Injury Recovery vs Rehab – What’s The Difference

Mark: Hi, it's Mark Bossert. I'm here with Wil Seto of Insync Physio in Vancouver, BC, Canada. And we're going to talk about something that I think people confuse. Injury recovery versus rehab. How are you doing, Wil? 

Wil: I'm doing really well. Thanks, Mark. 

Mark: What's the difference? Is there a difference? 

Wil: Yeah. So first of all, recovery is really like an aspect of healing within a certain time frame. And it's obviously very dependent on the kind of injury that you're experiencing. So it could be like, you know, a simple ankle sprain to something a little bit more of a back strain to a disc or something like that. But ultimately the time frame, the time frames vary, but the process is the same. In the varying time frames. 

So I'll just give you a simple example, like with an ankle injury, a simple ankle injury where you tear some ligaments, maybe, and you may have a recovery time frame where it needs to heal, right, within four to six, to possibly even up to eight weeks. But it doesn't mean that you're not improving and you that you can't work on the rehab of that injury at the same time.

And so that recovery process really is looking while you're healing, addressing sort of the three main processes of that healing, where the first part of it is really when you're injured and you have the most swelling. Everything just balloons up. And sometimes it doesn't happen until the next day or up to 72 hours.

And so that's normal. That's all part of that physiological process of healing when you get injured. So there's essentially three stages to this healing. So there's that first phase that I just talked about where you get that acute swelling, and then you have the middle phase.

And so the middle phase is like the sub acute phase where you don't get any more new swelling. But then you start to go sort of in this process of the healing is now about okay, yeah, that's lay down a little bit more like groundwork here to kind of repair things. So the analogy is sort of like, let's say you got a cement building structure and that a pillar gets damaged and, you know, the concrete gets wiped out a little bit.

And now this phase, where we're pouring the concrete. We're trying to mix it, get things stabilized again to a certain extent. And so that's kind of that phase of it in the sub acute stage, like it's sort of the, your body is now trying to regenerate and reproduce cells to basically repair, right, and heal.

And so a large part of that is obviously clearing out that swelling. And then trying to get things functional again, and this is where, like, rehab is actually important in all aspects of these phases. And then in the, sort of, the third stage of that healing phase is really, and like I said, it varies. It could be, like, a shorter phase or a longer phase, depending on the type of injury, but then they call this the remodeling phase. 

So the remodeling phase is in that second phase, we talked about it being sort of like you're pouring the concrete and you're just pouring it over the broken areas or the patches that need concrete. Well, in the remodeling phase now we're trying to shape it. And then to take it a step further, we're also strengthening it a little bit more. And so we're changing the integrity of that repair aspect. 

 So to give you more concrete example, really looking at, no pun intended, so you have an ankle injury. Now you're in this third phase of healing and the swelling's come down. So you do specific strengthening to get it stronger, so it actually influences how that joint and the function of that joint will actually behave biomechanically. So how it will move in other words. So not just motion, but like a function of that motion.

So not only do I want it to move forward, backwards, left and right, and then all these other angles, but I want it to be strong in that way, and I want it to also have the reflexes to be stable. That's the remodeling and that important part of that rehab in the later stages. Now, a lot of this stuff starts to, like, happen, but if we don't, like, mold it specifically, then it may not be as nice and as specific as the way that we guide it to be.

So for example, like a lot of people that sprain their ankle and will go through the three stages of healing on their own and will do what they think they can to rehab it on their own. And it ultimately seems fine. They don't feel like they have a problem. Well, let's say they decide to like, say five years or maybe not even five, maybe two years or five years or 10 years down the road. I want to take up triathlon training. I want to do an Ironman. And then so they go through this process of or of initiating a training regimen. And then they start to increase intensity and everyone's different, some people might hit certain barriers quicker than others.

But if you're not fully rehabbed and you think you are from, like, say, this ankle injury that you had a couple of years ago or five or 10 years ago, and it will be expressed in like something that you do later on. And so what ends up happening is that then you have all these things that have happened in terms of compensation.

So in other words, your body has adapted to the slight limp that it's produced because you weren't able to fully put weight on that left ankle for the first three weeks properly or whatever, right? You weren't strong enough that left ankle and you're still compensating on the other side and your balance and your reflexes in that side weren't fully developed.

So the problem with this is that you can also come back with, you know, as you're training and you're increasing intensity, you can actually re injure that area or injure something else even worse. 

So research studies have shown that when you injure your back, and let's say you just run through that whole process of recovery and you get better. And then you do your own rehab, which is legitimately fair because there's a lot of information out there on the internet. But you don't fully rehab it properly. There is a very, very high likelihood that you can re injure your back, but even injure it worse or do something else. 

So that's pretty clear like when you extrapolate that to like other injuries and other areas of the body that get injured. And you look at this concept of recovery and rehab, they happen hand in hand. Like you do the rehab process during your recovery process, but then it continues on. 

So that last phase, which we call the remodeling phase, can be anywhere from like two weeks, three weeks from like a very simple injury, like maybe a very minorly sprained thumb and you rehab it. It only takes two weeks for that last phase in your rehab. Then like something a lot more involved, where it can take up to a full year to rehab. So like a year and a half, for example, like a total knee reconstructive ligament surgery. 

Mark: So would it be fair to say that rehab is actually, anytime you've injured yourself, there's a corresponding change in how your brain kind of operates the nervous system to compensate for that injury. And then part of the rehab is really reprogramming your brain and your nervous system so that it starts to work as you get stronger and recover properly. So that it goes back to normal or even better than what it was before it was injured?

Wil: Absolutely. And I think you hit on something that was really important. You mentioned about how you reprogram your nervous system and and you change your brain in the way it thinks about things. So that process is done through the actual physical act. 

So you set yourself up in your environment to be able to succeed. And I want to take a quote from James Clare, the author from Atomic Habits. He wrote this book that basically, I think is just amazing. He talks about how you do a whole bunch of little habits. All these little things in and of itself is not going to give you a result that you want, but you you do them every day or you accumulate them. And over time, you can get one big result. 

And I think that's amazing because in that concept is very similar to, I think what you're speaking about Mark, is that the change in your nervous system, it doesn't just happen like that. Like it takes time. And you have to it do the thing over and over again. And that's the same thing with like our bodies. In order to get strong, I can't just do the exercise once or even just three sets of 10 for even a few days. I may get a little bit stronger for a couple days, but it's not going to be sustained.

But if I do that same exercise every day for six to eight weeks, I'm going to definitely notice a difference, but I'm also going to notice a sustained difference, which is the key. And that's the thing right there and that's how your nervous system gets changed.

And I think that that's the really important key point about rehab because as you look at the kind of things that you want to do, you also want to ask yourself, well, how do I want to behave? Like, who is it that I want to be? Like, it's almost an identity around the kind of activities that you want to do.

So instead of just focusing on the goal, it's like developing habits or a system. And so James Clare very succinctly says that, "people who set goals will win once, people who set systems win repeatedly". And it's the same thing with rehab, it's got to repeat it over and over again.

Mark: If you're looking for superb recovery and rehabilitation in Vancouver, the guys to see are Insync Physio. You can book online at insyncphysio.com or you can call them at (604) 566-9716. Or if you're in North Burnaby, you can book at that office online the same or by calling (604) 298-4878. Thanks Wil. 

Wil: Thank you.