We go outside, we do crazy things enjoying the warm weather, we swim, cycle, climb trees and then - OOPS - we fall out of trees! We hurt ourselves and our body goes into the mode of mobilizing everything it can to prevent the injury from getting worse and to enable repair. Acute pain is the pain that makes you wince. In assessing pain, this is the type that is the warning bell. Not the aching muscle soreness of doing a gym workout and going "oh my its so hard to move up the stairs because I started a new gym program". It's the sharp, sudden pain usually associated with movement or impact that makes you pull all manner of funny faces and utter expletives.
When we are injured the one thing we all want to feel is 'less pain'. At a fundamental level though, pain is there to make you realise something is wrong. It's there to 'tell you something'. It serves a purpose and if that purpose is to STOP you from doing an action that is going to hurt you or make the injury worse then you need to listen to that. Of course sustained pain is boring. It's just something that we don't want to have to put up with day in and day out. This is where acute pain and chronic pain differ in nature and likewise, usually, the treatment protocols for both these types of pain are very different. In this post we are dealing with ACUTE pain.
Pain also involves inflammation and this seems to be the main point where a lot of views clash. Basically it comes down to whether you are 1) pro inflammation or 2) reduced inflammation.
Inflammation is the body's natural process of protecting an area for healing. Inflammation is often accompanied by heat, a natural way for the body to promote the metabolism of cells, provide the right environment for cellular exchange and keeping the area rich in blood supply. Inflammation often is accompanied by swelling. This is the body locking an area down so that you 'don't move it', a natural splint if you like. Swelling prevents a joint from being able to move freely thus it prevents movement from potentially causing more damage. Now if you are on the court and playing an Australian Open final then maybe you do want to reduce any inflammation you can to continue playing. However, be aware that the pay off for this action is that you are going to be stressing a compromised structure. This can and most likely will result in further damage.
Inflammation is also needed for healing. It shuts an area down and locates an injury in it's own 'sphere' where it can contain the bleeding, leaking, release of cytokines (cells that signal a call to action of other cells) and creates a 'closed environment' for healing. Excessive inflammation is definetly not to be left un addressed, but for the cellular interchange between Human Growth Hormone (IGF-1 that is needed for cellular repair), macrophages (the pac-man of the body that cleans up the area) and protein synthesis (formation of collagen to build tissue), inflammation is vital and a desired condition to make these initial responses to injury work.
So interrupting swelling and inflammation can sometimes be of more detriment than benefit. Yes you do want to be aware of excessive swelling and containing interruptions to other articulations and muscles, but you don't want to curtail the process completely. There is a natural function for swelling and inflammation that we need to allow to happen so that our body can heal. This is where excessive ice therapy and anti-inflammatory drugs can be of less benefit to you. Be wary of too much self administration to ward off pain. Pain is telling you something. Don't ignore it because it won't simply go away.
After this initial stage of healing (which depends on the severity of the injury) which usually can last a few days to a week, you want to start to introduce all the factors that contribute to assisting the body with the healing process. Welcome to Stage II of injury rehabilitation.
With this in mind, massage can be of great benefit for this area. Obviously you don't want to be pushing into areas where there's a delicate process of healing and inflammation going on as you may disrupt the cellular process but a massage therapist can assist with other gentle techniques that help and assist injury recovery. Light effleurage, fascial release and upward movement of the lymph fluid (which is important for getting rid of the debris from injury) is most helpful in assisting the process' of the body to deal with injury.
It can also be very important to encourage movement at this stage. This can be a role of the the therapist, manipulating the limbs and joints without the muscular contraction or with minimising the muscular involvement. Movement is good. We want to move and you need to move in active recovery to encourage the correct line of movement of a tissue. Opening up flexion/extension, incorporating lateral rotation and literally getting the joint space to move can be as much of a benefit here as you want to encourage a tissue to be as open as possible through its range of motion without fibrotic formation of fibres. WHEN to introduce this movement into an injury stage is the vital question as movement too early in the recovery when fibres are not fully attached or strong enough to warrant stress can impede the injury and set you back further in recovery. Which frustrates the injury and usually - the athlete. Be mindful of when you should start stressing injuries. This is where a good team of therapists is vital.
In later stages of regeneration, the all important scar tissue formation is what you want to influence. At this stage the Type III collagen fibres are beginning to be laid down. These are immature fibres that are meant to provide structural stability and all important tensile strength that helps to keep a muscle in tact under stress. At this stage, you ideally want the collagen fibres to be laid down in the direction of movement. If a muscle or tissue is required to move in a certain direction, then the tissue needs to be more concentrated in that line of direction and massage can help encourage this directional formation of fibres. Like fresh cotton, you can help to encourage the fibre to lie in a certain direction when they are softer. Like a linen shirt out of the dryer. It's easier to iron when it's fresh and warm, rather than having been in the sun all day. So light directional flow massage is most helpful at this stage.
Patience is key with injury recovery and recuperation and you have to listen to your body as it will let you know what it can and can't do. There is a lot to be said for 'feeling' your pain and letting it dictate to you what you can and can't do. reintroducing actions and movements will test your pain. It's a constant negotiation, pushing into the barrier just that little bit but being wary of listening to pain and letting it tell you WHEN TO STOP. Playing sports is the hardest. When yu are on the field you are not listening to your body so much as focusing on your team, the ball or the players. Your attention is not on your pain so be wary of getting into competition environments too early.
Your rehabilitation team is like your Director - and should be working with you to keep checking in and following progress. Staying in touch is vital and using the skills available is key. Don't go it alone. Do your work that is prescribed, check in and talk openly about what you are feeling and how you are progressing. This is the best way to listen to your pain and get back to 110% sooner.
