The Movement Cure: The Post-Injury Recovery Roadmap

Dr. Erin Boynton

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The Performance Pyramid

After an injury, it’s hard to know how to get back in the game. If you push too hard too fast, you end up making the injury worse. If you spend all day in bed, your muscles stiffen and atrophy, making a proper recovery near-impossible. So what do you do? Well, that’s where the Performance Pyramid comes in. The Performance Pyramid is a graduated approach to recovery that begins with the fundamentals of the 3Rs and neuromuscular patterning, and then slowly takes you through each tier: endurance, strength, power, and speed. Put simply, the Performance Pyramid is your roadmap to recovery. Now let me show you how to read it.

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Relax: The stresses and movements of everyday life create tension in our musculoskeletal system, often felt in our body as trigger points or, as you probably know them, knots. These musculoskeletal tensions can impede our range of motion, hamper recovery, and lead to future imbalances. So before you can restore the imbalance(s) in your body, you must first relax the affected muscle and surrounding fascia. To relax the tissue, you can use any number of techniques, such as foam rolling, massage therapy, mindful breathing, or acupuncture. While each of those modalities differ from one another in numerous ways, they all help relax the tissue by releasing the tension trapped within the musculoskeletal system.

Reblance: An imbalance is when either our muscles aren’t working properly or our fascia is too tight, and the joint can’t go through its normal course of motion. For instance, if you’re a quarterback who’s been throwing long bombs for the better part of a decade, it’s likely the connective tissue around your shoulder has grown overly tight, leading to an imbalance that prevents your shoulder from fully rotating, and making it very hard to throw. Or, if you’ve been sitting with bad posture at your desk for forty hours a week for the last fifteen years, you very well might have an imbalance in your neck and shoulders. To correct the imbalance you need to first correct the way you move. So instead of slouching forward at your desk, engage your back and core to hold your torso and head up straight. Once you do this, the proper muscles will engage, your neck and shoulders won’t be so overloaded, and the pain will start to dissipate. It will also send the right signals to your body, giving it the chance to repair, remodel and correct the neurological pattern of how you sit.

Reactivate: Think of your inactive muscle as someone who’s fallen asleep or a machine that’s been powered off. It’s not dead or broken, but it needs to be woken up and turned on before it can get to work again. Have you ever sat so long that your glutes (read: butt) fell asleep? It may not have seemed like a big deal at the time, but when one muscle group falls asleep, all the surrounding muscles have to pull double duty, making themselves vulnerable to injury. So how do you wake up a muscle that’s fallen asleep and not firing properly? Well, in the case of your glutes, you can start by tapping them. And yes, that means smacking your butt. You can also activate them, or any muscles failing to fire properly, by consciously contracting and relaxing the muscle, over and over again. However, doing this a few times won’t cut it. To ensure the muscles stay awake and keep firing, you should repeat these exercises 1-2 times every hour for a total of 10-15 times a day.

The 3 R’s

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Neuromuscular PatterningThe term neuromuscular patterning may sound like something out of a sci-fi movie, but the concept isn’t as complex as you’d think. Put simply, our neuromuscular patterns are the sequence in which our muscles fire along the kinetic chain. For the most part, normal neuromuscular patterns start at your core and then move outward. For instance, as you push off the ground to take a step, the pattern should be:

Core Glutes Hamstring

If the neuromuscular pattern gets reversed, and your hamstring fires before your glutes, then your hamstring will be overstressed (meaning future imbalances) and you’ll have less energy for the movement (meaning poorer performance). To fix faulty neuromuscular patterns, you need to fire the muscles in the correct order. And I mean a lot. For a new neuromuscular pattern to become ingrained, you have to repeat it almost 50,000 times. Like a bad habit, it’s hard to break, but when you do change it, it’ll be well worth the effort.

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Endurance is what allows our muscles to remain active as we play our sport or perform our activity, especially for long periods of time. Developing endurance is especially important for those newly activated muscles that’ve atrophied from lack of use and are prone to falling asleep. So how do we develop our musculoskeletal endurance? Two things: light resistance exercise and cardio.

1. Light Resistance Exercise The core of endurance training is high-repetition, low-intensity exercise. This means light weights, low-impact calisthenics and resistance band exercises. During this phase, it’s important to start slowly and then gradually increase the intensity. Remember, pain is your body’s voice, so if you’re hurting after some light resistance work, that means you need to dial it back and focus on your 3 Rs for a bit.

