FAQs

• Pain is used by your body to activate its protective response to actual or potential tissue damage. It is context specific and can be pleasant or unpleasant. 

• Your body uses its nervous system to learn from its environment so that you can adapt and survive by responding quicker and more efficiently. 

• However, this also means your body can learn to detect and respond to pain. A process known as sensitisation of the nervous system. This results in muscle stiffness and trigger points in our myofascia, aimed at protecting the tissue.  

• Nerve cells located in our body tissue outside of our brain and spinal cord are known as first-order neurons and are part of our peripheral nervous system. 

• There are different types of first-order neurons that are attuned to different stimuli that will be subject to a pain experience in the brain. These include fine touch, pressure, temperature, and chemicals such as those responsible for inflammation. 

• These neurons transmit signals back to our central nervous system where it travels through the spinal cord, brainstem and to the brain where it undergoes the pain experience. This helps you to respond instinctively, without conscious thought, based on your past experiences. 

• Therefore we can modulate the experience of pain by acting on any of these systems including our thoughts and beliefs. This is why pain management requires a holistic, biopsychosocial approach. 

• Connective tissue network that surrounds and holds every organ, blood vessel, bone, nerve fiber and muscle in place. 

• Almost as sensitive as our skin - when stressed it tightens up.

• Fascia has millions of nerve endings (25% more than skin and 1000% more than muscles).

• Made of solid collagen fibers (structure) and liquid hyaluronic acid gel (lubrication and communication).

• Too much strain, injury, or lack of movement can cause the liquid gel to thicken and clump, making fascia stiff and pain receptors more sensitive, reducing mobility.

It activates other local sensory nerves like mechanoreceptors (pressure) and proprioceptors (changes in muscle length or position) which reduce:

• pain signals from local nerve endings (gate control theory)

• the release of acetylcholine (which contracts muscle)

• sensitisation and sympathetic nervous system activity

It acts on fascia by dispersing clumps of hyaluronic acid, improving glide and soft tissue mobility.

Increases local blood flow to enhance tissue healing through increased parasympathetic nervous system activity (rest and digest) and by removing myofascial trigger points that restrict blood flow. 

The tissue healing process occurs with all injuries in every tissue, regardless of whether it is a strain, tear, break or micro-trauma due to overloading. Healing times vary depending on the tissue’s blood supply and the stress or load placed on it at each stage of the healing process.

Muscles:

• Muscles have a rich blood supply which is why they heal fast. Contracting and stretching muscles, as well as resolving trigger points, stimulates blood flow through the muscle tissue which encourages a healthy tissue environment and healing. 

• When muscles are overloaded or stressed this leads to micro-trauma and initiation of the healing process. Without correcting underlying muscle imbalances this can lead to chronic inflammation, pain and further trauma or tearing of the tissue. 

Tendons

• Tendons attach muscles to bones, and generally have a more limited blood supply than muscles as they require less energy for their function. This makes them somewhat slower to heal.

• Bloody supply to tendons is stimulated through tension, when they are stretched or when a muscle contracts. 

• Tendon remodelling typically responds better when they are lengthened under tension, which is known as eccentric loading. However, excessive tension whilst they are in the inflammatory phase can prolong healing and cause pain.

Ligaments

• Ligaments attach bones to other bones, prevent excessive movement around joints and provide valuable sensory information. They have a more limited blood supply than muscles and tendons, which increases their healing time.

• Ligaments are prone to reinjury as they never truly regain their full strength once they heal. 

• Protecting the ligament from strain associated with excessive movement, whilst allowing the joint to move and blood to circulate, is critical to promote healing. For example, bracing is often used for ankle and knee ligament injuries to support this function of the ligament while it heals. 

Bones

• Once bones are stabilised to prevent movement at the fracture site they heal best with gentle loading. 

• However, too much or too little load can prolong the healing process. For example, immobilisation boots are often used in ankle and foot fractures rather than plaster casts, which allows for gentle and stable loading while walking. 

Cartilage

• Cartilage, such as your knee’s meniscus, or the labrum in your hip and shoulder, has no blood supply. This means it is very slow to heal and times can vary greatly depending on the severity of the injury or type of surgical repair. 

• Recovery can take anywhere from 6 weeks for a simple cartilage repair known as chondroplasty, which shapes and smooths the cartilage, and up to 6 to 12 months for major cartilage restoration or grafts. 

• Cartilage also has no nerve supply, so pain is not felt when the cartilage is damaged until it has been worn down significantly, and movement at the injury site starts to impact surrounding tissues.

