Recovering From Training Injuries and Pain: How Long Does It Take and What Can You Do About It?

One should be delightfully surprised when any treatment is shown to be more effective than natural history.

– Archie Cochrane

Pains and injuries are parts of life.

But some pains and injuries tend to cling on longer than we think we deserve, despite our best efforts to treat them.

Or do they?

In this article, you’ll learn about the most common training injuries and pains and how long to expect to be in pain or for your body to heal them.

You’ll also learn what you can do about them to speed up your recovery and which “recovery” methods you can skip altogether.

Let’s begin by looking at the phenomenon that will solve most of the pains and injuries you’ll ever encounter: natural history.

Mother Natures Healing Touch

Natural history is the time it takes for your body to show off its healing skills without any outside help.

In other words, it refers to the time it takes for an injury, pain, pathology, or other condition to improve on its own without any treatment.

How long this natural history gig lasts depends on what’s wrong, what conditions the body gets to work with, and a whole bunch of other contributing factors.

But here’s the kicker: natural history recovery times tend to follow a bell curve.

This means that most people with the same condition (pain or injury) tend to get better at around the same time, but there will always be a few early birds and a few laggards.

Picture a marathon where the bulk of runners cross the finish line together, but there’s always that one gal or guy who sprints ahead and that other one still chugging along hours later.

Or take the common cold: It usually packs up and leaves after a week or two. Sometimes, it takes a little longer and sometimes a little shorter, but it is usually somewhere between these time frames.

And this is regardless of how well-armed you are with nasal spray and herbal tea.

Know Your Natural History

Understanding natural history helps you stay calm(er), knowing you’re healing as expected.

Thereby, you might avoid unnecessary panic, treatments, or interventions.

Contrary to popular belief, speeding up recovery beyond the usual natural timeframe for different health conditions, such as back pain, is as tricky as teaching a cat to play fetch.¹

Think about the nasal spray again: it’s great for relieving symptoms of a common cold, but it won’t do much for the viruses that push on the infection.²

And the same goes for many other conditions, which we’ll dive into below.

Types of Pain and Injury and Their Natural History

Listed below are some typical aches and pains that sometimes come knocking on your door, how long you should expect them as your guest, and what you sometimes can do to make them leave early.

Enjoy!

Acute Low Back Pain

This type of back pain can debut in different ways. It can either unexpectedly hit you out of the blue or strike more expectedly, like an irate neighbor dropping-kicking you in the back for shoveling snow onto their driveway.

Either way, the diagnosis refers to pain, not injury.

If nothing’s broken but pain appears, the diagnosis is “acute low back pain”. 

When you have low back pain, various types of manual treatment (like massage, foam rolling, needling, and so on) might temporarily relieve some symptoms but they hardly change the time it takes to recover.^{1 3 4}

For actual recovery, you need to rely on natural history.

Low back pain has a natural history of 6–12 weeks, regardless of how you treat it. ⁵

Yet again, some will recover faster and some slower, but this is the time frame you should expect.

Sciatica

The sciatic nerve is a pinky-thick nerve that runs along the back of the thigh. It is a composite of several smaller nerves that exit via passage holes from the spinal cord.

Sometimes, these smaller nerves can sustain injuries or inflammatory processes that make them thicker (swollen) and more pressure-sensitive, leading to unpleasant experiences.

Just like a pimple that gives you an unpleasant experience when you just have to touch it. The skin is usually not that pressure-sensitive, but a pimple hurts like hell because of a local inflammatory process.

The most common unpleasant experience from sciatica is pain, but in some cases, it doesn’t just stop there. It might also throw in some tingling or numbness in your back or butt, and if it’s feeling extra spiteful, shoot that sensation right down your leg.

The natural history for first-time sciatica is 6–12 months, which means that for most people, it’ll take around half to a full year for the symptoms to go away.⁶

Some surgery options exist depending on the cause of the nerve damage/injury. Still, these are only (or should at least only be) used as a last resort if the recovery time differs too much from the natural history.

Herniated Disk (Lower Back)

Disc herniation is when one or more discs in the spine break.

The causes of disc herniation are complex, but the most common risk factors are:

• Genetics ⁷
• Sedentariness ⁸
• Occupation ⁹

In some cases, they are associated with lifting objects from the ground, but disc herniations occur far more commonly in those who don’t regularly lift than those who do.¹⁰

Herniations come in different sizes, and the symptoms can vary depending on the location and what nearby structures it affects.

For example, if a herniation affects a nearby nerve, a potential symptom is sciatica, which you read about earlier.

However, the most common symptoms of disc herniations are … none.

