The first aim of treatment in healing a muscle strain is to reduce pain, swelling, bleeding and secondary tissue damage by utilising PRICE (protection, rest, ice, compression and elevation). Encouraging circulation, after the acute stage, through gentle massage lymphatic drainage can help recovery. There are three stages to healing a muscle strain: inflammatory, proliferative and remodelling.
Inflammatory: this is the body’s reaction to the injury and preparation for the repair phases.
The inflammation stage is when the immune system increases circulation to the injury site, with the aim of producing edema (swelling). Pain will be felt at the site, which indicates that the immune response to injury is working as it should. In response to inflammation the body produces chemicals which eliminate dead muscle fibres and begin repairing the fibres. Inflammation also causes heat and redness to occur in the area because of the dilation of small blood vessels. Once the blood in the area clots the macrophages can start to remove dead tissue and digest any cell and bacteria particles. This ‘cleans’ the area ready for the next stage and blood vessels can begin to re-grow in the area and restore oxygen flow. Massage can help to speed up this process by flushing out the toxins and dead cells from the area, increasing circulation to bring oxygen and fresh nutrients to the area.
Proliferative: this is the stage when cells produce the materials to repair the injury. Fibroblasts begin to multiply and produce small fibres of collagen which is laid down, increasing the strength of the fibres. When a tear of the connective tissue in a muscle occurs it is fibroblasts which lay down collagen. The collagen fibres which make up the scar tissue mature and become aligned along lines of external stress and are able to withstand more force. This is how the area becomes functional again. In significant tears the adhesion could form in connective tissue layers. Adhesions in the fascia result because of abnormal cross-links forming in the collagen. The formation of scar tissue is where a matrix is formed in the damaged area. This is the result of bleeding which forms a scaffold to join the two sides of the scar together. In a typical injury the muscle will become shortened and can lose extensibility. Satellite cells help myoblasts develop into muscle fibre and regeneration is generally achieved within 3 weeks. At this stage massage will help align fibres correctly and keep scar tissue formation to a minimum.
Remodelling: this is where the body tries to restructure the injury site back to the pre-injury state. It consists of the new replacement tissue settling down to its ultimate structure. With maturation of the scar the site becomes shortened. This can be prevented by use of the muscle, thus maintaining the length of the fibres which are needed for normal function. Once the fibres are being used normally the scar will steadily mature until it resembles the tissue that was present before it became injured. Massage continues to play an important role in this phase, enabling the body to adapt in a functional way.