Pillars of Rehab Success

Turns out pain is very complicated (see previous blog about pain science). The medical world has come a long way in understanding and treating pain, but we still haven’t found that magic pill for resolving pain. However, we do know pain is much more than just the body part involved and impacts (and is impacted by) other body systems. The goal of this post is to identify and discuss a few key lifestyle behaviors that can greatly impact the recovery process. Addressing these “Pillars of Rehab Success” along with following the guidance from medical providers will greatly increase your chances of overcoming or better managing whatever physically ails you. There are many lifestyle choices that can impact recovery, but the pillars we will be discussing in this article are sleep, diet, stress, and exercise.

Sleep is arguably the most impactful modifiable lifestyle behavior as sleep plays a role in nearly every bodily system and function. Regarding pain and recovery, our naturally produced growth hormone spikes in the deep sleep cycles. This hormone is responsible for rebuilding and growth. Additionally, our stress hormone cortisol is lowest while we sleep. This flip in hormone levels is one reason why sleep is considered restorative. The less quality sleep we get, the less restoration we achieve. Additionally, since the mental, emotional, and cognitive effects of sleep deprivation are processed in the brain alongside pain processing, there can be some crosstalk between them. It’s very common to have increased pain symptoms after a night or two of poor sleep. For most adults, we should aim for at least seven hours of sleep but try for eight or more, if possible. This typically requires being more mindful of when we need to be in bed and practicing good sleep hygiene before bedtime (avoiding stimulants, dimming lights, reducing screen time, etc.).

We know food is certainly good for the soul and the way to anyone’s heart; however, the quality of food consumed can impact pain and the recovery process. Most importantly, we need to remember the original purpose of food is to provide the appropriate nutrition to fuel our bodies. What we put into our bodies will be what our body uses to provide energy, grow, and recover. Simply put, crappy nutrition will lead to crappy fuel. Additionally, highly processed “unhealthy” foods can irritate the gastrointestinal system, generating local inflammation than can have a systemic effect. This effect can then be like fuel to a fire for someone already in pain and dealing with an injury. Ideally, we would eat a 100% healthy diet full of veggies, fruits, lean meats, fish, seeds, nuts, healthy fats, and whole grain carbs. However, going on a fulltime strict for most of us eventually leads to mental irritability and eventually caving in. If this is you, my recommendation is to aim to eat “healthy” 85-90% of the time each week. This still allows for some splurge meals/snacks while maintaining the overall fairly healthy diet for proper fueling.

Research has shown a link between persistent pain and sympathetic nervous system (SNS) overdrive. The SNS is the “fight or flight” part of our autonomic nervous system responsible for priming our bodies in threatening and extremely stressful moments. A heightening SNS is good when in that moment (facing a bear, in a battle, etc.); however, we ideally only want to spend a small portion of time in this state. Unfortunately, our SNS cannot differentiate between the stress from an actual threat or the stress of our day-to-day lives. Therefore, due to stress, many of us live each day with an amped up SNS, reducing our ability to relax, restore, and recover. If you find yourself in this category, there are several ways to help reduce stress. These include, but are not limited to, finding an appropriate outlet (ex: hobbies, exercising), talking/counseling, gratitude logs, journaling, and meditating.

It’s common to avoid all physical activity when injured or in pain. However, general exercise is very therapeutic and aids greatly in recovery. Actively moving the joints and muscles can reduce swelling better than ice and medication by mechanically pumping the fluid into the lymphatic system. Additionally, the more we move a joint, the more synovial fluid the joint will produce, which is the body’s natural WD40 lubricant. Exercising increases blood flow, bringing in oxygen and nutrition to aid in recovery while flushing out inflammation and other metabolites. Hormonally, exercise has been shown to increase endorphins, growth hormone, and protein synthesis, all of which assist in pain reduction and recovery. Now, I’m not saying to ignore the pain and injury and to train as if 100%. When hurt, it may be advised to rest a healing joint or muscle, but there are usually other ways to exercise without physically aggravating the injury. For example, if one shoulder is injured, the lower body, trunk, and the other arm can be worked. If high impact activities are bothersome, try low-impact machines or get into a pool. If one limb hurts, don’t avoid exercising the other in fear of creating imbalances. Working the non-injured side will actually assist in the injured side’s recovery. It’s important to continue cardiovascular and strength training while hurt, unless advised otherwise by a medical professional.

The above four pillars discussed are only some of the many lifestyle behaviors that can be modified and optimized to improve recovery and pain management. These recommendations are general based on my experience with orthopedic pain and injuries. It’s always recommended to see a medical provider for further evaluation, treatment, and guidance when appropriate. However, regardless of the presence of pain or injury, following the above recommendations will certainly lead to a healthier life!