Yep, you read that right. Disc herniations can very often be found with MRI examinations, even in humans who don’t have any pain.¹¹

And, in line with the topic of this article, they usually heal on their own.

In fact, the larger the herniation is, the more likely it is to heal.¹²

The natural history of disc herniation can vary greatly depending on different factors (herniation size included), but most people recover within 12 months.

So, instead of forced admission to the nearest operating table, time, patience, and healthy decisions can heal your disks just like a scrub wound heals if you stop fiddling with it too much.

Muscle Injuries

Muscle injuries are what they sound like.

They can have an acute or more of an insidious debut.

Depending on the extent of muscle damage, an injury is diagnosed as a grade 1, grade 2, or grade 3 sprain.

The size of the injury is best diagnosed with an ultrasound or MRI examination, which establishes the diagnosis.

And after that, it’s time to, once again, trust the natural history.¹³

• Grade 1, Sprain: 2–3 weeks
• Grade 2, Partial tear: 2–3 months
• Grade 3, Full tear: 3–6 months

These time frames are what it takes for the different sizes of muscle injuries to heal.

But, good news for all you training fanatics: an early rehabilitation program could help you recover quicker from muscle injuries!

A study from the University of Copenhagen showed that amateur athletes who began rehabilitation two days after a muscle injury recovered faster than those who waited nine days.

Early rehabilitation reduced injury time by about three weeks, highlighting the importance of starting rehabilitation as early as possible.¹⁴

So get moving and maybe get some guidance from a healthcare professional.

Ligament Injuries

Ligament injuries are quite the same as the title above but instead refer to ligaments.

Ligaments are much stiffer than muscle tissue. They are located in various places in our bodies, usually around our joints, and are designed to be stable but still allow for movement.

These small rascals are a little slower when it comes to time to recover.¹⁵

The ligaments don’t get as much blood as muscles do, slowing the recovery time compared to muscle tissue damage.

• Grade 1, Sprain: 2–8 weeks 
• Grade 2, Partial tear: 2–6 months
• Grade 3, Full tear: 6–12 months

But yet again, this natural history time is not your call for more Netflix since an early return of pain threshold movement and loading leads to a favorable recovery.¹⁶

Different rehab protocols can be useful depending on which ligament is damaged.

Still, in the case of an ankle sprain (a common ligament injury), balance training can be a good alternative since it’s often done at a suitable load for the injured body parts tolerance.

Balance training also reduces the risk of a similar re-injury, which is smart since the most common cause for an ankle sprain is a previously not rehabilitated ankle sprain. ¹⁷

Other ligament injuries are usually rehabilitated similarly, focusing on movement and loading at a tolerable pain that does not have an alarming trend, meaning it follows the expected time for the natural history.

Shoulder Pain (Sub Acromial)

This type of shoulder pain refers to all kinds of pain originating from a structure “sub the acromion”. Or in English, from a structure inside your shoulder.

There are ways to separate and give more exact structural diagnoses, but that seems to play less of a role in pain recovery time.

As long as you do not do anything reckless that aggravates or maintains the pain over time, most shoulder pains of this kind (regardless of what exact structure) have a natural history of 3–6 months.¹⁸

Depending on why you are in pain, a good strategy during this period could be to read “Shoulder Pain When Bench Pressing: Causes & How To Fix It” and apply what you learn!

In general, rehab exercises could be useful for managing pain intensity and maintaining shoulder function while natural history does its thing.

Regarding exercise choice, it matters less what exercises you do, where you do them, whether they are eccentric, concentric, open-/close-chained, and so on, as long as you do them.¹⁹ Exercise works if you do it.

So try to figure out what exercises don’t provoke too much pain but still hit you up with life’s purpose: gainz in the gym!

Lateral Elbow Tendinopathy (“Tennis Elbow”)

This is a classic tennis elbow. But don’t let the name fool you—this pesky condition isn’t always caused by perfecting your backhand on the court!

Rather, it’s a fairly common condition for the non-training population after spending too many hours at the work desk.

The pain is located on the outside bump of the elbow, where the forearm extensor muscles connect to the elbow bone via muscle tendons, and is often described as either aching or sharp (or both).

Although different rehabilitation exercises are usually a good idea (since training is better than not training for many reasons), there is very little evidence that exercise is better than other treatments for tennis elbow.²⁰

Other types of treatment are surgery, steroid injections, acupuncture/dry-needling, or shockwave therapy, which can help with pain for the moment but does NOT change the time for natural history to occur. ^{20 21 22 23}

So, the best treatment for tennis elbow seems to be to carry on and give it time since around 90% of people with untreated lateral elbow pain achieve full resolution within 6–12 months, the same as a treated one.²⁴

Lateral Hip Pain

Lateral hip pain could be described as a tennis elbow to the hip, or something similar.

