How can pain from a previous injury be normal you say?! The important thing to remember is that pain happens for many reasons, it's multifactorial. It's better to reframe the way we think about pain and remember we aren't broken humans if we have a flare up. Stay positive, it helps, there's good research that says so ;) Flare ups happen all the time, I see it often clinically. Patients come in discouraged and I see it written all over their face. However, oftentimes when patients are armed with the proper knowledge on how to manage flare ups and why they happen, the look of discouragement slowly fades. They hop right back on the saddle, and get over that "rehab hump."
So why do flare ups happen? Again, pain is a complicated subject, it's not just due to your body mechanics or bad posture, many things can magnify the pain of a previous injury. The "easy" reason is your body's tissue demands exceed what specifically that tissue can handle at a given time. But again, the human body is never that easy. While tissue demands may be part of the reason, it's often important to also look at your sleep patterns, stress level and nutrition prior to the flare up. Also did you get sick recently? All these can contribute to an old "pain memory" rearing its ugly head again. The most random and arbitrary movements can trigger a flare up if these areas are compromised. In other words, the pain can magnify again when your body is overly stressed from all areas of life.
Your nervous system has a way of storing pain and it can remind you at the most unforgiving times. It can cause areas of previous injury to be "sensitized" and your body may still be on "high alert" causing the pain to be magnified by any of the things mentioned above (sleep, stress, work, nutrition, illness, hydration, relationships etc.). It's your body's protective mechanism in a way. I won't go into detail about "central" or "peripheral" sensitization since those are extremely loaded topics, just remember your body can become more sensitive to pain after injury and it has way's of storing these "pain memories". There is an actual change in our nervous system/brain and how it perceives pain, making a flare up happen from any arbitrary movement (I know, it's annoying). Pain, after all, is an experience. And just like with any experience, we are often reminded in the strangest times.
So how do we manage a flare up?
I mentioned many factors that can contribute to a flare up above, sleep patterns, stress level, nutrition, hydration, relationship/work stress, training loads, or even getting sick etc. Here are some tips that can help:
Decrease stress levels- meditation, breathing exercises, reading, do your best to eliminate or lessen life's daily stressors (eliminate the toxicity right?)
Have a night time routine and get to bed at a normal time, be consistent with it
Provide the right fuel for your body, eat a more balanced and nutritious diet. Find ways in which you can stick to a more healthy way of eating. Consistency with sleep and nutrition is key. Consistency beats any fancy diets or sleep hacks.
Drink more water, it helps everything
All of the factors above encompass your body's physical and emotional recovery, so focus on it little by little, small steps go a long way, listen to your body and adjust accordingly, its a great skill to cultivate (in other words when you feel run down, manage your training accordingly or take a day off)
Regardless, it's important get your body moving again but in a graded and safe manner. It takes time for your body to "recalibrate" its nervous system again and lessen the level of sensitivity to pain (go from high alert to lower levels of alert so to speak). It's important to move again and increase levels of loads/stress to improve your tolerance to physical activity again. It's ok to seek help, that is our jobs as doctors of physical therapy and also the job of a mental health professional. We are here to guide you and return you to your normal self. I can't speak much on the mental health side however In terms of physical therapy, we slowly and SAFELY help you get back to your movement/athletic goals. As doctors of physical therapy, we help recalibrate your nervous system again through movement and individualized rehab exercises. So reach out, we love what we do :)
Remember, flares ups can be normal, learning how to manage them with all the contributing factors mentioned above is crucial. It requires a whole body approach (mental and physical) to help you get back to your normal self. Keep a positive mindset and know that us doctors of physical therapy are here to help you. Let me know if you have any questions in the comments below or send me an email if you're struggling with a flare up.