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MANAGING MUSCULOSKELETAL INJURIES

he word ‘musculoskeletal’ simply formation, joint and muscle or hiking poles. Partially immobilising means anything to do with the weakness. the injured area by using a sling, splint, muscles (musculo) and/or It’s important to remember that or brace may also be a means of T(skeletal), including and symptoms lasting longer than three months protection. forming joints and supporting your spine. become habitual and are much harder to Rest (to avoid pain and further So, a could vary from solve. The sooner you get on top of your damage): Rest from painful exercise a muscle tear or strain; to a sprained ankle symptoms the better your outcome. R or movement is essential in the early where the ligaments are overstretched or injury stage. We call this active rest. torn; to a meniscus or tear in the TREATMENT PHASES The saying ‘No pain, no gain’ does knee or a large contusion (muscle bruise) Acute - Protection Phase not apply in most cases. The rule of on your thigh. Early accurate assessment and thumb is - don’t do anything that prompt1 appropriate treatment is much reproduces your pain for the initial two WHEN SHOULD better than delay. What may appear to be or three days. After that, you need to YOU COMMENCE a simple muscle, or get it moving or other problems will TREATMENT? injury can include a hairline fracture, develop. In most cases, ‘the early bird catches bruising or dislocation. Regardless of what Ice (20 minutes every two to three the worm’. Researchers have found the injury is or where it is on your body hours): Ice is preferred for the initial that intervention with physical therapy the early management is the same – that I two or three days post-injury. Ice treatment for acute soft tissue injuries means the fi rst 24-48 hours. should also help to reduce your pain within a few days has many benefi ts. A is termed as acute and swelling in traumatic soft tissue from the initial time of injury and while the injuries, such as ligament , Prompt treatment benefi ts include: pain, bleeding and swelling is at its worst. muscle tears or bruising. ● Relieving your pain more quickly via joint Your body’s aim at this point is to protect Compression (to support the injury mobility techniques, soft tissue massage, your injury from further damage. The usual and minimise swelling): Yes. If it is electrotherapy time frame for your acute symptoms to C possible to apply a compressive ● Improving your tissue quality using settle is two to four days post-injury, but bandage or elastic support to the techniques to guide the direction it this can vary depending on how you treat injury, it will help to control swelling forms your injury. and bleeding in the fi rst few days. ● Getting you back to sport or work In the fi rst three days after injury, use In most cases, the bandage/support quicker through faster healing rates the P.R.I.C.E. method. If you are unsure will also help to support the injury ● Loosening and/or strengthening of on any of these stages ask for advice from as the new scar tissue is laid down. your injured region with individually your physical therapist This should help to reduce your pain. prescribed exercises and techniques Protect: Protection is meant to Some injuries will benefi t from more ● Improving your performance when you prevent further injury. For example, an support such as a brace or rigid do return to sport, work or simply daily P injured leg or foot may be protected strapping tape. life by limiting or avoiding weight-bearing ● Correcting any biomechanical faults through the use of crutches, a cane, that may be affecting your movement, technique or predisposing you to injury.

WHAT IF YOU DO NOTHING? Research shows that injuries left untreated do take longer to heal and can result in lingering pain. They are also more likely to recur and leave you with abnormal scar tissue

