Musculoskeletal Injury is a broad term for any injury to the soft tissues, joints or bones. It encompasses everything from sprain and strain injuries to dislocations and whiplash. Regardless of the diagnosis, the end treatment goal is to promote tissue healing/scarring/regeneration, regain full pain free range of motion to any affected joints and full strength and mobility to all affected tissues. Such injuries can be assessed, diagnosed and treated with Athletic Therapy, Physiotherapy, Osteopathy or Massage Therapy. If you are uncertain which would be best for you, please call or email with your questions. We are happy to point you in the right direction.
Inflammation is the body’s immediate way of telling us that there’s tissue damage and that your immune system is already hard at work making repairs. Depending on the severity, you may see and feel edema/swelling/bruising around the injury and typically an associated pain response. Pain is meant to stop you from continuing with any activities that could cause further injury. For active people and athletes, it’s important to learn the difference between “feeling the burn” and pushing through pain that is causing tissue damage. Never take pain medications before a workout/sport/activity as this increases the likelihood of aggravating an existing injury and/or the occurrence of new injuries.
The Pain Threshold: your nervous system is an all or nothing threshold system. You can have tissue damage and inflammation that you don't notice until you go above your pain threshold line. Have you ever experienced pain after doing something pretty insignificant, like "all I did was bend over to pick up that thing and my back went out" or "I just stepped funny and now I can hardly walk." You were probably hovering just below your threshold and whatever you did was enough to push you over and now you're in pain. On the other end of recovery, people will sometimes return to activity too soon because they're below the threshold zone and think they're fine. The tissue may not be completely healed yet, it's just healed enough that it's not triggering your pain sensors. Return to activity needs to be slow and gradual to prevent re-injury.
When skin, muscles, ligaments or tendons are injured/torn, your body will regenerate new connective tissue made up of collagen fibres. This is commonly called scar tissue. There are 3 phases to healing connective tissue:
Acute Phase: starts immediately after injury and lasts about 3-4 days. Symptoms include edema (swelling), redness, heat, pain and often loss of function depending on severity, may be accompanied by spasm and muscle guarding/tension. Possible bruising black, red, purple or blue.
RICE (Rest, Ice, Compress, Elevate) has been the long standing immediate treatment protocol for acute injuries. New research is suggesting that ice and use of anti-inflammatories during this phase may actually impede the body’s natural healing process. Unfortunately all the research articles we searched through had inconclusive results on this topic. https://www.ncbi.nlm.nih.gov/pubmed/22744434
Early Subacute Phase: starts within about 3-4 days and can continue for as long as 3-6 weeks after the injury. The symptoms of inflammation begin to reduce. Tissue damage is gradually being restored; skin and muscle heal faster (5-8 days) than tendons and ligaments (3-5 weeks). Symptoms include mild edema/swelling, warmth around the area, less painful, less muscle spasming. Bruising will likely still appear the same as in the acute phase. Pain with range of motion but to a lesser degree and reduced muscle guarding/tension.
During this phase your body is laying down new collagen, which is very fragile and susceptible to reinjury when overstretched.
Late Subacute Phase: Begins about 2-3 weeks into the subacute phase. Pain is significantly reduced but possible limited range of motion due to adhesions and weakness. Bruising may change to yellow, brown or green then disappears. Area is still tender to the touch.
Wound contraction and scar remodeling happen in this phase. Myofibroblast cells contract to pull the tissue cells tighter together, while reshaping and remodelling of the collagen fibres strengthens the area. Massage Therapy can be very effective in preventing the formation of adhesions during this phase, which contribute to chronic pain and reduced range of motion.
Chronic Phase: occurs about 6-10 weeks after the injury and can last for years. In extreme cases people can experience a permanent change to the injured area that never fully heals. The inflammation process has finished and there is likely no residual swelling/edema. There is typically pain that can be constant or intermittent, restricted range of motion and guarding/muscle tension due to adhesions. The quality of this tissue can still be positively affected with massage therapy techniques, stretching, mobility, strengthening exercises, etc. Full recovery is still possible.
Full Recovery: Complete return to activities with no pain and full range of motion. The new tissue/scar tissue that was laid down at the injury site will never be as strong as the original tissue (skin, muscle, tendon, ligament). In fact, it will only be about 70-80% as strong, therefore the area may always be prone to re-injury. Re-injury can be prevented by continuing with the same exercises your physiotherapist, athletic therapist, osteopath or RMT would likely have had you doing during recovery. We call this “maintenance.” If returning to the same sport or activity that the injury was related to, a “tune up” treatment every 1-3 months for the first year is ideal.
Factors that Affect the Healing Process
Vit A: supports fibroblasts and increases collagen synthesis
Vit E: promotes tissue healing and prevents scarring
Zinc: required for many enzyme reactions and for production of cells
Protein and Calorie Intake: promote the cellular process
Conclusion: the best chance you have at making a full recovery from any injury is to have it properly assessed right away. For acute sport injuries such as sprain, strain, contusion or concussion we highly recommend a consult with an athIetic therapist. It is also important to determine if there were factors such as muscle imbalance, faulty firing patterns, overuse, postural dysfunction that may have contributed to the cause of the injury in the first place.
This blog is collaborative collection of information provided by several of our therapists. We hope you find some useful information and tips.