Treating Soft Tissue Injuries

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In the space of 2 days, I’ve had 2 clients turn up to their scheduled PT sessions with back pain, both of which occurred 2-3 days prior.

Upon closer examination, it was revealed that on both occasions, the client’s injured themselves doing nothing in particular around the home.

One was simply sitting down on the toilet and the other simply slept poorly.  The scary thing was that neither of them knew how to correctly treat their injuries and as a result, they’d not done anything about their condition since it occurred and their injuries have in fact gotten worse.

So I’ve decided to write this article to educate you guys on how to look after yourself in these times.

What is a soft tissue injury?

Usually referred to as a sprain or a strain, soft tissue injuries can occur to muscles, tendons and ligaments.  Ligaments are the connective tissue that joins bone to bone and tendons are the fibrous tissue that connects muscles to bone.

You will know when you’ve suffered a soft tissue injury.  There will most probably be a sharp pain in the area, followed by swelling and maybe even bruising.  If the pain is severe, then chances are you’ve also suffered a fractured bone and this can only be diagnosed with an x-ray.

What to Do

Most sports people are familiar with the acronym “RICE” as the method of treating soft tissue injuries. I’ve altered it slightly to “RIACE”.

FROM IMMEDIATE POST INJURY TO 72 HOURS

REST: Whatever you were doing immediately prior to suffering the injury must be stopped.  The reason is this.  When you injured yourself, you most likely tore some tissue.  The body’s response to this tear is twofold: firstly it floods the damaged area with fluid containing blood, serum proteins, clotting factors and platelets.

These are designed to start the healing process.  Secondly, that sharp pain that you felt when you suffered the injury sent a message to the brain.  The brain’s response to this message is to protect the damaged area by sending a signal to the surrounding musculature to shorten in length.

By stopping immediately whatever you were doing, you minimize the chances of worsening the injury.

ICE: The injured area needs to have ice or some form of cold pack applied to it immediately.  This closes off the blood capillaries and minimizes the swelling to the damaged area.  Crushed ice cubes wrapped in a damp tea towel, an ice pack or a bag of frozen peas is also a good alternative.

By minimizing the swelling you dramatically reduce your recovery time and I’ll explain why in a moment.  Ice should never be placed against the bare skin and take it from me, don’t ever fall asleep with an ice pack left on.

Which brings me to the next point, ice should be applied in 20 minute intervals.  20 minutes on, 20 minutes off, repeating this process 3-5 times a day FOR THE FIRST 48-72 hours.

ANTI-INFLAMMATORIES: Depending on the seriousness of the injury, (usually governed by the level of excruciating pain) anti-inflammatories can be taken either orally (tablets) or externally (Gel) for the temporary relief of pain.

The good thing here is that you don’t need a doctor’s prescription to purchase these over the counter at any pharmacy.  Personally, I prefer the tablets during the first 48-72 hours over the gel because the gel needs to be massaged into the pain area and the massaging can create heat through skin friction and heat can induce further swelling.

COMPRESSION:  In between icing episodes the damaged area needs to have a compression bandage wrapped around it, again to reduce the swelling and to immobilize the affected joint.  Again, keep this aspect going for at least 48-72 hours for maximal affect.

ELEVATION: In between icing episodes, try and keep the injured area elevated above the trunk to assist with draining the area of any fluid.  Where practicable, do this for the first 24-72 hours.

All of these treatment strategies are designed to minimize the swelling to the localized area and increase the recovery time.  They should be rigorously adhered to for at least 24-72 hours.

FROM 72 HOURS TO ONE WEEK

Post 72 hours, it’s time to start mobilizing the damaged area again.  To fully understand why this phase of the treatment plan is so important, you need to fully understand what’s going on within the damaged area. When you injured yourself, blood and lymph vessels suffered severe trauma.  The immediate area suffers vasoconstriction, followed by vasodilatation.

Ever noticed when you cut yourself with a knife, it goes real pale first and then bleeds profusely.  This is vasoconstriction and vasodilatation occurring.  Platelets and serum proteins contained within the blood stimulate clotting and bind to the damaged fibres that were exposed when injured and create a temporary plug.

Because the lymph vessel was damaged also, any extra cellular fluid can’t be removed, hence the reason why reducing the swelling to this area is so important in the initial stages of the injury occurring.  Over the next 24-72 hours, the body starts to remove the damaged debris from the area and new tissue is starting to form to knit the damaged fibres back together.

Once the area becomes stable, (around the 72 hour mark) the temporary plug is broken down enabling the lymph vessel to become operational again, enabling the body’s own swelling reduction mechanism to be turned back on.

Once the damaged fibres have been knitted back together, the surrounding musculature that was shortened by the brain in a self protection feedback loop, needs to be re-educated back to their normal length and here’s where you start to introduce heat and gentle mobilization.

ISOLATE AND THEN INTEGRATE

HEAT: Using a wheat pack heated in the microwave oven, gently place it on the injured area for around 3-5 minutes.  The heat will promote fluid to the damaged area and warm it up.

MOBILIZATION: The area that suffered the injury now needs to be gently mobilized. Utilizing an appropriate flexibility program, slowly introduce stretches or movements to the area to lengthen the shortened muscle fibres back to their original length.  This gentle mobilization also slowly unlocks the self protection mechanism that the brain activated way back when the original injury occurred.

Remember those surrounding muscles that were told to shorten when the injury happened?  Well they need to be stretched back to their normal length as well.  If this doesn’t occur, the damaged tissue will heal but the range of movement that you enjoyed pre-injury won’t return until such time as the area is stretched back to normal.

ICE: At the conclusion of the mobilization session, you can re-apply ice, compression and or elevation to the area again as a precautionary move.

INTEGRATE: The final stage of the treatment plan is to slowly reintroduce pre-injury movements into your normal training regime, with the objective to get you back to your pre-injury levels of fitness and mobility.

Summary:

This injury treatment plan is designed for you to take responsibility for your injury and to self treat yourself back to better health.  It doesn’t preclude you from seeking medical advice when such things occur. Your GP can prescribe other medications to assist in pain relief.

A good physiotherapist can also treat your injury on top of what you do to assist in the recovery period.

A good personal trainer can also assist you into getting back to full range of movement by modifying your existing training program to accommodate your current restrictions.

The reality is you can choose to do nothing about it, or you can take control and do something.

(please consult your Dr before following any advice I offer)