The Reality of Soft Tissue Injury and Repair
Without proper rehab, smaller traumas create limitations in mobility and stability that sets us up for a larger injury. It’s the continued cycle of repetitive injury and incomplete repair that create the chronic health issues that eventually sideline us. It’s not as simple as reducing swelling and eliminating pain, because that is only the beginning of the repair process.
Let’s face it; those of us who choose an active lifestyle are going to face multiple injuries in our lifetime. While many injuries may be minor, there can be a cumulative effect over time. Without proper rehab, smaller traumas create limitations in mobility and stability that sets us up for a larger injury. It’s the continued cycle of repetitive injury and incomplete repair that create the chronic health issues that eventually sideline us. It’s not as simple as reducing swelling and eliminating pain, because that is only the beginning of the repair process.
Soft tissues consist of muscles, tendons, ligaments, fascia, cartilage, blood vessels and nerves. These all work in harmony to allow our bodies to properly function and move. Muscles, tendons and ligaments are the soft tissues that are mainly involved in movement. Muscles are attached to bone by tendon and work in harmony to move the bones. Bones are connected by ligaments that form joints and allow articular surfaces to glide more smoothly. When we suffer an injury, sports or trauma related, we are setting in motion a three phase process of repair.
The first phase of soft tissue repair following injury is known as the Inflammatory Phase, which lasts for up to 72 hours. During this phase, blood cells rush in to provide nutrients and clean up the damage. Swelling and pain are characteristic during this period. You can assist the healing process by applying ice (not heat) and elevation of the injured area. Ice should be limited to no more than 30 minutes at a time and not placed directly on the skin. A Proteolytic Enzyme Formula (taken between meals and always on an empty stomach) can also be used to help support the initial phase of repair.
The second phase is called the Repair Phase, which may last for several months. Immune cells migrate to the area of injury to release growth factors and proteins that help direct the repair process. Collagen is synthesized to bridge the gaps and create a matrix for the repair process to begin. During this phase it is important to use caution with Nonsteroidal Anti-Inflammatory Drugs (NSAIDs: Advil, Motrin, Aleve, Motrin, Ibuprophen, etc.) and Corticosteroids that have been shown to damage articular cartilage and weaken collagen repair. A better approach would be to eat a healthy diet, increase supplementation and hydration to supply the proper nutrients required for repair. Early mobilization using chiropractic manipulation, muscle work and targeted progressive rehab have been shown to break up scar tissue and properly direct the orientation of collagen fibers. Full mobilization of the joint is the goal of therapy during this phase of repair.
The third phase of repair is called the Remodeling Phase and can last from 12 months post injury to years. During this phase the collagen fibers mature and strengthen to be able to withstand the stresses placed on the soft tissue. Specific stabilization exercises are vital during this phase to ensure the soft tissue fibers support the joint and properly anchor the muscle. If the area is not stabilized and the proper alignment of joint surfaces is not achieved, then the repaired tissue will become prone to future injury. It’s a common misconception that injured soft tissue will be as strong as it was prior to injury. In reality, scar tissue is not as strong and will always remain weaker than the undamaged tissue. Still there is much an athlete can do to obtain a favorable outcome in soft tissue repair with the help of a properly trained healthcare practitioner and some home therapy.
There are a number of techniques like Chiropractic Manipulation, Graston (Guasha), Active Release Technique (ART), Voodoo Flossing (Compression Shearing), Progressive Rehab, Rock Tape, and Myofacial Release that a practitioner may use to optimize the soft tissue repair process. Athletes can also utilize foam rolling, muscle work using therapy balls, mobilization using monster bands and stabilization exercises to support soft tissue repair outside of the office. In the end, the goal is to keep us all doing what we love by restoring proper function and mobility to our soft tissues.
Dr. Mark Lewis is a Chiropractic Physician at HealthSource Chiropractic and Progressive Wellness (www.HealthSourceManatee.com). He uses a functional movement exam to identify musculoskeletal problems, which he treats using a combination of chiropractic, progressive rehab, and muscle work to restore proper movement.