Our body has lots of soft tissues like skin, muscles, tendons, nerves, blood vessels, fascia, synovial membrane etc. They connect, support and surround different parts of the body. Injuries to soft tissues can result from a direct trauma, as in a fall/sports injury (i.e. macro trauma) or from repetitive strain from day to day routine. Sprain is injury to the ligament which connects a bone to another bone and strain is injury to the tendons connecting muscle to the bone. It is good to know what happens after a soft tissue injury, the signs and symptoms and what can be done to manage the symptoms and to ensure maximum recovery.
The process of healing after a soft tissue injury is divided into three stages:
- Inflammatory phase ( 1-7 days)
Inflammatory phase presents with pain, swelling, warmth, redness, muscle spasm and reduced range of motion. This is the first phase right after an injury. These signs and symptoms happens as a result of body’s natural protective mechanism to guard the injured area from moving by creating muscle spasm and swelling, to kill any bacteria that has entered into the body through the open wound if any, to clean any tissue debris and to start the healing process by pooling more blood in to the affected area. During this phase patient will notice a lot of limitation due to the constant pain and swelling and will feel like it is constantly annoying and limiting many activities of daily living.
This acute phase of healing will not be present in overuse injuries or derangement syndromes.
It is extremely important to make sure that the acute inflammatory phase stays under control as it can spread to other areas, kill healthy tissue and also compromise the strength and mobility there by resulting in some serious secondary complications.
The following are the things that you can do to help manage the signs and symptoms of acute inflammatory phase.
Rest – Rest enough to avoid unnecessary stress placed on the affected tissues. Avoid any heavy or prolonged activities. It is essential to understand that complete rest is not recommended unless and until advised by a healthcare professional which could be the case in some special cases. Do not use a brace to immobilise the injured area unless recommended by your healthcare provider. Movement is the key to recovery!!!
Ice/heat – Do short duration frequent icing lasting for 10 -15 mins every couple of hours for the first 48-72 hours, you can use a gel pack from the freezer or frozen veggie bag wrapped with a paper towel, after 72 hours when the symptoms starts to subside you can start using heat.
Medicine – Anti-inflammatory drugs prescribed by the family doctor is also something that will help in managing the situation.
Exercises – You can start with passive range of motion (ROM) or active assisted range of motion exercises, within pain free range to maintain the range of motion and strength of the affected joints and muscles based on a doctors or physiotherapist recommendation. This will help to recover quicker in most cases and also prevent any secondary complication resulting from immobilisation and muscle disuse.
- Proliferative phase /repair phase (6 days to 2-3 weeks).
This phase follows the acute inflammatory phase. This is the time when your body is laying new tissues (collagen) to replace the injured tissues resulting in scar formation. Patient will start to feel better as the constant pain, swelling, redness and all the acute symptoms subsides. Patient continues to experience pain with movement and palpation/pressure of the affected area. Activities of daily living get easier even though there will be limitation with challenging activities like heavy household chores, workout routine and sports activities.
Medicine – Some studies have shown that using the anti-inflammatory drugs or NSAIDs beyond the acute inflammatory phase will actually slow down the process of healing. During the proliferative phase Anti-inflammatory medication or pain killers must be taken only after discussing with your family doctor.
Heat – The use of heat to the affected areas for 15 minutes twice a day is recommended as it will help to promote more blood circulation to the injured tissue which will help in facilitating the healing process. Application of heat will also help in pain management when needed.
Exercises – Active range of motion exercises, resisted isometric exercises and some stretching exercises can be started in this phase. The new scar tissues should be stretched carefully as it is being formed, otherwise it tends to shorten. The active ROM exercises through full range itself will put some stretch to the affected tissues. The collagen that makes the scar tissue is very weak and can be easily torn, so the stretches and strengthening exercises should be done according to the tolerance of the affected tissues and possibly under the guidance of your healthcare provider. Your physiotherapist is the best person to plan a good exercise routine for you at this phase.
- Remodelling phase (2 weeks to 6 months or may be up to two years)
This is the last phase in the healing process of the soft tissue injury. The proper moulding and alignment of the newly laid tissues (collagen) at the injured site happens in this phase.The collagen that is laid during the proliferative phase is not organised and the scar is thick. The proper stretch and alignment of scar tissue happens with appropriate stretching and strengthening exercises. By the time of remodelling phase most people will feel 80% better with no problem during activities of daily living. People often forget to exercise, strengthen and stretch the tissues at this phase as they feel mostly good, but until the proper stretching and alignment of the scar tissue happens with consistent challenging exercise routine, it is easy to reinjure the new tissue and result in recurrent injury of the same area/tissues.
Compared to the three phases of healing, the remodelling phase is when exercising is most important. Regular stretches and challenging strengthening exercises will ensure that you obtain maximum recovery to the preinjury status.
So remember to continue with your rehabilitation sessions well in to the remodelling phase of recovery and continue with your home exercise program as per the physiotherapist even after discharge to prevent re-injury/recurrence and to ensure maximum recovery.