How to Prevent an Acute Injury From Becoming Chronic
Robert Inesta
9/14/20267 min read
Pain, although unpleasant, is a normal and essential part of life. It is part of the body's protective system. Think of it as an internal alarm designed to get our attention when the brain and nervous system perceive actual or potential threat.
With an acute injury, such as a sports injury, tissues may be damaged, irritated, or stressed beyond their current capacity. Pain encourages us to protect the area and change our behavior while recovery takes place.
In many cases, pain decreases as the injury heals and normal function returns. But sometimes it doesn't. Pain can persist long after the initial injury, eventually becoming a chronic problem.
Why does this happen, and more importantly, what can we do to reduce the chances of it happening?
When the Alarm Doesn't Turn Off
Pain physiology is complex, and there is rarely one single factor that determines whether pain resolves or persists. The nature of the original injury, repeated irritation, deconditioning, sleep, stress, beliefs about pain, fear of movement, emotional state, and other biological, psychological, and social factors can all potentially influence recovery.
Sometimes, even after an injured tissue has substantially or fully healed, the nervous system can remain sensitized and continue interpreting otherwise normal or less-threatening signals as potential danger. In this situation, the protective pain response may persist even though the original injury no longer fully explains the symptoms.
This is one reason why understanding pain and how we think about it can become an important part of recovery.
One factor researchers are investigating is cognitive flexibility: our ability to adapt our thinking and behavior in response to changing circumstances and new information.
Research has found an association between lower cognitive flexibility and a greater likelihood of persistent pain, suggesting that our ability to adapt to changing information may play a role in the transition from acute to chronic pain.
Interestingly, the relationship may work in both directions. Reduced cognitive flexibility may increase vulnerability to persistent pain, while ongoing pain itself may interfere with cognitive performance.
A 2024 randomized study published in Pain Reports found that five weeks of neurocognitive training produced modest improvements in cognitive performance in people with chronic hip, knee, or back pain and was also associated with reductions in pain severity. The researchers emphasized that larger studies are needed, but the findings add to growing evidence that how the brain processes and adapts to information may be an important part of the pain experience.
What might this look like in everyday life?
Imagine that you injure your knee. Early on, bending it hurts. Your brain appropriately associates that movement with danger and you protect the knee.
Several weeks later, the injury has improved substantially, but the knee still feels uncomfortable when you bend it. One response might be:
"It still hurts. Something must still be damaged. I better not move it."
A more flexible response might be:
"This is much better than it was two weeks ago. I can do more now. Some discomfort doesn't necessarily mean I'm causing more damage. I can gradually continue progressing."
The injury has changed, so our interpretation of the injury should be capable of changing with it.
This doesn't mean ignoring pain or convincing yourself that nothing is wrong. It means continually updating your understanding based on what is actually happening now rather than remaining locked into the experience of the injury when it first occurred.
Preventing chronic pain, therefore, may require addressing both sides of recovery: the injured body and the nervous system's interpretation of what's happening.
Here are some strategies that can help.
Mindset
Trust your body's capacity for healing, adaptation, and recovery. Rather than fearing that every sensation means ongoing damage, remember that pain is a protective experience and that most acute injuries improve with time and appropriate care.
Thoughts, beliefs, emotions, and expectations can influence how the nervous system interprets signals from the body. Fear and catastrophizing can amplify the sense of threat, while understanding what is happening and developing confidence in movement and recovery can help reduce it.
When we develop a healthier relationship with pain, recognizing it as a protective signal rather than automatically assuming it means ongoing damage, we can respond appropriately without becoming unnecessarily fearful of it.
Another potentially useful approach is mindfulness, not necessarily in the sense of meditation, but in actively noticing change.
Rather than labeling yourself as "injured" and viewing every sensation through that lens, pay attention to what is different today.
Can you move a little farther? Is the pain less intense? Are there movements that no longer hurt? Can you do something today that you couldn't do last week? Are you becoming stronger or more confident?
This type of flexible attention may help us continually update our perception of what's happening rather than remaining stuck in the original experience of the injury.
Research involving a mindfulness approach based on the work of psychologist Ellen Langer has also found evidence that this type of cognitive approach may influence the experience of pain.
Don't Fear Pain, But Don't Ignore It Either
There is an important difference between not fearing pain and simply ignoring it.
A healthy response is to recognize that something is happening, understand the situation as well as possible, take appropriate action, and continue living and moving within reasonable limits.
Ignoring significant pain and repeatedly aggravating an injury, on the other hand, may interfere with recovery.
Your body has a remarkable capacity for healing and adaptation. The goal is to support that process physically while allowing your thoughts, expectations, and behaviors to adapt as recovery progresses.
Ideally, the physical and mental sides of recovery should be pointing in the same direction: toward progressively restoring safety, confidence, movement, and function.
As an article from Harvard Health Publishing puts it, "The best way to stop acute pain from becoming chronic is to confront it straight on."
So, what can we do to help that process?
