INJURY MANAGEMENT
Many of us don’t know what to do when we hurt ourselves, whether it is a new injury or an old one we’ve done time and again, like rolling your ankle. The most critical time in the treatment of an acute soft tissue injury is the first 24-48 hours immediately following the injury.
During the acute phase of the injury, inflammation is the body’s primary response. The cardinal signs of inflammation are Redness, Heat, Swelling and Pain. A bruise, ligament sprain, or muscle strain results in damage to the local blood vessels in the area. Consequently, blood accumulates around the damaged tissue, resulting in swelling and compression of adjoining tissues, which leads to further damage because oxygen is unable to reach the tissues, so cells die. The dead cells release a chemical which dilates thousands of tiny intact blood vessels in the area. This causes the redness and heat within a few hours of your injury. Pain is caused by the chemicals released by the dead cells, which act on the nerve endings of pain fibers. It is also caused by an increase in fluid in the area which puts pressure on the nerve endings. Swelling usually takes a few hours to develop unless there has been extensive bleeding in the area. It is caused by the dead cells (again!) changing the permeability of the blood vessels, which means that the fluid in the vessels is allowed to be sucked out, into the damaged area. Swelling can continue for up to five days as a result of the chemicals acting on the blood vessels.
Your body cannot start the healing phase until the inflammation has resolved. Although it sounds like a negative aspect of healing, inflammation is also an essential stage the body must go though to move onto the next stage of healing. If it is disrupted by an external influence such as Non-steroidal anti-inflammatory drugs (NSAIDS) or Advil, Ibuprofen it can actually slow the body’s healing down. The body recruits different substances, prostaglandins, to the injured area to help with the repair and clean up. NSAIDS can inhibit the enzymes from converting prostaglandins, which mediate the inflammatory response.
The management of your injury during the acute phase can have a huge impact in the speed of your recovery. So what do you do about this Red, Hot, Swollen, Painful body part of yours? MICE! Gentle movement will improve the circulation in the area through lymphatic and venous drainage. This should be done in a pain free range of motion, on an hourly basis. But only after 24-48 hours! Depending on the severity of the injury, complete rest may be required, with the use of crutches for the lower limb or a sling for the upper limb.
Ice will cause vasoconstriction and decrease the bleeding into the area. If you are not careful with ice you can give yourself an ice burn. It should be applied over a damp cloth to protect the skin, for a maximum of 20 minutes every hour. Frozen peas or crushed ice are the most effective, but the gel packs are more convenient.
Compression will raise the pressure in the tissues, preventing all the fluid from leaking out of the blood vessels into the injured area. A tensor bandage over your ice pack is very effective for this and should be applied after icing as well. Ensure that the bandage is not too tight and that you don’t have blue body parts or tingling or numbness.
Elevation will increase the drainage through lymph vessels and decrease the pressure in the injured area. You must elevate the injured limb above your heart.
There are a number of things you should avoid in the initial stage of injury in order to optimize the conditions for tissue healing:
Heat, heat rub, hot tub, alcohol, moderate/intense exercise and vigorous massage. All of these increase blood flow, resulting in excessive bleeding into the injured region, prolonging the swelling.
After an injury, the healed tissue is never the same as it was before. Ligaments and joint capsules heal, but do not have the same structure as the original tissue. Muscle does not heal with the muscle fibers, but is replaced with scar tissue. This leaves the injured area with less flexibility and strength than previously, also predisposing it to recurrent injuries. The scar tissue gradually shortens when it is fully formed, this process can occur from 3 weeks to 6 months. The tissue must be stretched to it’s maximum length for up to one year following an injury, to achieve pre-injury range of movement.
Physiotherapists treat this with joint mobilizations, active and passive range of movements, stretching, acupuncture and ultrasound. Scar tissue is weak unless there is stress/load put through the fibers as the tissue is laid down. Active Release Techniques at the early stages of healing minimize the scar tissue formation and break up existing scar tissue. Tissue strength can be increased by active movements, specific strengthening exercises, range of motion exercises, and ultrasound can minimize excessive scar tissue being laid down. There are many other aspects of the recovery that need to be addressed to prevent recurrent injuries, and achieve full movement and strength recovery. If you have any questions about injury management or need help speeding up your recovery, please consult one of your local physiotherapists.