“It still hurts, why hasn’t it healed yet?”
“it’s still weak, but my injury was like a year ago!”
‘Healing’ and ‘recovery’ are two words that people often use interchangeably. However, to clear up a some confusion about injuries and pain, it’s helpful to distinguish the two words as separate but closely related ideas.
How are they different? Why? And why is this important?
Throughout this article, you’ll see how this distinction is very helpful in understanding the science of pain, injury rehabilitation, and in later articles, the endlessly interesting concept of placebo.
First, another important distinction:
Disease best refers to an abnormal condition affecting an organism. This abnormal condition could be due to infection, degeneration of tissue, injury/trauma, toxic exposure, development of cancer, etc.
Illness best refers to feelings that might come with having a disease. Feelings like pain, fatigue, weakness, discomfort, distress, confusion, dysfunction, etc.- the reasons people seek healthcare.
It’s very important to understand that feelings of illness can be vastly affected by many non-disease factors, such as expectations, beliefs, fears, other feelings and moods, and even culture. Being ill is a very personal experience.
For more details, read Disease vs. Illness.
Now, Healing vs. Recovery:
For the purposes of this article, we’ll keep things very (over?) simplified:
- you heal a disease (or in the context of this website, an injury), and
- you recover from an illness.
Healing – The body’s natural process of repairing damage or combating a disease. For example, you could say healing is complete when the damaged tissue is repaired, or an infection has been eliminated.
Recovery – The return to pre-injury or ‘pre-morbid’ (medical jargon for “before illness”) condition. This certainly can include sufficient healing, but complete healing isn’t necessary (nor sufficient) for complete ‘recovery’. Recovery also includes how you function, and how you feel. Recovery is what you need to be able to do what you did before – and feel better.
In the end, it’s recovery that people want.
It’s not “black and white”
Of course, it’s not a black and white difference – which is probably why these words are so often used interchangeably. They usually occur together, and they are closely related. Sometimes, you really need to heal before you can fully recover – for instance, if a muscle isn’t reasonably healed, it’s unlikely to be as strong as it was before.
So why is this important to distinguish?
You can have one without the other.
Let me explain:
Full Recovery without Complete Healing:
An injury might never fully heal, yet you can make a full recovery to your previous function. This can occur through adaptations made through rehabilitation.
For example: perhaps you sprained a ligament, and it’s still loose, even after a couple years (maybe forever!). BUT, your ankle muscles are stronger than before, you wear a brace to stabilize, you may be much more conscious of your technique, and you’re more coordinated.
Because of these adaptations, you are able to play or dance or exercise at full capacity, maybe even better, and with no pain!
Complete Healing without Full Recovery:
On the flip side: you may achieve complete healing, but not truly recover – which can happen for a variety of reasons.
For example: with a muscle strain, the muscle tissue can heal back together nicely, perhaps even stronger than before. BUT, your muscle still seems weak, and pains when you move it a certain way, ultimately keeping you away from your sport.
This could be due to deconditioning (you slacked off after the injury, and didn’t rehab yourself properly). Or, you might develop a fear of the movement that caused the injury, or perhaps chronic pain, which persists after healing has occurred.
Therefore, the goal is:
For injuries, provide an optimal healing environment, so that nothing can slow healing. Be smart, and follow the usual progression after an injury: 1. P.R.I.C.E., with an emphasis on proper active rest; 2. early mobilization; 3. rehabilitation; 4. gradual return to sport. And in general, stay healthy. That’s about all you can do to “optimize” healing.
However, for full recovery, steps 2, 3, and 4 are especially important. But so are many other factors you may not think of. You may have to overcompensate for some remaining weakness or loss of coordination. Psychologically, you have to reduce stress and anxiety, and come to terms with your injury. Learn from it. Build back your confidence (best achieved through proper rehab). And if pain persists, treat it appropriately.
Then you will feel and function as you did before.
Then, you can live how you want to again.
It’s not easy, but it’s worth the effort.
Hope this distinction helps people get in the right frame of mind, and focus on what’s important, to conquer any disease, injury or illness!