The pain is located around the bony bump of the external part of the upper thigh/glute and can occur with the same conditions as a tennis elbow: too much or too little activity.

It is also often described with the same pain characteristics, aching or sharp (or both).

Once again, a rehab exercise protocol could be a good idea, but it is also wise to add a 6–12 month acceptance and patience plan since that is what natural history says it will take for recovery.²⁵

Appropriate rehab exercises are everything that you feel is valuable according to your training goals and do not worsen the pain symptoms for more than 24 hours.

This could be basically everything you already do at the gym, but maybe in a slightly different way, with a temporary lighter load or fewer reps than you usually do.

Experiment and evaluate the pain intensity for the next 24 hours. Or in accepted rehab language: Fuc* around and find out!

Plantar Fasciopathy (“Plantar Fasciitis”)

This is a stubborn bastard.

Plantar fasciopathy is a pain in the plantar fascia, which has its home under your foot.

It’s typical to experience pain during pressure activities like walking or running, which can often be partly relieved by wearing shoes or orthosis with a soft insole.²⁶

But no matter how cuddly your shoes are, the pain usually takes 12–18 months to resolve. ²⁶

So make sure you have really cuddly shoes to boost your patience in the meantime.

Other options that swirl around are:

• Surgery
• Steroid injections
• Dry-needling
• Shockwave
• Tape
• Stretching

but … 

… surgery has low evidence for plantar fasciopathy, with many reporting worsening pain.²⁷

… steroid injections may increase the risk of rupture. ²⁸

… dry-needling has no effect on plantar fasciopathy and may only be considered an adjunct intervention. ²⁶

… shockwave treatment can assist the core approaches of education and load management but should not be considered an individual solution. ²⁶

… tape can reduce pain and predict an individual’s response to foot orthoses or comfy shoes. ²⁶

… stretching can reduce pain in the short term but does not change the time needed for natural history. ²⁶

So basically: give it time, try to manage the situation, and let the body again take the time it needs to recover.

Frozen Shoulder

This is an even more stubborn bastard.

A frozen shoulder often begins subtly with pain during shoulder movement.

The shoulder gradually becomes increasingly stiffer and stiffer, persisting for several months after the initial pain.

This makes everyday tasks like combing your hair or brushing your teeth difficult. Additionally, shoulder pain often worsens at night, making sleeping difficult.

General treatment includes rehab exercises, pain relief with pharmaceuticals, and time.

There are some surgery options, but they are in no way superior to conventional rehabilitation. Some surgery options are even associated with unwarranted complications like fractures of the humerus bone or rotator cuff tear, which should be taken into account when considering this type of treatment plan.²⁹

So, back to where this article started.

Natural history lasts about 24–36 months.³⁰

As we say in Sweden: patience is a fisherman’s and frozen shoulders best friend.

However, remember that these are just average times for the majority. Some people can recover sooner, but some can take longer.

Also, some may not recover due to things getting in the way of natural history, which we will take a deeper look at in the next section.

What Prevents or Speeds up Natural History?

Some factors could affect the natural history of different conditions, resulting in a shorter or longer recovery.

Speeds Up Natural History

Typical shortening factors are stuff like living and being overall healthy and having a more educated view, understanding, and acceptance of the affecting condition, including natural history.

A healthy lifestyle typically includes good sleeping habits, good dietary habits, avoidance of cigarettes, balanced life stress, regular exercise, sane provocative patterns, and so on.

Education, understanding, and acceptance are often followed by a more relaxed attitude toward the situation, eliminating unnecessary stress and other panic-driven behaviors that negatively influence recovery time.

All the above gives the body better conditions to recover, keeping you within the time frame for natural history.

Slows Down or Prevents Natural History

Typical factors that could hinder or prevent natural history and, therefore, extend the time for recovery are …

1. Wrong diagnosis.

A mixed diagnosis, with another condition that has a totally different natural history mimicking the one we thought, will affect the expected time to recover.

So, make sure to get it right from the beginning.

2. Co-morbidities.

Another interference factor is when a person is simultaneously affected by two or more conditions.

This could be both direct physical conditions like:

• A dislocated shoulder plus a fractured humerus bone (your upper-arm bone)
• An anterior cruciate ligament (ACL) Injury plus a meniscal tear
• Plantar fasciopathy plus achilles tendinopathy.

