A common topic when helping people recover from back pain is the difference between repair and condition.

This is particularly relevant when people were active before their injury, have had to endure a period of rest while injured, and are now looking to return to activity.

Repair

Some cases of pain are related to tissue damage. It might be muscle, tendon, ligament, or it might be a joint injury.

All damaged tissues take time to heal, but the time taken varies according to the type of tissue. Muscles heal relatively quickly, joints can vary, but tendons and ligaments definitely take longer.

Helping a patient make the most efficient recovery requires an understanding of what type of tissue is affected. This way we can understand how long their recovery might take (their prognosis) and we can employ suitable tactics to restore the function of the damaged tissue. 

With tissue recovery complete, pain should be gone, and function should be restored.

But that's not always the end of the story...

Our need for condition

Activities such as running, lifting weights, and playing competitive sports require participants to be in the right condition as well as uninjured. Even spending prolonged time working in the garden or walking a dog takes a level of conditioning.

When people do something that they are not in the right condition for, the risk of injury is higher than if they were in a good condition. It doesn't mean injury WILL happen, but it can predispose to it.

We need context. 

We shouldn't discourage people from lifting weights, but we should warn against lifting too much weight when they're not ready for it.

We shouldn't discourage people from running long distances, but we should warn against running too far without the correct preparation.

We should encourage everyone to return to their meaningful activities, but we should caveat that by making sure they're ready.

Re-conditioning

As you can hopefully see, an injury can not only be caused by a person's state of condition, but an injury can also have a detrimental effect on a person's condition by preventing them from taking part in the very activities that maintain their condition. Bit of a vicious circle...

The trap that many people fall into is that they wait for their injury to heal but then jump back too soon into their favourite activity, unaware that they are no longer in the correct condition for that activity.

This can cause a relapse of the injury, which is of course frustrating and can create fear that the injury might never heal. It did heal! But the correct condition hadn't been restored before re-engaging in activity.

Patients often need support and education through cycles of boom and bust. Tell them that it is great that they felt ready to try their activity again, but this time, let's prepare better.

The balance

The message to take away is to think not only about injury and pain but also about your condition.

Not being in the right condition can cause injury.

Having an injury can rob you of your condition.

A healed injury doesn't mean restoration of the prior condition.

Re-conditioning will help prevent re-injury.