days.

Why is this, should I be worried? In these cases we usually have two situations:

  1. Pain or discomfort during training.
  2. Post-workout pain or discomfort.

Let's go for points,

1. During training:

This sensation of pain is largely caused by the compression of nerve receptors and other tissues, such as blood vessels, due to the increase in muscle volume in the areas we are working, as we accumulate more blood. (nos solemos referir a esta situación como “congestión”).

As soon as we stop exercising, everything starts to return to its basal state (normality).

To give an example, it would be that burning sensation and/or pressure that we feel in our thighs during the last repetitions of the backsquat or in our biceps when we finish the 100 pull ups of the Murph.

In addition, we can use this sensation to adjust and control the exercise or training load. For this purpose, there is the RPE or Rate of Perceived ExertionOn a scale of 1 to 10 where from 1-4 we would speak of a very light effort and we would go up to 10 which would mean a maximum effort.

In this case, keep in mind that it is not advisable to always train with sensations close to 10. Program your sessions well and select the intensity level according to your capabilities and objectives.

2. Post-training:

La presencia de dolor debido los entrenamientos puede considerarse algo “habitual” si hablamos de dolor tolerable.

It is usually described as a pain that from 0 to 10 on the pain scale is around 3-4, which could qualify as more of a nuisance.

The most common case is the appearance of DOMS (Delayed Onset Muscle Soreness) o más conocidas como “laces“, suelen cursar con un aumento o pico de las molestias las 48h-72h. Durante este intervalo de tiempo es importante controlar la carga de los entrenamientos para permitir una buena recuperación de nuestro cuerpo.

We can refer, for example, to the pain we may feel in the quadriceps after a high repetition heavy backsquat training or the discomfort in the lumbar/thigh muscles the day after a deadlift session..

This type of pain appears when we perform movements that we do not yet control or move loads/volumes above our capabilities. This is necessary in order to generate adaptations in our tissues that will allow us to tolerate these loads, volumes and movements in the future.

The appearance of stiffness does not mean that we have caused an injury (for example, stiffness in the lower back after a deadlift). But it can be a sign that we have overdone the load, that our body is not yet ready for it.

Es estos casos, no es para nada recomendable estar siempre con agujetas. Planifica bien tus entrenamientos y permite que tu cuerpo pueda recuperarse bien de cada sesión. En caso de aparezcan, no te alarmes, simplemente se consciente de ello y actúa en consecuencia (disminuir carga, cambiar tipo de entrenamiento, …).

After all,

We can have pain with or without injury, so a good diagnosis and assessment by a physiotherapist is very important. Having pain is normal and is part of the mechanisms that our body has to protect us against a threat, if we know why it occurs and act accordingly we can solve it.

Debemos saber diferenciar entre los diferentes tipos de dolor y contextos en los que se producen. No es lo mismo el dolor tipo “agujetas” que el dolor constante al hacer ciertos movimientos. Cada uno de ellos tendrá un pronóstico y abordaje distintos.

However, in both cases, 100% recommended to have the help of a professional who knows how to guide you. At first, in the presence of pain, the physiotherapist will be the most indicated. He will be able to rule out that it is something serious and address the problem in the best possible way.

Later on, the same physiotherapist, if he/she is trained in training, or the trainer, will be figures we can rely on to keep improving and to know that we are doing things right.

Is it too expensive?

Within the healthcare world, physiotherapists, as professionals in the sector, are generally not among the best paid. We can discuss the reasons, but it is a fact.

That said, when you go to a physiotherapist you are going to a health professional who will listen to you, assess and try to understand what is happening to you to give you the best treatment and tools available. All this, so that you can recover from pain or injury as quickly as possible and with guarantees.

Para llevar esto a cabo, no solamente son los 30 o 60 minutos de sesión presencial. Hay un trabajo “extra” que hacemos en otros momentos dónde revisamos la historia clínica y el tratamiento, monitorizamos la evolución, buscamos información y planificamos las fases de la recuperación. Además, estamos disponibles para atender dudas y aportar los conocimientos clave al paciente para que tenga herramientas útiles que le permitan afrontar el problema.

