I had a lovely few days hiking up in the Peak District over New Year but at the end of a long day, I felt a twinge in my lower calf and it suddenly hurt quite a bit to walk on it (and I still had to walk 2 miles up hill to get back to the cottage we were staying at). It's always annoying to pick up injuries, especially doing something as innocuous as walking, but it has given me a chance to practice what I preach in terms of treating minor soft tissue injuries!
What should you do if you find yourself with a similar injury? A muscle strain is a tearing of the muscle fibres, typically caused by overloading or overusing the muscle. Strains can classed according to their severity, with symptoms and healing times increasing the more severe they are. Symptoms can include a sharp stabbing pain at the point of injury and there may be pain when you try to contract the affected muscle. You may be able to palpate a lump in the muscle where the torn fibres have recoiled and bunched up. You may have localised pain and swelling, bruising may appear and there may be loss of strength to the tissue and a limited range of motion.
The guide below is a great summary of the best way of treating a soft tissue injury such as a sprain or strain in the first 72 hours and why each action is important. If you would like a copy emailing to you, just let me know. The important thing to know is that the sooner you treat soft tissue injuries, the better the healing response.
Massage therapists don't treat soft tissue injuries with massage in the first 72 hours (the acute phase). This is because the damage is only just starting to heal and applying pressure via massage techniques to the affected area could cause further and more extensive damage (imagine getting a wound to your skin - in the first few days, the scab is delicate and if disrupted, the wound starts to bleed again). However, massage can be used on surrounding tissues to help to improve the blood flow and to promote the removal of excess inflammatory exudate to reduce swelling.
As the soft tissue repair progresses into the sub-acute phase (3-21 days post injury) and the signs of inflammation have gone down (reduced redness, heat, swelling, pain and dysfunction), the therapist can start to work into the area. The new tissue is fragile and easily damaged so gentle massage over the injury site can be applied initially, with deeper massage and light frictions possible from around 7 days after injury. Swelling can be reduced by using lymphatic drainage massage to aid the removal of accumulated fluid and damaged cells from the area.
At this stage of the healing process, collagen fibres are being laid down in a random configuration . Gentle frictions help to encourage the remodelling and optimal alignment of the collagen fibres, avoiding abnormal crosslinks that may restrict normal movement. Muscle/joint mobilisation can be used to improve the range of motion in the joint and load tissues functionally to encourage healing of fibres in the direction of stress. Soft tissue therapy on other areas of the body could be beneficial at this time to ease imbalance, for example, in the case of an ankle sprain, the client could be putting more weight through the uninjured leg (limping) and those muscles could be painful due to overcompensation.
Moving into the chronic phase of healing (3 weeks onwards), the aim of soft tissue therapy treatments is to restore muscle strength, function and proprioception. The new tissue is maturing and has enough strength to withstand deeper massage. More vigorous frictions can be applied to break down excessive scar tissue and a combination of massage techniques will ensure good circulation, assist with healing and promote venous and lymph return. They also ensure the collagen fibres in the scar tissue realign in an optimal orientation and the scar has good tensile strength. If not appropriately treated, scar tissue can cause weaknesses in the tissue and are a major cause of reinjury, even many years later. Mobility work will gradually increase the load on the tissue to return it to full function.
Postural and functional assessments can be performed to identify root causes of injury or potential risk factors and training advice and preventative treatment may help to prevent additional injuries from occurring.
So, with my calf strain on day 19 of injury, I have had a 3 treatments on the injury itself and the surrounding lower leg muscles and I've been able to continue to train on it without any issue. Further treatments will ensure that it doesn't become a problem as I increase the intensity and frequency of my training.
If you have picked up a niggle or a more serious sprain or strain, why not book in to see me and ensure you give it every chance of healing properly? Contact me on 07527154675 or firstname.lastname@example.org to book.
References: Acute Soft Tissue Injury Management Update (Sport EXSport medicine 2013, 58 (October) 16-20); Remedial Massage Therapy, Mel Cash; Evidence Based Massage: Part 1, Nick Dinsdale (SportEX dynamics 2009; 22 (Oct) 12-17).