Sometimes it’s the body that knows best when it’s time to take a pause and stop exercising. If we don’t listen to those small sprains and niggles, by choosing to carry on, we can often end up doing serious damage to ourselves. Think of a small chip in your car’s windshield. If we don’t fix it early, then the years will end up turning a small nick into a big problem. In this blog, MSK physiotherapist Hardik Nimla will be recounting a time when he first felt a small chip in his knee, and via the correct recovery practices, was able to avoid causing himself any further or permanent damage.
Why recovery matters more than pushing through
It was the perfect spring morning for a hike in the Peak District. The fields around me lay shrouded in mist, the valleys were chiming with the chorus of birdsong; and as I walked, I felt the plushness of the earth gently pressing against the soles of my hiking boots as they went digging into the soft and dew-soaked terrain. I am a physiotherapist, and hiking is one of my great passions. As perhaps you can tell, these sorts of moments in nature are sacred to me. They are that perfect blend of solitude and movement, and here in the Peak District, we have the joy of witnessing a landscape that rarely appears the same way twice.
My route was from Castleton to the summit of Mam Tor, and about halfway going down on one of the steeper descents, it all took a turn for the worse. I felt a sudden, uncomfortable twinge in my right knee that stopped me from walking. I took one more step, and there it was again: the alarming sensation, as if my leg was soon about to give way. I took a moment to lean for support on the nearest fencepost I could find. I was afraid to move any further, concerned that I might cause my knee further damage.
I found a rock on which to sit and calm myself down. There was no sharp pain, no locking and no obvious swelling. These were all reassuring signs, yet the dull aching in my leg was still enough to make me fear there may be serious damage. My clinical brain considered that maybe there was something wrong in the kinetic chain. Possibly my glutes were not fired up as they should be? Or perhaps, my recent lack of strength training had left my knee vulnerable to injury when overused? Whatever the cause – as a physiotherapist – I understood just how important it was to treat my injury seriously. I knew that, as tempting as it was to suck up the pain and limp my way back down the hill, this was not the time to be recklessly pushing myself and risking my knee further.
Struggling, I gently moved my knee by trying a slow squat. It wobbled slightly, and so, I resisted putting my full weight on it due to the pain. Thankfully, it did not collapse. I then lengthened my trekking poles to offload my knee and practised a few steps using them for support. The pain was at least bearable, and with a tighter core, upright posture and short, zigzagging steps, I very cautiously went down the hill to make my way back home.
That evening, as I was relaxing at home with a cup of coffee and settling in for a Netflix session, I turned to a recovery technique that I often recommend to my clients called the ‘PEACE & LOVE’ protocol. A modern, evidence-based approach to soft tissue injuries devised by therapists Blaise Dubois and Jean-Francois Esculier, this method provides a comprehensive list of steps to follow when hampered by injury.
First came PEACE
I started by giving my knee time and space to recover. Protect: No overuse. I avoided stressful movements for a few days and kept my knee Elevated. Additionally, I Avoided taking anti-inflammatories and let my body’s natural healing processes do the work. I also applied light Compression to manage the already existing inflammation. Perhaps most importantly, I relied on Education: to trust your body, know the warning signs, and to feel some security in treating pains so that you never feel uncertain or panicked.
A few days in, I then shifted on to LOVE
To begin LOVE, I started by gently Loading onto my knee with bridges, step-downs and controlled single-leg work. I stayed Optimistic by focusing on what could be done; and added Vascularisation through low-impact movements such as stationary cycling or brisk walks. Every motion was a step towards getting my mobility back and it felt good to be moving again without fear or restraint. As the week progressed, I came to the final stage which resuming regular Exercise. This exercise focused on strengthening my glutes, quadriceps and core muscles to help support the recovering joint.
Three weeks in and I felt it was time to start testing my knee’s mobility on one of the Peak District’s smaller and more forgiving hiking trails near Edale. This was to rebuild trust in my knee by carefully easing it back to full strength. The hike was a success and so I continued to pace myself with gentle walks until, six weeks after that unfortunate wobble, I decided I was ready to go full hiking once again. Soon I was back at the base of Mam Tor and eager to have another go. The same climb, the same descent; only this time, I would move slower and pay closer attention to my posture, stride and breathing.
Knees do give way sometimes, and my injury reminded me just how important it is to pay close attention to your body. Once bitten, twice shy, and I am grateful that my minor scare left me with nothing permanent. Rather, it has since made me a more sensible hiker with a heightened awareness of the dangers involved. Six weeks after that incident, it felt incredible to be standing on the summit of Mam tor once again – filling my lungs with that crisp country air and feeling stronger and more assured than I ever have done before.
Written by Hardik Nimla, MSK Physiotherapist
The research behind these insights
Bohne, M., & Abendorth-Smith, J. (2007). Effects of Hiking Downhill Using Trekking Poles
while Carrying External Loads. Medicine & Science in Sports & Exercise, 39(1), 177–183. https://doi.org/10.1249/01.mss.0000240328.31276.fc
Bottoni, G., Heinrich, D., Kofler, P., Hasler, M., & Nachbauer, W. (2015). The Effect of Uphill and Downhill Walking on Joint-Position Sense: A Study on Healthy Knees. Journal of Sport Rehabilitation, 24(4), 349–352. https://doi.org/10.1123/jsr.2014-0192
Dubois, B., & Esculier, J.-F. (2020). Soft-tissue Injuries Simply Need PEACE and LOVE. British Journal of Sports Medicine, 54(2), bjsports-2019-101253.
https://doi.org/10.1136/bjsports-2019-101253183
Mitten, D., Overholt, J. R., Haynes, F. I., D’Amore, C. C., & Ady, J. C. (2016). Hiking: A Low-Cost, Accessible Intervention to Promote Health Benefits. American Journal of Lifestyle Medicine, 12(4), 302–310. https://doi.org/10.1177/1559827616658229
Park, S.-K., Jeon, H.-M., Lam, W.-K., Stefanyshyn, D., & Ryu, J. (2019). The effects of downhill slope on kinematics and kinetics of the lower extremity joints during running. Gait & Posture, 68(Volume 68 (2019), 181-186), 181–186. https://doi.org/10.1016/j.gaitpost.2018.11.007
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