.. but could also be variables of psycho-social or environmental topics like depression, dissatisfaction at work, fear, anxiety, or other things limiting daily life that do not originate from the physical body.

These examples are complex and should be handled by well-educated healthcare professionals specialized in psycho-social diagnostics and management.

3. Nocebo

Another annoying but highly influential factor that delays or prevents natural history from occurring is the belief that pain is harmful or dangerous and needs to be completely gone before it’s safe to progress with tasks and activities.

This often occurs when people in pain Google research or are inappropriately told misguided things about pain, injury, disability, and how the body functions.

Things like their pelvis or spine are out of alignment, their muscles are imbalanced, or their core is too weak.

Which rarely is the case.^{31 32 33 34 35 36 37 38 39}

Statements like these can cause feelings of fear and fragility, potentially delaying a normal return to pain-free activity.

This is particularly problematic today, as information of varying accuracy spreads faster than a specific bacterial infection during spring break.

Once again, if you are in pain or have an injury, seek help from educated healthcare professionals instead of relying on uneducated misinformation.

Valuble Stuff to Know or Do When You Are Injured or In Pain

Life is not over.

It might just feel that way, especially if its a first time episode which often comes with more fear and anxiety than if its something you’ve dealt with before.

It’s important to manage this time in favor of both your physical and mental health so it does not add on more stress than what an adult life already involves.

A study by Chen et al (2018) summarized some good things to consider.⁴⁰

Try to avoid:

1. Passive coping.
2. High pain intensity.
3. Negative thought patterns.
4. Perceived lack of control over the pain.
5. Low expectation of improvement.
6. Social isolation.

How the heck do I avoid this in practice?

1. Trust yourself and your ability to handle your pain. Do NOT rely on someone else to fix it for you.
2. Pain relief. Manual therapy is a common example, but physical movement has been proven to relieve pain just as well as manual therapy. Plus, it’s a much cheaper and more accessible option. Walking is a good example of physical movement—perhaps to the pharmacy.
3. Think positively, as much as you can. Focus on what you can do during the pain period instead of dwelling on what you can’t do. Difficult but valuable!
4. Take control. Find strategies where YOU manage your pain. Examples could be: Modifying painful movements. Try to challenge your pain at a manageable level, and so on.
5. Expect improvement. Understand that you will actually get better. Throw catastrophic thoughts in the trash. Remember natural history.
6. Engage in social activities. Don’t let the pain interfere with your social life. Do something fun  with friends or family to distract yourself. Netflix is a bad friend if it doesn’t involve chill.

Go In Peace And Recover

Pain and injuries come and go. They are unfortunate parts of life, but they also give us the opportunity to learn something valuable for the future.

Natural history can be used as a guide to relieve stress, knowing you’re healing as expected. However, it is important to base your recovery expectations on the right diagnosis, so ensure you get that right from the beginning.

If you want to prevent injuries and pain we have a app that can help you with just that!

Check it out and see you in the gym!

