Basic Injury recovery - Part 2, the repair stage
This article follows on from 'Basic Injury recovery - first steps' and as ever, the most important advice for any injury is that you should first seek professional advice to assess the extent of the injury. This is vital as the grade or extent of the injury will directly affect both the short and long term protocol for your injury recovery.
The sub-acute or repair stage of a recovery process is generally thought of as being between 3 to 21 days after the initial injury and begins once the immediate issues have settled down. During this period, the swelling will begin to ease as the damaged tissues settle down, although there may well still be some residual pain in the area. The aim of this period is to continue the healing process and begin to bring the repaired tissues back to their original strength and flexibility.
Encouraging blood flow (and the corresponding nutrition) into the damaged area and lymphatic drainage away from it is vital for continuing the healing process. This can be achieved in two ways. Firstly, expert and mild massage around the area of the injury will have these effects as well as an additional benefit of keeping the other muscles in the area working, at a time when the injury means that they are not likely doing the same activities as previously.
Secondly, contrast bathing will also help in the same way in that it promotes “flushing through” of the injury. This can be done over a period of six days or so once the injury is in the sub-acute stage.** For the first two days, heat is applied to the area for one minute and cold for three minutes, repeated three times and done in three sessions through the day. For the following two days, apply two alternate minutes of hot and cold to the area on a similar basis. For the final two days, change to three minutes of heat and one minute of cold which will further improve flexibility in the area. Timings are dependent on the area on the body, so for example you should ice a finger for less time than you would a forearm to prevent over chilling and damaging the area – if in doubt seek professional advice.
For contrast bathing, methods of application will obviously differ dependent on the location of an injury. For the extremities of a limb, hot and cold buckets of water may be used – in each instance the water should be of a temperature to colour the skin slightly but not cause pain. Other areas of the body can be served by using specialist cold and hot packs, although these can be expensive to buy. Also effective for cold are packets of frozen vegetables, a cloth filled with ice cubes or a polystyrene cup of water left in the freezer. For heat, a hot water bottle provides the best household alternative to specialist products.
From a physiological point of view, at this stage the damaged area of tissue has been effectively sealed off by a sticky matrix of fibrin which is laid down in a haphazard fashion forming a scar tissue. Whilst this repairs the damage, it is not as strong or effective as the original tissues it replaces, and in fact is often the primary cause of re-injury in the future. The aim therefore is to breakdown the scar tissue and re-organise these cells into the correct lines corresponding to the other tissues around them.
Once again, gentle massage is excellent to start encouraging the fibres into the correct alignment. Whilst not stressing the injury at this stage is appropriate, total rest is also unhelpful. Very gentle movement and muscle activation is excellent both for encouraging fibre alignment and also setting up a return of strength and flexibility. This mobilisation should be done in a low key way with only gentle movements that do not stress the injury, and initially, without involving any weight bearing or load on the muscles. For example, for a leg injury, do gentle leg extensions or flexes whilst sitting or lying on a bed, do NOT immediately start doing single leg squats as this is likely to cause further damage.
As ever with any injury recovery process, pain is the main indicator. Many of the processes of recovery are likely to cause mild discomfort, but at this stage of the process, pain is bad and so should be a sign to ease off on the exercises or activities.
So to recap, for the sub-acute stage of injury recovery the aim should be to flush through the area of the injury as much as possible, as well as begin gentle mobilisation and movement to make the new tissues as strong and flexible as those which they have replaced.
In a third article we will look at the final rehabilitation stage of injury recovery, addressing issues such as continued strengthening, flexibilty and range of motion, and improvement of proprioception skills to prevent a recurrence of the problem.
** NB Do not apply any heat to the injury (as used in contrast bathing) until the acute stage of the injury has passed as otherwise this may increase the swelling.
Jeremy Waite works as a Sports Massage Therapist in Berkshire covering areas such as Streatley, Goring, Pangbourne, Wallingford and Reading.
Providing sports and remedial massage as well as training and rehabilitation advice throughout Berkshire and Oxfordshire and especially to clients in Streatley, Goring, Pangbourne, Wallingford and Reading.