By Dr. Jerry Yoo, DPT, CSCS | NL Physio
You pull something. A calf, a hamstring, a groin. Doesn't matter how it happened. What matters is what you do in the next three days, because that's where most guys and gals over 40 blow their own recovery timeline without even knowing it.
Below, I've included my “WWJD” (What Would Jerry DO?) advice along with what the research actually says. Remember, in most cases, a muscle injury doesn't always mean you’re incapacitated.
The instinct to just stop moving and do nothing may feel like the right thing to do, unless you have a serious injury like a full-blown muscle tear. In that case, of course, rest and immobilization of the limb may be warranted while you wait for surgery, but in most everyday cases, complete rest is something I often don't recommend. Generally, a little rest early in the game is fine, but I'm a firm believer in active rest- do what you can that doesn't make you wince or worsen the pain.
One study found athletes who started controlled movement just 2 days after injury got back to full activity about 3 weeks faster than the ones who waited 9 days. Same healing quality, less pain, more confidence.
In fact, total immobilization for days and weeks often leads to more problems, more muscle loss, and a slower comeback, which particularly affects us over 40 where maintaining muscle mass is already a battle for many of us.
WWJD (What Would Jerry Do?)
Protect the muscle injury for about 36–48 hours, then start gentle, pain-free movement. Now, if you can get around independently, and you really feel the need to do something physical, continue to limit motions or activities that involve the injured muscle. Work out other areas of your body instead, just at much lower intensity, duration, and frequency. You don’t want to steal resources that your body needs to repair itself.
I’ve had my share of injuries over the past 51 years. I dislocated my left shoulder during a Spartan race 15 years ago, and while I didn’t need surgery, I had to limit the use of my arm for the first 4–6 weeks. The good thing was that I was still able to do A LOT: lower body strength, left arm isometric strength in limited ranges, right arm strength, abs, incline walk, bike, and kick in the pool. I also did my own aquatic rehab in the pool along with my dry land rehab. Since then, I’ve been able to get back to all my usual activities without restrictions. Thankfully, I know a thing or two about physical therapy. ;)
RICE, right? Not anymore. While ice feels therapeutic, it's mostly a pain “distractor,” which is not necessarily a bad thing. However, there's no solid human evidence that icing for days on end speeds up tissue repair, and animal studies suggest going overboard with cold can actually slow the healing process down by blunting the inflammation your body needs to rebuild.
WWJD
Understand that while ice feels good, it's not healing tissue and in fact could be slowing down the repair process. Using it intermittently is fine in the first 6 hours if it helps you feel better. After 12 hours, ease off. If you do ice, 10-15 minutes at a time, a few times a day, with a barrier between the ice and your skin. For leg injuries, in particular, I prefer prescribing compression boots and compression socks with elevation over using ice.
In the earlier part of my career 25 years ago, over-the-counter NSAIDS (Advil, Tylenol, etc) were prescribed all the time for injuries and pain. Literally, all the time. It was discovered more recently that NSAIDs can interfere with the healing process. while inflammation is often thought of as a negative phenomenon, it really isn't the enemy here; inflammation is the process that clears damaged tissue and kicks off repair. Hammering it with high dose or long term NSAIDs can work against you. Animal studies show delayed or prolonged NSAID use interferes with the muscle regeneration process itself.
WWJD
I fully acknowledge that sometimes you just have to do whatever it takes to get through your day, and I've had to use NSAIDs from time to time as well. Short term, low dose may be fine for pain, especially after the first 12 hours of an injury. Acetaminophen works too. Just don't turn it into a multi-day pill popping habit.
The urge to “work it out” with foam rolling, deep stretching, or a massage in the first day or two intuitively seems like it would be helpful. In reality, you're disrupting fragile new tissue that's trying to knit itself back together, and you're raising your risk of re-injuring the same spot. Remember, when you've strained or pulled a muscle, you've already stressed or stretched it beyond its capacity to withstand or generate load.
WWJD
Once again, movement is medicine. Gentle pain-free range of motion, low intensity isometrics, etc just nothing aggressive for the first 48 to 72 hours. Real stretching can come later once you're in the subacute phase or Phase 2 of our MEI Method.
