As a physiotherapist based in the Chelsea/Belgravia/SW1 area, I like to keep my eye on what my footballing neighbours up the street are up to. This morning I learnt that John Terry has a nerve injury that is causing him pain and may keep him away from football for many weeks or months.
Not good news for Terry certainly, but there are a couple of interesting points that this raises. First, lets consider the length of time it will take to get better. Now I don’t know exactly what the problem here is, but I do happen to know that Chelsea have an excellent medical team that know what they are doing. So even with the best medical care available, this problem is still going to take a long period of time to get better. This is important. No miracle cures, no ‘specialists’ on foreign shores, just a sound understanding of the biology involved in healing and the need to be patient.
Consider this example. Say you injure a nerve in your leg. Now normal healing of some injuries involve a dying back of the nerve to its cell body located in your spinal cord, a process known as wallerian degeneration. Once this process is complete, the nerve then has to grow back out to reach its target tissue which it does at the rate of between 1.5-1.9 mm (!) a day. This would be the best case scenario. Imagine then that this target tissue is in the foot. Given that some people, John Terry being one, are over 6ft tall and that nerves are arranged in a spiral fashion as a means of protection, then we could be looking at a distance of up to 1.5m that a nerve has to grow. At a rate of less than 2mm a day we would be looking at a time frame of over 2 years for complete re-growth of the nerve! Even if the problem occurred nearer to the spine we would still be looking at considerable amounts of time.
The good news is that certain treatments do exist to help treat the pain that can result from nerve injury and repair. Great. But lets have a quick think about what else nerves do. Sensory nerves, are one part of a body system that ‘looks after’ you. So the tissue the nerve innervates can be thought of as a structure the nerve ‘looks after’. So what happens to the tissue in the absence of an intact nerve supply? Well there is research to show it becomes less healthy and may be at increased risk of injury. For example, we know that people who undergo achilles tendon rupture have a higher incidence of sciatica – a symptom that may suggest a problem with the nerve supply that ‘looks after’ the leg.
Interesting isn’t it? In football we frequently hear of footballers with a history of back pain and sciatica whose career then goes on to become blighted by recurrent muscular/ligamentous injuries. Could this be due to subtle nerve injury and the absence of a regulatory nerve supply for prolonged periods of time? It is interesting to speculate, not least if you are Owen Hargreaves or Michael Owen.
Can we get better at predicting injury and managing it more realistically? The answer is almost certainly yes. The problem is that many powerful individuals still make their living from more and more detailed assessments of’core stability’ and biomechanics, and although this is often a necessary component in their rehabilitation, it won’t all of a sudden speed up many of the physiologic processes required to make you better.
So what would the enlightened therapist do? In the case of John Terry it’s hard to say without knowing an exact diagnosis. But we know what sort of things can delay recovery (stress, worry, concerns, fears, beliefs, over ambitious therapy etc etc). So John Terry, if you are reading this, get better soon and I hope you are lying on your back in the sun with your loved ones around you.
Pimlico Physiotherapy: Thoughtful physiotherapy for the SW1 area