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Feature - Beyond the comfort zone

Getting back to game after injury

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"The physiotherapists know the progression of how the tissues are healing and how to get mobility and strength back," says Wilson. "I really think that physios know more than doctors about the actual rehabilitation."

Dr. Fisher articulates the physiotherapist’s role, particularly for athletes.

"I think the best physios have a good idea of the range of motion required for the athletes they’re treating to do their sports. They know how to increase the range of motion and allow the athletes to get back sooner. Part of the role of the physiotherapist is to be a coach. To say, ‘I know you have pain, and a limited range of motion, but it’s okay to feel hurt.’ But there’s a big difference between hurt and harm. So they can coach you through the pain, just like a coach of an athlete will say, ‘Run this lap at 59 seconds, instead of 1:01. I know it’s going to hurt, but it won’t be harmful.’"

Wilson agrees.

"The rehabilitation I’ve been doing and the physiotherapy visits especially are an exercise in pain, just moving the limb to the far edge of your range of motion and stretching the tissues to regain mobility. My physiotherapist always says she’s sorry, but I know she secretly loves it."

Still, like the runner pushing through the pain to achieve his goal, Wilson had his eye fixed firmly on the prize.

"I was motivated to get back to skiing. And I didn’t question at all what my physiotherapist was doing. I’m happy with the timeline of my recovery, and in a large part it’s due to the surgeon and the physiotherapist."

Healed tissue is scar tissue, and this scar tissue is dense, fibrous, inflexible. The primary goal of rehabilitation is to recover the pre-existing function of the joint, by treating that scar tissue, by stretching it, increasing the range of motion. In a word, by suffering.

Getting back to game doesn’t necessarily mean recovering full range of motion or normal function. Optimum recovery simply means you can still practice your sport. Downhill skiing, fortunately for Dave Hobson, Mike Wilson and the rest of my creaky colleagues, involves a fixed, tight posture, which enables a skier to get away with certain weaknesses, dodgy knees, a reconstructed shoulder, some insolent ribs, a certain lack of flexibility.

"The worst is head injuries," says Dr. Fisher, "because we don’t have good rehabilitation for head injuries. The sport’s specific requirement for brain function is 100 per cent. You can’t get away with any less motor control. So in sports associated with a high risk of head injury, an athlete really needs to wear protective gear and consider whether the risk is worth it."

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