Physiotherapistsin general, we are among those who We give more importance to being up to date and we spend more time and money on training. It is a constantly evolving profession and most of us, perhaps because of the same vocation, try not to be left behind.

Due to the constant evolution and growth, physical therapy is moving away from the more traditional framework of only stretcher and massage with a structural and mechanistic approach, to be placed in the framework of clinical reasoning, biopsychosocial approach and the use of exercise as a very powerful tool without forgetting other techniques of the profession such as manual therapy.

As in all professions and services, there is the possibility that you will meet someone who does not meet your expectations. To try to avoid this:

Verify that the physical therapist is registered.
Ask for information and references.
Check out their website and social networks to get an idea of what you will find and if it fits you.

Being a little more directHow much money can you spend on knee braces, supplements, accessories, alternative therapies and a long etc. to try to improve pain, mobility or discomfort? Whether it is too little or too much, it is too much, because it will not substantially change your situation.

Seeing a physiotherapist on time you will save time and money.

Should I stretch more to avoid injury?

Today we know that stretching does not have a relevant impact on the increase of physical capacities nor on general health markers.

Es más, en algunos casos se recomienda no realizar estiramientos porque pueden influir negativamente en el rendimiento o incluso aumentar el riesgo de lesión en deportes que requieren de cierta rigidez (o “stiffness“) como es el caso del CrossFit u otros como el fútbol, baloncesto, …

In contrast, in other sports such as figure skating or ballet, stretching can be useful because these disciplines require a lot of flexibility. Context is key.

Siguiendo con la intención de mejorar nuestro estado de “fitness“, existen otras capacidades que sí que causan beneficios importantes en nuestra salud como el strength trainingThese can be used to maintain and improve flexibility or mobility if this is what you are looking for.

In the presence of pain, we often make the mistake of relating it directly to a lack of mobility or flexibility, when these are secondary factors. Other factors such as the progression of the load, the adaptations we produce to it or rest are much more important and we do not pay as much attention to them.

To improve that mobility or flexibility we decide to stretch, but we must keep in mind that:

In order to improve mobility, the passive stretching are not the most suitable.
In certain lesions such as tendinopathies (so frequent in CrossFit) stretching is contraindicated.
Mobility is the ability to apply force in a given position and not just the ability to reach that position.

For these reasons, it is important that a physiotherapist assesses your situation to determine the causes and can guide you in the exercises that you should perform and that will have a positive impact on the development of your injury or pain. If you need to work on your mobility to improve, you will get the right tools to do so.

If I rest for a few days, will I get better?

No, resting by abandoning any physical or sports activity is not going to make you recover sooner. Well-planned rest is essential in any training program, but to improve our physical problems, total rest is not going to be a good option.

Una vez determinadas las posibles causas de tu dolor o lesión se debe planificar un trabajo activo con el objetivo de recuperar y mejorar las capacidades necesarias (fuerza, control, movilidad, …). Si hay lesión de algún tejido, respetando sus tiempos de curación.

We must understand injury recovery as the training in the presence of pain or injury.

Rest will probably improve symptoms, basically because we will be reducing the demands on the tissues and they will receive less stress, stimulating fewer receptors that inform us of potentially dangerous stimuli.

resting does not usually cure the injury

Dicho de otra forma, si experimentamos dolor al levantar “X” kilos o al saltar o al realizar alguna actividad metabólica como remar, en el momento que dejemos de hacerlo ya no estimularemos los receptores de los tejidos implicados en esas actividades por encima de los umbrales que disparan la percepción de dolor.

On the other hand, it is important to remember that prolonged periods of rest or inactivity also decrease your tolerance to the load. Therefore, if after a few days of rest we feel better and decide to return to training, we will probably feel pain again and run the risk of worsening the situation.