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TIME-SAVING RESOURCES FOR PHYSICAL AND MANUAL THERAPISTS Elevation (above your heart to assist Treatments in this phase may include: when throwing a ball. Your body works swelling reduction): Elevation of an ● Local modalities are used to assist as a chain, all joints and bones being E injury in the fi rst few days is very pain reduction and the natural healing connected through soft tissues; so any helpful. Think where your injury is response via an increase in energy stiffness or weakness in one area can and where your heart is. Gravity will (electrical, sound, light, magnetic, affect a different area predisposing it to encourage swelling to settle at the temperature) to the area. Some injury. lowest point. Try to rest your injury examples include, cryotherapy, heating, – Function or sports-specifi c rehabilitation. above your heart. Obviously some electrotherapy, ultrasound, laser, TENS. injuries are impossible or it would be These modalities have short-term Late Stage - Remodelling Phase detrimental to elevate, so please use benefi ts that can assist with the earlier Your body does not magically just your common sense and be guided by introduction of other longer-lasting 3stop tissue healing at six weeks post-injury. your pain. techniques such as exercise prescription. Healing is a continuum. At six weeks Your chances of a full recovery will ● Massage, acupuncture, dry needling post-soft tissue injury your healing tissue be helped if you avoid the H.A.R.M. ● Joint mobilisation - joint stiffness is is reasonably mature but as you stretch, factors in the fi rst 48 to 72 hours. a complication associated with both strengthen and your new scar tissue, joint and adjacent muscle, and it often fi nds that it is not strong enough to What are the HARM Factors? ligament injury. Your physical therapist cope with your increasing physical demand. Heat: Increases swelling and is highly skilled in regaining full joint When your body detects that a repaired H bleeding. Avoid heat packs, a hot motion via a range of skillful hands-on structure is still weaker than necessary, it bath and saunas. techniques. will automatically stimulate additional new Alcohol : Increases swelling and ● Protective strapping, bracing, tissue to help strengthen and support the bleeding. Plus, it can delay healing. supportive tape healing tissue until it meets the stresses of A Running or exercise: Aggravates the ● Exercise prescription has been shown your normal exercise or physical function. R injury which increases pain, swelling by researchers to be the most effective The period between six weeks and three and bleeding. Always check with a method to hasten recovery, reduce pain months post-injury is commonly referred health professional before resuming and improve your post-injury function. to as the remodelling phase. Not unlike a sport or exercise. These can start early in this phase and growing family putting demands on a small Massage: Stimulates circulation gradually the load and intensity will be one-up one-down house, a home requires which is a benefi t for healing and increased overtime and tissues heal and remodelling, expansion and alterations. So M relaxation, except in the acute phase strengthen. as you require more from the injured area so where you are wanting to reduce the – Specifi c stretching exercises your body does some remodelling! bleeding and swelling to the injured – Strengthening exercises: localised and area. Direct massage to the injured global. This means strengthening the Chronic Phase - Ongoing area may aggravate the damaged specifi c muscle that may have been Repair and Remodelling tissues and is normally best avoided injured with isolated exercises to that 4Beyond three months is referred to as the for the fi rst 48 to 72 hours. Indirect one muscle group. But slowly more chronic phase and refers mainly to pain massage (away from the injury site) functional exercises will be introduced that lasts more than 3 months. However, may be helpful. where the muscle or joint needs to your soft tissue is constantly being injured work in a co-ordinated manner with by your daily activities and workouts, only Sub-Acute – Repair Phase surrounding areas. Core stability (that to magically repair and remodel the tissue A soft tissue injury is termed as sub- being your pelvis and abdominal, to meet your specifi c exercise demands. 2acute when the initial acute phase makes lower back area) are also key areas to Balancing training, rehabilitation and a transition to repairing the injured tissues. strengthen in any back and lower limb matches, as well as adequate recovery This phase commonly lasts up to six weeks injury. Similarly an injury to the upper time, is key to ensure your body adapts in post-injury when your body is busy laying limb or neck requires strength of the a positive way to the stimulus without down new soft tissue and reducing the upper back and entire shoulder girdle, becoming overly fatigued and need to protect your injury as the new even your core, as no muscle or joint injured. scar tissue, muscle or ligament fi bres are works in isolation. Your treatment will vary beginning to mature and strengthen. – Proprioceptive and balance retraining depending upon the needs of The purpose of physical therapy in – correction: Biomechanics your injury. Your physical therapist the sub-acute injury phase is to assist is how your entire system (body) works is an expert in the diagnosis and nature to quickly reduce the infl ammation, together through a movement or treatment of soft tissue injuries and hasten the healing process and avoid action. For example how your foot the best techniques for your complications such as joint stiffness, position may affect your legs and specifi c injury and phase of healing. muscle tightness and weakness which may hips whilst running or how your trunk predispose you to re-injury. rotation affects your shoulder and arm

The information contained in this article is intended as general guidance and information only and should not be relied upon as a basis for planning individual medical care or as a substitute for specialist medical advice in each individual case. ©Co-Kinetic 2019

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TIME-SAVING RESOURCES FOR PHYSICAL AND MANUAL THERAPISTS