I'm sore, but am I that sore?

How to Know When You Need Physio

Physiotherapists understand the difficulty the average person has in knowing when it is an appropriate time to call up for an appointment. For example, those who exercise regularly often suffer mild aches and pains but self-manage very well with ice, stretches and massage. People may feel embarrassed to present with a ‘trivial’ injury and often don’t have the time and financial resources to get treatment on every little problem. Alternatively we often have patients with serious injuries who didn’t realise they should have come for treatment much sooner.

Why is early referral so important?

Why do we prefer to see injuries as soon as possible? There are many benefits to early diagnosis and treatment:

• In some cases you may be doing more damage by continuing to exercise or work in pain e.g. stress fractures, bone spurs, tendon calcification.
• Early treatment of ligament sprains ensures a stronger tissue repair and less recurrence of injury e.g. ankle sprains.
• Injuries left untreated develop chronic tissue changes such as scarring, joint stiffness, muscle weakness and chronic pain sites. They are more difficult and take longer to treat and are more likely to leave ongoing and recurrent symptoms.
• One untreated injury may cause secondary problems in several adjoining areas e.g. a stiff ribcage and thoracic spine will predispose you to shoulder, neck and lumbar spine injuries.
• Appropriate rehabilitation exercises and advice can be introduced quite early in treatment to prevent secondary and recurrent injuries.
• Overall, physio will speed the recovery of any treatable soft tissue injury, allowing quicker and safer return to normal activity.

Who Do I See?

See your doctor first if you think you may have suffered a fracture, need prescription medication or a medical certificate, or think your pain may be related to a medical problem unrelated to any physical injury. Otherwise it is appropriate to head straight to physio. Your physio will advise you if it’s necessary to get a medical check.

Acute injuries

Suppose you’ve just suffered an injury and have started your RICE management (rest, ice, compression, elevation). How do you know if you need to see a physio asap? These are the bad signs:

• severe pain
• early swelling
• warmth or redness at the injury site
• immediate muscle inhibition (shaky, weak feeling) and muscle wasting within 24-48 hours
• muscle spasms causing pain and restricting movement, particularly in the neck or back
• throbbing inflammatory ache at night affecting your sleep

Nerve Tissue Signs

If you’ve injured your neck or back and have symptoms of nerve tissue involvement then an early physio or medical check is definitely warranted. In particular look out for:-

• sharp shooting, pulling, burning or electricity pains down your arm or leg
• pins and needles, tingling or numbness
• weakness in the arm or leg

The Subacute Phase

Let’s say you’ve been spared the bad stuff and you have a relatively mild or moderate pain. What then? We suggest you continue self-management and consult a physio if:-

1. the pain is getting worse over the first 2-3 days or
2. the pain has not improved over the first 3-4 days

In both these cases it is unlikely that the injury will resolve properly without treatment and, as mentioned previously, the earlier the intervention the better.

Overuse Injuries

Overuse injuries often sneak up on you over time, making it difficult to decide when to seek treatment. You may recall mild pain starting some time ago. It was only present once a week after you’d cooled down from an exercise session. Gradually the intensity of the pain increased and it was present after every session. Then the pain would only subside after warming up and finally it was there when exercising as well and has been affecting your performance.

It is most important you understand this process and can recognise it if it happens to you. Beware niggling pains that are increasing in intensity, lasting longer and becoming more frequent. As you might suspect, allowing overuse injuries to progress unchecked does do more damage to the tissues and prolongs recovery time.

You must decide for yourself when you think the injury appears to be getting out of hand, perhaps if the pain is worsening or persisting despite rest and self-management. In particular, if the onset of pain has coincided with a change in equipment, technique, position or training method then these may have to be examined and modified as soon as possible.

The Take Home Message

Becoming more aware of the nature of injuries and warning signs will ensure you know when it is an appropriate time to seek treatment. Early presentation to physio is important to ensure a full and speedy recovery from significant injuries.