In these cases, the physiotherapist will help you adapt the exercises to continue with the sport activity if possible, control the load and take into account what is necessary to ensure your return to sport.

Have I injured myself due to poor technique?

Another unlikely assumption. While it is true that movements are taught with a specific technique and by fulfilling certain points, we also know that every exercise has a spectrum of possibilities to be performed, and all of them can be correct.

Each person has a different anatomy and specific movement patterns (motor strategies) that will configure a unique movement for each exercise. With this, I don't mean that anything goesIt is simply that there is no single way to do the exercises and we must contemplate the fact that there are variations in each person.

¿Cuántas maneras diferentes de hacer un clean, un peso muerto o incluso dominadas podemos ver en atletas? Pues muchas, diferentes agarres, diferentes set-ups, …y todas están “bien”.

Each person will do the movement in the most efficient way that his or her system creates or in the way it responds to certain stimuli. This will change over time, the system will learn and create new movement patterns and more efficient strategies.

Is your technique in clean Is it the same now as it was on the first day of school?

This way of understanding movement in physiotherapy allows us to know if the technique of execution of the exercise may be playing an important role in the evolution of pain or injury.

Finally, there are indications that a perfectionist attitude in athletes in relation to performance technique may lead to an increased risk of injury. Probably because it involves an attitude of hypervigilance (they are too much focused on posture), adds stress (worse recovery) and distorts the focus of attention (worsens the execution of the exercise).

Don't be overwhelmed if your snatch PR is not similar to what they do in the Olympics. If it doesn't hurt, feels comfortable enough and you maintain the minimum standards of the movement, keep working. Over time, you will improve your motor strategies for that particular movement and become more and more efficient.

Control the load and perform technical work to mechanize the movement and improve it.

But as I said at the beginning, not everything goes! If, on the other hand, you feel uncomfortable, the movement is aberrant and you do not maintain the same movement over time (throughout the training), it is better to look for alternatives or regressions of the exercise to work on the base before moving on to complex movements.

Do I have to do more "corrective" exercises?

The answer is a bit along the same lines of "good technique", to think that the pain comes only from a decompensation, bad posture or lack of mobility and the solution is to correct it is to fall into a reductionist view.

Pain is more complex than this. While it is true that these factors may have their relevance, and we must take them into account, we would only be contemplating the mechanical aspect and the symptoms.

Fijarnos demasiado en ellos e intentar corregirlos mediante ejercicios “correctivos” puede hacer que dejemos de dar importancia a otros aspectos del entrenamiento más importantes y que realmente vayan a tener un impacto positivo a nivel de salud o rendimiento.

We could say that dedicating time to this type of exercises under the premise of correcting aspects such as posture or decompensations may be taking away time that we could be dedicating to work on other capabilities which would be more important.

De tal manera que no solo nos estancaremos en la evolución de nuestra lesión si no que, además, podemos ver como nuestro nivel de “fitness” disminuye con el tiempo.

Corrective exercises may have a place in the sporting arena, but they cannot replace the role of the strength work or the load control. Moreover, it is not very clear that it will really improve our performance or pain since, as we have said before, they are based on a mainly mechanical view.

And as we have said in the previous block regarding technique, each person will have different motor strategies for each movement.

En los casos que detectamos una incongruencia en ese movimiento, podemos incluir un trabajo específico para mejorarlo. Personalmente, evito la palabra “correctivo” puesto que se da por hecho que el paciente tiene un error o defecto y su connotación es negativa (nocebo).

From the sports physiotherapyIn the case of pain, we take into account all the factors that influence pain and on which we must act in a precise manner.

Should I take anti-inflammatory drugs?

Although they may improve pain in the short term, they will most likely not solve anything and will also hinder your body's recovery.

Most of the pain, of non-traumatic origin, that appears in sports practice is due to an excess of load on the tissues and does not involve an inflammatory process that requires anti-inflammatory drugs.

Again, the recountthe causes and work accordingly.. Adapting the training and controlling the loads until function and fitness are restored.