Get the Injury Properly Assessed
Determining what is going on is important because different injuries require different approaches.
Some injuries are relatively minor and resolve with time and simple self-care. Others may involve more significant tissue damage or carry a greater risk of long-term dysfunction.
If pain is severe, an injury involves significant trauma, function is substantially impaired, symptoms are unusual or worsening, or recovery isn't progressing as expected, it is important to have the situation properly assessed by an appropriate healthcare professional.
Understanding the injury can also reduce unnecessary uncertainty and fear while providing a clearer path forward.
Keep Moving
The appropriate amount and type of movement will vary depending on the nature and severity of the injury, but in most situations it is beneficial to continue moving in some capacity.
Movement supports circulation, neuromuscular function, mobility, and overall physical conditioning, all of which are important during recovery.
There are, of course, situations where an injured area needs to be protected or temporarily immobilized. A fracture, for example, may require an affected body part to remain relatively still while the bone heals.
That doesn't necessarily mean the rest of the body needs to stop moving.
If you have a shoulder injury, you may still be able to walk or train your lower body. If you have a knee injury, you may be able to perform appropriate upper-body exercise. If you temporarily can't run, perhaps you can walk or perform another activity that doesn't aggravate the injury.
As healing progresses, gradually reintroducing appropriate movement and load can help restore strength, mobility, coordination, and confidence in the injured area.
Too much rest can contribute to stiffness, weakness, deconditioning, and increased sensitivity, while doing too much too soon can repeatedly irritate healing tissue.
The goal is to find the appropriate middle ground.
Prioritize Sleep
Sleep is when the body performs a tremendous amount of its repair and recovery work.
Just as movement and activity are important while we're awake, quality downtime is essential as well. Sleep affects immune function, tissue repair, metabolism, cognition, emotional regulation, and pain sensitivity.
During recovery, do everything reasonably within your power to get enough good-quality sleep.
Seek Treatment When Appropriate
Not every injury requires professional treatment. However, treatment can be helpful when pain or dysfunction is limiting activity, recovery isn't progressing as expected, or there are physical or neuromuscular factors that need to be addressed.
Depending on the injury, treatment may focus on reducing pain, improving mobility, helping regulate the nervous system, addressing muscle and fascial restrictions, restoring strength and stability, and gradually returning the person to normal activity.
Myofascial therapies, physical therapy, acupuncture, and chiropractic care are examples of approaches that may be useful depending on the individual and the nature of the injury.
In my practice, I often combine myofascial treatment, chiropractic care, and acupuncture or dry needling as appropriate to the individual.
In some cases, medications, injections, surgical intervention, or other medical treatment may also be necessary. The appropriate approach depends on the diagnosis, severity of the injury, and individual circumstances.
Support Recovery With Good Nutrition
Nutrition provides the building blocks needed for tissue repair, immune function, and recovery.
A diet centered around minimally processed, nutrient-dense foods—including vegetables, fruits, adequate protein, healthy fats, and other whole foods—helps provide the body with the nutrients it needs during healing.
It's also wise to limit excessive amounts of highly processed foods, added sugars, and alcohol, particularly during recovery.
And don't overlook adequate hydration, which supports normal physiological function throughout the body.
Gradually Return to Activity
Feeling better doesn't always mean an injured tissue is immediately prepared for maximum stress.
As symptoms improve, gradually rebuild mobility, strength, endurance, coordination, and, when appropriate, the specific demands of your sport, work, or activity before returning to full intensity.
What we don't want is to become afraid of using the injured area, feeling as though we're constantly "walking on eggshells" and anticipating re-injury with every movement.
That fear can influence how we move, what activities we avoid, and how the nervous system interprets sensations from the area.
Instead, the goal is to progressively demonstrate to both the body and nervous system that movement and loading are becoming safe again while still giving healing tissues appropriate time to adapt.
As the body changes, our expectations and behaviors need to change with it.
The Goal Is to Help the Alarm Reset
Injuries and pain are part of life, but our bodies also have a remarkable capacity for healing, adaptation, and recovery. The key is responding appropriately at each stage of that process.
Early on, pain may be telling us to protect an injured area, modify our activity, and seek appropriate care. As healing progresses, however, the message needs to evolve.
Movement can gradually increase. Tissues can be progressively loaded. Strength and mobility can return. Confidence can grow. And our perception of what is safe can change along with the condition of the body.
We don't want to ignore pain, but we also don't want yesterday's injury to permanently define what we believe our body is capable of today.
Preventing acute pain from becoming chronic requires addressing both sides of recovery: the injured body and the nervous system's interpretation of what's happening.
Understanding and respecting both sides gives us the best opportunity to move beyond the injury and return to living, moving, and functioning with confidence.
If you're in the Berkshires and looking for help with an injury or pain, I'd be happy to help. Contact us here.
Berkshire Functional Chiropractic & Acupuncture
FREE RESOURCES
info@berkshirefunctional.com
(413) 274-7161
© 2024. All rights reserved.