A ‘flare up’ of injury symptoms, especially whilst you are currently seeing a physiotherapist is very frustrating. As physiotherapists, we are naturally empathetic people and share that frustration with the people under our care.

For certain conditions, especially in persistent pain and injuries that have longer recovery times, flare ups are very common and often expected as part of the recovery journey.

For example, somebody with medium to long term Achilles tendon pain trying to return to any level of running will most likely experience at least 3 flare ups in their recovery journey. This can often be a good thing.

Fortunately, we can use the crucial information learnt from a particular ‘flare up’ to help track towards the end outcome of performing well without pain. We can learn about the following:

• The amount of training load (distance, intensity, weight, frequency) which caused the flare up

• Recent levels of sleep, stress, energy & nutritional status preceding a flare up if the training load hadn’t significantly changed

• Whether there was enough or too much rest in between training sessions

• We can use the above information to set up an individualized ‘flare up’ management plan

Often the cause of a flare up is a combination of factors mentioned above. It is up to a skilled physiotherapist to gather important information from the injured person, tweak the relevant aspects of the management plan to ensure a smooth return to pre-flare up levels and beyond.

In a nut shell we are trying to increase the capacity in the person to withstand the loads needed for their desired activity or sport. If we under load them we may completely avoid a flare up during physio rehabilitation but are unlikely to build enough capacity to prevent future injury or achieve higher levels of performance.

Like Goldilocks and the three bears, we can accept a few ‘flare ups’ before we get the load ‘just right’.