“Simplicity is the highest form of sophistication” ~ Leonardo Da Vinci
There are a few common pitfalls with remodeling that I have observed. One of them is that the individual never makes it to remodeling. I see this happen when the tissues in question were subjected to countless boom and bust cycles in proliferation. Eventually the tissues do seem to pull past proliferation and an actual repair is laid. However, the repair is so tight and weak it can hardly stand any force at all. Worse yet, it has become chronically sensitized. And also, the regions around the repair have become tight, weak, and sensitive by proxy of misuse. Without proper intervention, I see individuals in this category resign themselves to “babying” the body part in question sometimes for the rest of their lives. Occasionally, they may use the area to the point of pushing it back into inflammation and then they are right back in a boom-bust. Or the inflammatory response that occurs is weak and not much happens afterwards.
This is a terrible situation, but there is a way out of this mess. And that is to start over. Through carefully executed exercise, or perhaps employing some dry needling, the effed-up tissues need to be loaded to the point of moderate damage, thus stimulating a solid inflammatory response. Read moderate damage. Large would be to the point that the person is in pain/inflammation for days. Small would be you don’t feel anything. Moderate means the person gets legitimately sore for at least a couple hours. What happens after said person gets sore is of utmost importance. They need to follow the protocol for the inflammation phase and the proliferative phase exactly. Read, no stymied inflammation and no boom-and-bust cycles! For more detail go back and read this entire series of blog posts again. The whole point of stimulating the tissues was to push them back to square one so that they have a chance to try again. The repair will never be as good as it could have been if you had done it right from the beginning but better integrity of the tissues is possible on the other side.
Another common mistake is that the individual does make it to the point of remodeling but then does not do it right or does not see it all the way through. Maybe this person just doesn’t progressively load their tissues specific to their desired activities. Or maybe they do this for a while and then stop. This is the six-month mark in the clinic when people start coming in saying things like “well I guess this is the way it is now” or “is there surgery to fix this?” or something like that. I want them to know that there is nothing wrong with them in the least. They are just in the middle of a process.
I personally have been amazed recently with the progress of my right shoulder after suffering two glenohumeral dislocations in rapid succession about 18 months ago. I followed my own healing protocol to the letter and was clicking along with regular progress for months. I made it all the way back to my heaviest snatch weight and set a 10# personal best in the clean and jerk. My pressing strength and endurance was the best that it has ever been. I could knock out a handful of strict pull ups, some even with a weight tied around my waist. But every time I tried to do kipping pull ups, my shoulder gave me the signal that it was too much (felt unstable). I have to admit that even as the author of this blog, I thought to myself several times that I had hit a permanent ceiling. However, I kept working on pull up strength and mobility and then one day, I just felt so good I thought I should give kipping pull ups another try. So, I did. I busted out three sets of three really good ones all in row. My shoulder felt great the whole time. This is certainly not elite but it is progress. And now I have faith again. Who knows where I will be in another year.
The final pitfall that I would like to comment on is using passive modalities in lieu of the real deal. The real deal being progressive and specific forces, of course. I know that I mentioned dry needling earlier, and I fully believe that massage, cupping, needling, hot/cold therapy, et cetera has its time and place BUT these DO NOT remodel tissues. They make you feel good or attune your nervous system or potentially help stimulate an immune response but they don’t prepare to you lift heavy, go long, send it, or walk around the block (if that’s your fancy).
What does that? Good, old-fashioned exercise. The flashiest and most expensive physical therapists in town will make little money off of you. You won’t have cool kid cupping welts all over your body. And you will have to work hard and be diligent. But you will have truly healed.