Signs you went too far
Physical therapists often discuss exercise like physicians discuss medication. With both exercise and medication, there is a dose-response relationship between the amount and its effects. Too little of either and you won’t see the benefits you are looking for. Too much and you may experience unwanted side effects.
When it comes to exercise like skiing, hiking, running, or biking these side effects often look like delayed onset muscle soreness (DOMS), joint pain, dehydration, fatigue, or injury (in the worst-case scenario). Most of these side effects will not last, but some require additional care or attention; however, it can be difficult to differentiate soreness from the beginning of an injury.
Understanding the process of inflammation can help individuals better differentiate positive soreness from an injury. Inflammation is rarely discussed in a positive light, and diets and interventions that are touted as anti-inflammatory are more popular than ever. Most of this is due to the fact that inflammation is often identified as a root cause of pain and injury.
Although inflammation and the molecules associated with this process are often present with pathology, inflammation itself is not always a bad thing. In fact, inflammation is a complex biologic process that is necessary for normal tissue healing and fortification. Follow the general rule of thumb that short-term or acute inflammation helps facilitate positive change, while long-term or chronic inflammation is problematic and requires direct action beyond rest.
Inflammation is a non-specific response to tissue injury. Regardless of the cause of cellular injury, whether it is a traumatic injury like a fracture or an especially challenging workout where muscle tissue had a less than adequate blood supply, damaged cells stimulate the inflammatory response by releasing their contents. The purpose of the inflammatory response is two-fold: to eliminate the presence of damaged tissue and facilitate the regeneration or repair of these cells.
Although inflammation is necessary for the fortification of healthy tissue, it does earn its bad reputation since some the cells that facilitate cell growth also increase tissue pain and irritability. Inflammation is uncomfortable by nature, but this tissue irritability should not persist beyond two days following a hard effort when a mild acute inflammatory response is executed properly—and the athlete is equipped with healthy tissue that is more than capable of handling another workout. Greater than three days of inflammation indicates likely excessive overload with potential structural injury.
In the event of a more significant overuse injury, the repetitive onset of acute inflammation prolongs the inflammatory response. This results in chronic inflammation which is more detrimental than helpful.
Chronic inflammation results in decreased tissue integrity and requires action including a combination of physical therapy and pharmacologic intervention to resolve the inflammation, restore tissue resilience and eliminate pain.
When an individual experiences an overuse injury like runner’s knee, the initial acute inflammatory response was unsuccessful—either due to an inefficient healing response or due to a rapid increase in training volume beyond the athlete’s capacity or base (ie., load exceeded load-ability)—and the quadriceps mechanism becomes less resilient to load. This is a vicious cycle because a decrease in load-ability results in further injury and irritation of the knee without an increase in training volume.
These signs and symptoms of “going too far” include pain with the first few steps of an activity, pain at rest, impaired performance (like limping), and pain with prolonged positioning. Increased pain with normal daily activities such as climbing stairs is also an early sign that intervention is necessary.
With an individualized physical therapy program, the runner and provider work together to eliminate inflammation by restoring joint mobility and myofascial integrity. After improving joint mechanics, loads are paced back in a way that restores tissue resilience for transition back to running, hiking, and skiing.