The Role of Adaptation in Musculoskeletal Rehabilitation and Injury Recovery

The first day of school can be a stressful time for kids, parents and teachers. I remember the first day of high school and how intimidating it all seemed. Of course, with time the nervousness disappeared, and I was able to handle it all very well. I adapted with time.

Another example is the first day of a new job. Over time you learn to adapt to the demands, and it usually gets less stressful than at the beginning. Adaptation to stress is a concept that applies to many different areas of life. It is also very common in human physiology and medicine.

Perhaps the most obvious example is a muscle’s response to strength training. Over time, the progressive overload repeatedly stressing the muscle causes the muscle to adapt. If you think of it logically, a bodybuilder has stressed his or her muscles repeatedly, and the adaptation to that imposed load on the muscle is an increase in strength and a change in muscle size (hypertrophy).

So, how might this apply to the realm of musculoskeletal rehabilitation and injury recovery?

Adaptation to Stress on the Body

George is a 70-year-old (fictional) patient with mild lower back pain who we will use as an example. His pain only happens when he is gardening which he likes to do regularly. He has found that his pain primarily occurs with digging, so he tries to avoid this activity. Instead of telling George to just stop gardening, perhaps we can get his system to adapt to the demand of gardening.

After examining George, we determined that he needed a little more range of motion in his hips to get into the digging position easily. We also hypothesized that his pain was occurring due to a lack of muscular endurance since his pain only occurred after around 15 minutes of digging. We implemented a program that he was mostly able to do at home. George would stretch his hips in a way that didn’t aggravate his back pain and he worked on improving the endurance strength of his abdominals, lower back muscles and some of the muscles around his hips. At the beginning, we started with isometric “hold” exercises like planks and gluteal bridges. With time we added some more functional movements, including rotational strengthening like “wood choppers”.

Perhaps the best preparation for gardening itself is to actually do some gardening. So after a period of time, George started gardening again. He started with only 10 minutes of digging, and when he started to feel uncomfortable, he stopped. When he felt up to it, he would go back to the same task but see if he could carefully increase his time. He altered his movement a little to avoid an obvious flare up, but nonetheless, George was gardening again.

Over the summer, he found that he was able to dig for longer before any pain occurred. By the end of the summer, George was able to do 45 minutes of gardening with no pain. He was ecstatic! He decided to continue his core training over the winter in the hope that in the spring, he would start the year with better tolerance to digging. He planned to slowly and carefully increase the time of gardening, being mindful of his symptoms and his biomechanics in the future.

Role of Rehabilitation Professionals

In this example, George’s biomechanics, joints, muscles and nervous system all adapted to a careful level of applied stress. For many people, their failure to recover from a musculoskeletal injury is because they never challenged the tissue to adapt and improve their capacity, or if they tried, they pushed far too hard and caused further tissue damage and sensitization of pain pathways. (This is perhaps where rehabilitation professionals can be helpful).

So as you can see, an appropriate amount of stress to the body can result in various adaptations that are important for injury recovery. This principle can also fit many other aspects of life, as well. Although taking someone out of their comfort zone can be difficult, if done carefully, it will likely make you stronger. As the expression goes, diamonds are created under pressure!

Have an injury that won’t recover? Are you missing out on a sport or activity because of an injury? Give us a call, we can help!


By Dr. Kevin McIntyre
Clinic Director
Burlington Sports Therapy