• Nutrients are flushed through the cartilage via joint fluid as load is applied and removed. This is why inactivity can cause thinning of the cartilage, making it more susceptible to injury. 

• Activities that promote smooth joint movement without excessive loading, like cycling and walking, can promote this process. Increased stress through joint loading needs to be applied gradually to protect it as it heals. 

Nerves

• Nerves need to stay mobile so they can glide smoothly among muscles and tissues; this mobility helps them send and receive signals properly.

• Nerves can be injured by pinching or overstretching, which may cause pain, tingling, numbness, or muscle weakness, sometimes along the whole length of the nerve.

• Nerves heal very slowly (about 1 mm per day), so recovery takes patience. Gentle, carefully planned exercises in short intervals can support healing without overstressing the nerve.

There are four tissue repair steps, which overlap but occur in the following order:

1. 1. 1. Haemostasis stage (stop the bleed)

If there is injury to a blood vessel the body will restrict its blood flow by initiating a spasm, followed by formation of a plug of platelets to seal the wall of the blood vessel within seconds. A cascade of reactions then occur utilising prothrombin, an inactive protein produced in the liver, to reinforce the platelet plug with threads of fibrin to stabilise the clot, and prevent further blood loss. 

1. 1. 2. Inflammatory stage (prevent infection)

Once clotted, the damaged blood vessels leak water, salt and a protein called transudate to the surrounding injury site. This enables healing and repair cells, growth factors, nutrients and enzymes to move to the site through the bloodstream. These are responsible for the swelling, heat, pain and redness that is commonly seen. White blood cells then remove damaged cells, bacteria and any pathogens that can cause infection. 

Inflammation is an essential part of the wound healing process and is only problematic if it is prolonged or excessive, which can occur with repetitive low load tissue trauma, infection or health conditions (diabetes, venous insufficiency etc) that may affect blood supply and this process. 

1. 1. 3. Proliferation stage (repair tissues)

Proliferation is the rapid reproduction of a cell, part, or organism, which means the injury site is then rebuilt with new tissues including connective tissue, collagen and a new network of blood vessels so the new tissues can receive oxygen and nutrients.

1. 1. 4. Maturation stage (remodelling)

Repair cells during the proliferation phase lay down collagen, however this is disorganised, thickening the injury site or wound. These repair cells are then removed by a process called programmed cell death and any remaining water is reabsorbed so the collagen fibers can lie closer together and cross-link along lines of tension. This reduces scar thickness and strengthens the injury site. 

• Blood supply - type of tissue and its function.

• Tissue health - sleep, age, nutrition, medications, metabolic health and lifestyle factors such as smoking, alcohol consumption and stress.

• Loading - opportunity for rest, followed by adequate, progressive loading to fast-track the tissue remodelling phase.

Exercise is essential, but it must respect the healing process. Pain is the best indicator for this. If it stays mild and temporary, the tissue is likely healing well. However if it spikes or persists, you may need to reduce intensity, duration, or modify the exercise.

Exercise is best at stimulating blood flow and promotes tissues to remodel and strengthen through lines of tension, making it stronger to endure more loading. It also helps to reduce swelling which increases stiffness and restricts normal movement, fast-tracking each stage of the healing process if used effectively. 

Rehabilitation that promotes correct biomechanics and movement patterns is important. This will ensure the injured tissue does not continue to be overloaded and other tissues are protected from potential injuries due to compensatory strategies.

Our thoughts drive emotions which drive behaviours and body adaptations

Stress stimulates our sympathetic nervous system, which prepares the body for physical activity (fight or flight) by opening airways and increasing airflow to deliver more oxygen to the muscles and the brain. This means:

• your respiratory rate increases

• your breathing pattern becomes deeper

However these changes to our respiratory system may not be aligned with the needs of the body but rather the anticipation of an action

Breathing light, low, deep and through your nose

• Helps to equalise the levels of oxygen and carbon dioxide in our body which makes our oxygen delivery to our tissues more efficient.

• Breathing slow but deep stimulates our vagus nerve which activates our parasympathetic nervous system (rest and digest) and reduces sympathetic nervous system activity. This relaxes our respiratory muscles which may be driving weakness and myofascial stiffness around our core.

• Nasal breathing warms, humidifies and pressurises the air we breathe, enhancing all of the above.

Types of breathing exercises

• pranayama (yogic) or 4 - 7 - 8

• alternate nostril breathing

• box breathing