Taking anti-inflammatory drugs does not cure injuries

We know that the use of these drugs also does not improve "stiffness" and their prolonged use can affect muscle development. Furthermore, especially in tendon injuries, they have a negative impact on tissue repair mechanisms.

In general, I would advise against taking this type of medication unless the pain is caused by an injury with a significant inflammatory component that may justify its use.

Will it hurt me?

Aunque esta idea está bastante instaurada en la sociedad y hay personas que incluso relacionan el dolor con mejoría (“si duele cura”), resulta que no es así.

There is no reason why it is essential to apply techniques that are painful or intended to cause pain. To recover from an injury you don't need to be poked, prodded, squeezed, electrocuted and so on.

On the other hand, it is true that there are some invasive techniques, such as dry needling, or manual techniques that can cause pain and that in a complementary way are often used with the intention of improving symptoms in the short term and acutely.

In these cases, the clinical criterion of each physiotherapist comes into play, who, taking into account the context and the risk/benefit, decides whether or not to apply this type of technique. In any case, they cannot become the basis of treatment nor should they be given more importance than they really have.

In addition, there are many other manual therapy techniques that can help us reduce symptoms in the short term in a more pleasant way and have considerable scientific support.

Not to mention exercise, which has become one of the most powerful tools in physiotherapy for the treatment of injuries and pain.

Therefore, do not worry about getting hurt. The keys to a good recovery, according to physiotherapists, are a good clinical reasoning (to find out the cause of the problem and work on that basis), patient education (give you the necessary tools and knowledge to be able to manage yourselves) and exercise. None of these 3 things will hurt.

From there, as physios we have other tools that identify us as manual therapy that can be very useful at certain times or, as we have already said, invasive techniques (such as dry needling) that can be painful but will only be performed in certain contexts and depending on the professional's criteria, being dispensable.

As patients, we must be clear that in order to recover from our injuries or pain we will have to be active participants in the same process. Finding a good physiotherapist to guide us on this path is essential.

Una vez aclaradas las dudas más frecuentes…

What should you expect from us?

For starters, we are the most qualified health care professionals to treat pain or injuries of the neuromusculoskeletal system and with more tools to do it conservatively and with good results.

We take into account all factors that may influence the development of pain or injury beyond purely mechanical aspects or imaging tests.

We do not treat pathologies, we treat people with problems and we are aware of it. Any injury or pain will affect, to a greater or lesser extent, our level of stress, worry or expectations. Addressing these aspects is part of the treatment.

In order to get to the source of the problem we rely on the clinical reasoningThis involves a rigorous process of obtaining and managing information, allowing us to be as accurate as possible.

We will help you recover from your injury or pain without you having to stop exercising. In fact, we understand recovery from injuries as "recovery from pain".training in the presence of pain".

For this purpose, apart from the techniques that we can perform on the stretcher, we schedule therapeutic exercise with the regressions and progressions that are necessary to make progress in the injury and to be able to generate the changes we need in strength, mobility or tissue tolerance. Lo we monitor with a control of training loads and different parameters such as intensity, volume, frequency or pain.

All this, we apply it thanks to a complete assessment and data collection to know where and how we must act to obtain the improvements we want.

So that you can be sure when training on your own, we can give you tools to adapt the exercises yourselves and to know how far you can go.

We will solve your doubts so that you can be more relaxed and confident in what you are doing.

In addition, we are in contact with other health and physical activity professionals que pueden resultar de mucha ayuda en determinadas fases de la recuperación (entrenadores, nutricionistas, podólogos, psicólogos…).

Our intention is that you will be able to recover better, faster and improve your physical capabilities in order to return to training or competition with the best possible results. maximum guarantees and confidences.

Finally, remember that as healthcare professionals we rely on the most current scientific evidence, on clinical experience and we are constantly learning to give you the best possible treatment.

If you still have questions or would like to discuss any of these topics in more depth, please leave them in the comments.

Thank you and see you soon!

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