As mentioned in a post earlier this month (Processes involved in healing a muscle strain) what treatment aims to do initially in a muscle strain is to reduce pain, swelling, bleeding and secondary tissue damage by utilising PRICE (protection, rest, ice, compression and elevation).
At the acute stage treatment is, as mentioned, to follow the PRICE protocol. You should immediately stop the activity which caused or aggravated the injury. Protect the area, limit movement either with bandages or splints and keep it away from danger. From the perspective of a massage therapist you may think that there is little that can be done. But, regular (perhaps daily) lymphatic drainage massage is very helpful in keeping the good fluids moving into the area and the toxins flowing away – this will promote healing and a quicker recovery. Sessions may only need to last 10-15 minutes, maybe shorter, depending on the size and site of injury. It can also be a good idea to start gentle, passive movement in the midrange; this will encourage any scar tissue that is beginning to form to form in a functionally efficient way. At no point should there be any stretching of fibres which are damaged – this will only serve to compromise the delicate matrix of scar tissue which is in the early stages of forming.
A good therapist will be looking for any evidence of compensation patterns and will start to address these – don’t be surprised if treatment is on parts of you well away from where you are injured, this is perfectly normal! The application of ice immediately following injury slows blood flow to the area thereby limiting swelling. And don’t forget elevation – if you’ve sprained your ankle you need to get your foot above your heart. It’s no use just putting it on a chair because the aim is to use gravity to help the flow of fluids away from the injury.
The next stage of healing is the sub-acute stage, which can last anywhere from 3 to 21 days from the time of injury. This is the repair stage, with treatment varying according to how healing is progressing. We can now carry out controlled movement of the injured area both passively and actively – but still keeping to midrange movements to protect the delicate healing tissues. The aim is to encourage a mobile and functional scar. When I say scar, I don’t necessarily mean surface scar which is visible after a cut to the skin. Scar tissues can form within muscles, on the fascia that wrap muscles and in all soft tissues within the body. This is one reason we can have muscular imbalances yet be uncertain where they stem.
One thing that happens following injury is muscle guarding; this is when muscles are in a state of readiness – i.e. partially contracted, and therefore not relaxed. They do this around the site of an injury to protect that area. In some ways this is good, but if the muscles remain contracted (partially or otherwise) for prolonged periods of time then they can become fatigued and inefficient. They can become part of the problem, perhaps adding to developing compensation patterns or causing muscle imbalances which can lead to other injuries later on. The good news is that as therapists we know to look out for these issues and help to prevent them. This is all part of managing compensation patterns in the sub-acute stage of healing a strained muscle.
So in the acute stage you were applying ice to the area, well now you can now use hot and cold therapy to help aid the healing process – applying ice (not directly on the skin) and heat with a hot water bottle or heat pack. Cold constricts blood vessels, preventing further inflammation and heat encourages fresh blood to flow to the area bringing oxygen and promoting healing. Both should only be applied for short periods of time to avoid further damage to soft tissues. Alternating the heat and cold helps to reduce pain and speed up recovery.
Proprioception (the ability to tell where your body is in space) can be disturbed following injury, meaning you are more likely to have a recurring injury at the same site if you don’t do strengthening and balance exercises. The disturbance to your proprioception may not be noticeable to you but it is caused by the transmission of sensory information being disrupted when nerve endings and sensory receptors are damaged. This means the brain doesn’t receive the correct information about where your body is positioned and, for example, in the case of an ankle sprain, can mean that if you start to go over on it again your brain won’t get the right signals to prevent that from happening – the result being a re-injury.
The final stage of healing is called the remodelling stage because it is all about the tissues in the area maturing over a period of 3 weeks up to 2 years depending on the severity of injury. The tissues need to become fully functional through stretching and strengthening to ensure that the collagen fibres are aligning correctly. If they aren’t then massage therapy using a variety of techniques can manage and reduce adhesions and encourage appropriate scar tissue development. Stretching can now be within the full range of the joint providing the healing process if going well. Tissue pliability can be restored and any remaining compensation patterns eliminated. The aim is to make tissues functional in response to their natural movement patterns. Taping the area can help at this stage to encourage correct alignment and functional use, and to assist in development of good proprioception.