2. Cardio Cardiovascular endurance may not be essential to your sport, but it is essential to the Performance Pyramid. As your heart rate rises during cardio, the blood flow to your musculoskeletal system increases, which brings more of the crucial nutrients necessary for healing and remodelling. The increased blood flow also allows your body to dispose of the waste which accrues in your musculoskeletal system during physical activity. It’s important to get a variety of cardio too. If you do the same motion over and over again—whether it’s running, swimming, or biking— imbalances develop from overuse. So switch things up! Instead of biking, go for a swim. Instead of running, go for a bike ride. If you stimulate your musculoskeletal system in new ways, you’ll build endurance and prevent further injury.

Endurance

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The core of strength training is high resistance and low repetition movements, and the goal is to get you stronger. At the physiological level, strength is improved by increasing the number of muscle fibres, the size of the muscle fibres, or the the number of muscle fibres recruited. Just like the other phases of the Pyramid, it’s important not to rush things. You must be comfortable with the light resistance work in the endurance tier before you start going heavy on the machines and free weights. And if you have a choice between the two, go with the latter. The best kinds of strength-building exercises involve multi-chain movements that recruit several muscles at once, like deadlifts, an exercise in which you bend down and pick up a weight, using your glutes, hamstrings, and lower back. These kinds of exercises not only better mimic our everyday movements, but they also require much more sophisticated neuromuscular coordination, a biomechanical ability that improves athletic performance and reduces the likelihood of injury.

Strength

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Strength is moving resistance; power is moving that resistance quickly. Strength enables you to lift a heavy weight. Power enables you to lift it in under a second. Now, while power might be fundamental to professional athletes, not everyone needs it. If your goal is simply to be able to play a casual round of doubles tennis, you can safely ignore this part of the Performance Pyramid. In fact, pursuing power might even be counterproductive as it’s the tier of the Pyramid where you’re most vulnerable to injury. However, if attaining power is crucial to your goal, then go for it, but tread carefully and remember to listen to your pain and watch for imbalances. To cultivate power, focus on explosive, but controlled movements. One of my favourites is the box jump. To do it, place a sturdy wooden box in front of you. Then squat, jump up, and land on the box. Step off slowly and repeat. As you grow comfortable with the movement, you can adjust the height of the box to keep challenging yourself. You can also adjust the pace of strength exercises to make them power-focused. For instance, if you’re performing a bench press, slowly lower the weight to your chest for a count of three seconds, and then explode upwards as fast as you can. Just make sure you’re nice and warm before you do this or you might end up with an injury.

Power

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Speed

Once you’ve hit the speed tier in the Pyramid, you should already be able to perform all the movements your activity demands. Speed just trains you to do it faster. Like strength, speed is really only for those aspiring to peak performance. You don’t need to be able to run the 100m dash in under fifteen seconds to be fit and healthy. However, for competitive athletes, speed is essential in almost every sport, and it can mean the difference between winning and losing. The kind of speed drills and exercises you need really depend on the sport you’re playing. As a tennis player, most of the speed drills I do happen on the court, and they involve a lot of starting, stopping, and lateral movement. Balance and agility can be improved with ladder drills. If you’re a quarterback, you’ll probably want to focus on improving your release time. I’ve seen drills that’ve done this in numerous ways, including running to designated spots on the field that the coach calls out at random, and then tossing the ball through a tire. Regardless of what drill you’re performing, it’s important to build from the ground up. Start small and gradually increase the intensity. It’s how we get better and how we prevent injury.

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The road to recovery isn’t easy. For many people, the imbalances in their bodies have developed over years, even decades, and it takes time and dedication for them to be properly corrected. So as you start reprogramming and remodelling your body, it’s important to remind yourself that change is gradual. Be patient. You must crawl before you walk, and walk before you run. But if you put in the work, you will get better. So what work should you be doing exactly? Well, it depends on where the imbalance is and the goal you’re trying to reach. For more specifics, have a look at the Made to Move blog or browse through some of my many instructional videos on YouTube. You can also follow me on Facebook and Twitter. There you’ll find links to the latest news and reports on musculoskeletal health along with great tips and tricks for resolving athletic injuries. And remember to stay active. Our bodies are a gift, and we are all made to move.

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