This is the big one, even for me. Admittedly, I am terribly impatient when it comes to my own recovery from injuries and strains. Maybe you are, too. Your muscles’ ability to repair itself declines with age. Surprise!
Slower satellite cell response, more background inflammation, less efficient repair signaling. So, if it seems like an injury is taking forever to heal compared to a decade ago, you're right. I like to call it, “OG” biology.
And, before you double fist your beers to drown your pain and misery, adding alcohol into the mix during recovery only makes things worse; alcohol suppresses muscle protein synthesis, adds additional inflammation, and slows glycogen recovery.
WWJD
I've learned to accept that physiological healing takes time, and I've had to lower my own expectations for how soon I can get back to full recovery. For many of us over 40, healing from a chronic, repetitive injury can be a journey, but there's a lot that's under your control that can help facilitate the process: eat enough protein. Take your Vitamin D, Collagen, and Omega-3s. Prioritize sleep. Keep moving. Yes, recovery at 45 isn't recovery at 25, but planning around it is how to keep strains from becoming chronic or repeat injuries.
Why did this happen? is a question I'm often asked by our community of runners and lifelong athletes who just don't want to stop.
In case you haven't heard me say this before, in physical therapy there's always 2 diagnoses. In the case of muscle injuries or strains, that's Diagnosis 1. The tissue that was torn or got strained (technically a strain is a tear and graded by severity). Any generic PT can point that out, but only addressing Diagnosis 1 is what often keeps PTs and patients chasing pain.
Diagnosis 2 is the root cause and arguably more crucial. In my experience, aside from a known trauma or incident, Diagnosis 2 is often NOT the muscle involved. When clients complain of a nagging problem that’s lasted for several months, I know something else is the culprit.
This is where a deep dive into your daily activities, lifestyle, past injuries/surgeries, training cycle, age-related changes, etc, comes into play and requires a lot of testing and investigation. Diagnosis 2 may be the one thing that you do repeatedly over time that puts too much load on the injured tissue, joint limitations up or downstream, not enough recovery, poor movement habits or technique.
Bottomline: BOTH diagnoses need a plan, and BOTH need to be addressed. “Just rest it” is never the solution.
CASE STUDY
“Jim” is a low handicap golfer who came to us with chronic low back pain that was affecting his golf game along with his everyday activities. “Dr. Jerry, I can sort of deal with the everyday things that have been limited because of my back, but what I can't deal with is how much my back pain has been affecting my golf game AND my time with my friends. I don't have a lot of time outside of work to connect with my friends or relieve my mental stress, and golf is my social and stress outlet.”
Jim's Diagnosis 1 was his central low back pain where he strained it while lifting a heavy garbage can at home 4 months ago. Diagnosis 2 we found to be a positional problem with his pelvis and lumbar spine. Once we corrected Diagnosis 2 in our Phase 1, Diagnosis 1 resolved within 4 weeks. In Phase 2 and 3, we focused on building Jim's back and pelvic stability and golf-specific mobility, and he was able to get back playing golf.
“I hit a 325 yard drive on my first drive back after rehab with you...Dr. Jerry, I've never been able to hit over 275 yards. Even my buddies were asking what I've been doing, and I just told them physical therapy at Next Level. You may be getting some of my friends coming in sooner than later!”
Remember, when you're over 40, the name of the game is staying ahead of problems and the best time to consult with a physical therapist is when you're NOT injured.
PS→ If you keep straining the same muscle or joint, or a new one every few months, that's likely your Diagnosis 2 talking.
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Medical disclaimer: This content is for educational purposes only and is not medical advice. Consult a qualified healthcare professional before beginning any new exercise program, especially if you have a history
of heart disease, back pain, or other medical conditions.
About the Author
Dr. Jerry Yoo is the Founder of Next Level Physio.
He has worked with runners and lifelong athletes for over 25 years, and is a clinical running research partner with Rutgers University. Dr. Jerry is an expert at helping athletic men and women over 30 who just don't want to stop.
He can be reached directly at Jerry@NLPhysio.com