Ac­tive Re­cov­ery Af­ter An In­jury

The Star (St. Lucia) - - HEALTH - Stage 1:

We have all heard that af­ter suf­fer­ing an in­jury “rest is best for a speedy re­cov­ery”. But what does that mean? Many vis­i­tors to my clinic, hav­ing suf­fered an in­jury and rested up for weeks, com­plain that their pain just won’t go away. When I ask them what ex­actly they’ve been do­ing in those weeks, their an­swer usu­ally is: “Noth­ing. I was told to rest!” To be fair, rest is de­fined as “ces­sa­tion of work or move­ment in or­der to re­lax, sleep or re­cover strength”. In­jury rest, on the other hand, ac­tu­ally in­volves move­ment— but not the kind that in­creases pain or ag­gra­vates symp­toms. Rest is then fol­lowed by a grad­u­ated re­turn to ac­tiv­ity, com­monly known as re­ha­bil­i­ta­tion.

No mat­ter whether it is a sprained lig­a­ment, torn mus­cle or a bro­ken bone, the body goes through the same process, al­though re­cov­ery times may dif­fer. Fac­tors that af­fect the rate of re­cov­ery are sever­ity of in­jury, gen­eral health, age, cause of in­jury, lo­ca­tion and type of tis­sue. The greater the blood sup­ply, the faster the heal­ing time. Mus­cles will heal quicker than ten­dons, and ten­dons quicker than lig­a­ments.

In some cases, early ex­er­cise can be ben­e­fi­cial. For ex­am­ple, ten­dons do not have a rich blood sup­ply and the con­trac­tion and stretch can stim­u­late an in­creased blood flow and bet­ter heal­ing. Mus­cles, on the other hand, need scar tis­sue to re­pair, and early ac­tiv­ity may be detri­men­tal al­though some move­ment is needed to en­sure that new fi­bres are ar­ranged in the right di­rec­tion. Dis­or­gan­ised mus­cle fi­bres can re­sult in mus­cle weak­ness.

Acute In­flam­ma­tory phase that lasts be­tween 1-7 days. Al­though we know in­flam­ma­tion can be prob­lem­atic, it is an es­sen­tial part of the heal­ing process. Whether you have sprained your an­kle, torn a mus­cle or a bro­ken bone, this stage of heal­ing brings nu­tri­ents to start the heal­ing se­quence and it is also re­spon­si­ble for clear­ing the area of dead tis­sue and blood. Un­for­tu­nately, the in­creased pres­sure as­so­ci­ated with in­flam­ma­tion can cause pain and dis­com­fort; this is why ice can be very ef­fec­tive dur­ing this stage: it slows down the in­flam­ma­tion, re­duc­ing the pain and swelling. But re­mem­ber, it’s im­por­tant to not stop this process com­pletely as it leads us into the next stage

Sub Acute Cell Re­pair phase can be­gin from day four and last up to six

Stage 2:

weeks. Dur­ing this phase fi­bres (scar tis­sue) are laid down; the more se­vere the in­jury, the more scar tis­sue will be pro­duced. Pain usu­ally sub­sides and this is the time when lots of re-in­juries oc­cur, as peo­ple take the re­duc­tion of pain as a sign the in­jury has healed. Re­mem­ber, scar tis­sue is still form­ing and is dis­or­gan­ised, mak­ing it weaker than reg­u­lar tis­sue. So, al­though you are ad­vised to start mov­ing to help re­or­gan­ise the fi­bres, in­crease range and build strength, it should be a grad­ual process with a slow re­turn to full ac­tiv­ity.

Stage 3:

The Re­mod­elling phase be­gins by week three and can last from a few months to sev­eral years. It is a stage that is of­ten over­looked but it is dur­ing this pe­riod that the scar tis­sue is re­formed and takes on the same prop­er­ties and strength as nor­mal tis­sue.

An­other con­sid­er­a­tion for heal­ing and re­turn to func­tion is al­tered move­ment. As well as the nor­mal heal­ing re­ac­tion, our pri­mary sur­vival in­stinct is to avoid move­ments that are painful. Each of our 650 mus­cles has a role when we move, and any changes to our move­ment can al­ter our biome­chan­ics. Imag­ine a train run­ning slightly off track. It will move, but not smoothly, and dam­age will even­tu­ally show. The al­tered re­ac­tion of our mus­cles and changes in move­ment can cause tis­sue and joint ir­ri­ta­tion which can pro­long the in­flam­ma­tory re­sponse and slow down our heal­ing and fur­ther af­fect nor­mal move­ment; this can start a cy­cle of pain and re-in­jury. This is when phys­io­ther­apy can help. Phys­io­ther­a­pists can as­sist with pain re­lief and all stages of the heal­ing process; giv­ing ad­vice on stretch­ing and strength­en­ing ex­er­cises, get­ting back to ac­tiv­ity quicker and re­duc­ing the re­cur­rence of in­jury.

De­pend­ing on the type of in­jury, both rest and ex­er­cise are im­por­tant for re­cov­ery.

Kim Jack­son is a UK-trained phys­io­ther­a­pist with over 20 years’ ex­pe­ri­ence. She spe­cialises in mus­cu­loskele­tal pain and dys­func­tion in­clud­ing back pain and sci­at­ica, stroke and other neuro con­di­tions plus sports phys­io­ther­apy, hav­ing worked with lo­cal, re­gional and in­ter­na­tional ath­letes and teams treat­ing in­juries and analysing biome­chan­ics to im­prove func­tion and per­for­mance. She is regis­tered with the Al­lied Health Coun­cil and is a mem­ber of PASL. She cur­rently works at Bay­side Ther­apy Ser­vices in Rod­ney Bay, O: 458 4409 or C: 284 5443; www.bayside­ther­a­py­ser­vices.com

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