Common Musculoskeletal Injuries – and the Principles of Good Rehabilitation

Most musculoskeletal injuries – whether a sprain, a tendinopathy or a muscle strain – follow some shared principles when it comes to healing. Understanding these makes it easier to understand why rehabilitation looks the way it does, and why "resting until it stops hurting" is rarely the right strategy.

The most common injury types

• Sprains – injury to a ligament, most often in the ankle or knee
• Muscle strains and tears – often in the thigh or calf, typically from a sudden acceleration or change of direction
• Tendinopathies – such as jumper's knee, Achilles problems or tennis elbow, which develop over time from repeated loading
• Bursitis – irritation of a bursa, often in the shoulder or hip
• Overuse injuries – gradually developing problems caused by too rapid an increase in training or activity

The acute phase: protect, but don't immobilise

The old advice of ice and total rest (RICE) has partly been replaced by a newer understanding, often summarised as PEACE & LOVE: in the first days, you should protect the injury, elevate it, avoid anti-inflammatory medication and excessive icing, apply compression if needed, and get educated about what's actually wrong. After the first few days, the focus shifts to gradually reloading the tissue, keeping optimism up, ensuring good blood flow through light activity, and exercising towards a gradual increase in load.

The reasoning is simple: muscles, tendons and ligaments need a certain amount of mechanical loading to heal with good quality. Too much prolonged, total offloading can actually delay healing and weaken the tissue further.

Gradual load progression is the key

Regardless of injury type, rehabilitation is usually built up in phases, with load increased gradually:

• Regain pain-free mobility
• Build basic strength and control
• Progress to heavier and more functional strength training
• Reintroduce sport-specific or everyday-specific loading
• Gradual return to full activity or sport

How quickly you move through the phases is guided by how the tissue responds – not by the calendar. A little soreness the day after training is normal, but increasing pain is a sign that the load has been too much, too soon.

Why the right diagnosis matters

A tendinopathy, a muscle tear and a ligament injury each require a different approach and a different pace of loading. That's why an accurate examination – in many cases supplemented by diagnostic ultrasound – matters before a plan is made. The wrong loading early in a course of treatment can extend the time it takes to recover.

Sources

1. Dubois B, Esculier JF. "Soft-tissue injuries simply need PEACE and LOVE." Br J Sports Med 2020;54(2):72–73.
2. Cook JL, Purdam CR. "Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy." Br J Sports Med 2009;43(6):409–416.