References

1. The clinical course of low back pain: a meta-analysis comparing outcomes in randomised clinical trials (RCTs) and observational studies. BMC Musculoskelet Disord. 2014 Mar 7:15:68.
2. Viruses and bacteria in the etiology of the common cold. J Clin Microbiol 1998 Feb;36(2):539-42.
3. A Meta-Analysis of the Effects of Foam Rolling on Performance and Recovery. Front Physiol 2019 Apr 9:10:376.
4. Effectiveness of Acupuncture Therapies to Manage Musculoskeletal Disorders of the Extremities: A Systematic Review. J Orthop Sports Phys Ther. 2016 Jun;46(6):409-29.
5. What is the prognosis of back pain? Best Pract Res Clin Rheumatol. 2010 Apr;24(2):167-79.
6. Prognosis of sciatica and back-related leg pain in primary care: the ATLAS cohort. Spine J. 2018 Jun;18(6):1030-1040.
7. The Twin Spine Study: contributions to a changing view of disc degeneration. Spine J. 2009 Jan-Feb;9(1):47-59.
8. Long-term effect of physical inactivity on thoracic and lumbar disc degeneration-an MRI-based analysis of 385 individuals from the general population. Spine J. 2020 Sep;20(9):1386-1396.
9. The effects of anthropometrics, lifting strength, and physical activities in disc degeneration. Spine (Phila Pa 1976). 2007 Jun 1;32(13):1406-13.
10. To Flex or Not to Flex? Is There a Relationship Between Lumbar Spine Flexion During Lifting and Low Back Pain? A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther. 2020 Mar;50(3):121-130.
11. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015 Apr;36(4):811-6.
12. The probability of spontaneous regression of lumbar herniated disc: a systematic review. Clin Rehabil. 2015 Feb;29(2):184-95.
13. British athletics muscle injury classification: a new grading system. Br J Sports Med. 2014 Sep;48(18):1347-51.
14. Early versus Delayed Rehabilitation after Acute Muscle Injury. N Engl J Med 2017;377:1300-1301
15. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. Br J Sports Med. 2018 Aug;52(15):956.
16. Acute treatment of inversion ankle sprains: immobilization versus functional treatment. Clin Orthop Relat Res. 2007 Feb:455:169-72.
17. Neuromuscular training for chronic ankle instability. Phys Ther. 2012 Aug;92(8):987-91.
18. The Maastricht Ultrasound Shoulder pain trial (MUST): ultrasound imaging as a diagnostic triage tool to improve management of patients with non-chronic shoulder pain in primary care.BMC Musculoskelet Disord. 2011 Jul 8:12:154.
19. Exercise-Based Muscle Development Programmes and Their Effectiveness in the Functional Recovery of Rotator Cuff Tendinopathy: A Systematic Review. Diagnostics (Basel). 2021 Mar 16;11(3):529.
20. Clinical effectiveness of shockwave therapy in lateral elbow tendinopathy: systematic review and meta-analysis. Clin Rehabil. 2021 Oct;35(10):1383-1398.
21. Surgical Treatment of Lateral Epicondylitis: A Prospective, Randomized, Double-Blinded, Placebo-Controlled Clinical Trial. Am J Sports Med. 2018 Apr;46(5):1106-1113.
22. Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial. JAMA. 2013 Feb 6;309(5):461-9.
23. Effectiveness of non-invasive therapies on pain, maximum grip strength, disability, and quality of life for lateral elbow tendinopathy: A systematic review and meta-analysis. Braz J Phys Ther. 2024 Mar-Apr;28(2):100596.
24. Persistent Tennis Elbow Symptoms Have Little Prognostic Value: A Systematic Review and Meta-analysis. Clin Orthop Relat Res. 2022 Apr 1;480(4):647-660.
25. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ. 2018 May 2:361:k1662.
26. Management of plantar heel pain: a best practice guide informed by a systematic review, expert clinical reasoning and patient values. Br J Sports Med. 2021 Oct;55(19):1106-1118.
27. Evaluation and Treatment of Chronic Plantar Fasciitis. Foot Ankle Orthop. 2020 Feb 13;5(1):2473011419896763.
28. Injected corticosteroids for treating plantar heel pain in adults. Cochrane Database Syst Rev. 2017 Jun 11;6(6):CD009348.
29. Clinical Guidelines in the Management of Frozen Shoulder: An Update!. Indian J Orthop. 2021 Feb 1;55(2):299-309.
30. Frozen shoulder. Nat Rev Dis Primers. 2022 Sep 8;8(1):59.
31. A radiostereometric analysis of movements of the sacroiliac joints during the standing hip flexion test. Spine (Phila Pa 1976). 2000 Feb 1;25(3):364-8.
32. Pelvic fractures-A guide to classification and management. Eur J Radiol. 2010 Apr;74(1):16-23.
33. Radiosteriometric analysis of movement in the sacroiliac joint during a single-leg stance in patients with long-lasting pelvic girdle pain. Clin Biomech (Bristol, Avon). 2014 Apr;29(4):406-11.
34. Movement of the sacroiliac joint during the Active Straight Leg Raise test in patients with long-lasting severe sacroiliac joint pain. Clin Biomech (Bristol, Avon). 2017 Aug:47:40-45.
35. The myth of core stability. J Bodyw Mov Ther. 2010 Jan;14(1):84-98.
36. Abdominal muscle activation of elite male golfers with chronic low back pain. Med Sci Sports Exerc. 2001 Oct;33(10):1647-54.
37. Isokinetic Trunk Strength in Acute Low Back Pain Patients Compared to Healthy Subjects: A Systematic Review. Int J Environ Res Public Health. 2021 Mar 4;18(5):2576.
38. The effects of Pilates exercise in comparison to other forms of exercise on pain and disability in individuals with chronic non-specific low back pain: A systematic review with meta-analysis. Musculoskeletal Care. 2023 Mar;21(1):78-96.
39. The Relationship Between Asymmetry and Athletic Performance: A Critical Review. J Strength Cond Res. 2019 Sep;33(9):2579-2593.
40. Trajectories and predictors of the long-term course of low back pain: cohort study with 5-year follow-up. Pain. 2018 Feb;159(2):252-260.