Archive for September, 2010

 

STAGES OF HEALING

I think I have talked about the stages of healing in past blogs so this might be a review.  Repetition is good.

The first stage is Inflammation. Yes inflammation is a necessary part of the healing process. Typically when there’s inflammation, you’ll feel pain in the injured area even at rest. It will be sore to touch (tender) and the soreness will get worse the more you rub it.  There may be swelling, redness, and warmth in the area.  As the inflammation reduces, your pain will typically get less. 

The second stage is Repair. The body is trying to clean up and mend the damaged tissues. This is when the scar tissue gets put down. You may no longer have pain at rest but the injured area may still get sore with certain activities, but generally will feel better when it’s being rested. 

 

The third stage is Remodeling.  This is where the body is attempting to refinish its repair work. You may not have any pain during this stage of recovery which in some cases may last up to a year. 

 

 

MOTIVATION

What motivates people to seek out treatment most times is pain that is interfering with what they want to do. Yes, usually there has to be some loss for the individual before they will book an appointment. And should the pain go away (maybe because the area was rested), then the person often cancels the appointment. 

For example, I had someone want to see me ASAP the other day because they had something in their back that had “spasmed” and they were not able to move.  But then they got a “pop” out of the area and the pain went away, so the person cancelled the appointment. But this was the second time this happened in the matter of a day. Why not get it looked at to see why it is happening before it is an emergency?  Because there was no pain.

The pain may come back when the person tries to do the activity again or another activity. It’s easier to assess someone when it is not an emergency with the pain at an intense level. It often will also take fewer sessions as we are not spending time settling the pain to see if we can find the “root of the problem.”

 

GETTING TO THE ROOT OF THE PROBLEM

Diane Lee (www.dianelee.ca) talks about finding the driver of the problem.  I like the terms “bully” and “victim.”    The “victim” is the area where you are experiencing the pain or the reason that you came for help (your neck is sore).  But what we may find on evaluation is that your mid-back area is very stiff and tight and it may be twisted or shifted to one side.  So we treat the neck and  the mid-back areas only to find you also have tightness, stiffness, or sometimes even too much movement in the lower back and pelvis area.  Maybe you have weak inner core muscles.  But as we move down the body we notice your quadriceps (front thigh muscle) is tighter on one side (see Aug. 8 blog Pain in the Butt…).  To top it off you have had no real history of trauma to any of the mentioned areas except for spraining your ankle 20 years ago.  On examination, there is stiffness in your heel joint and bands of ropy muscle tension in the outer calf. 

Where do we start?  What area is the “driver” or the original problem (our “bully”)? 

Sometimes we can just treat the area where the pain is currently and it will go away and the client stops coming.  The motivation is gone.  The pain may or may not come back depending on what activities they are doing or not doing, but eventually there will be a breakdown again. It’s like taking your car in for an oil change because the light came on, but your tires are worn, your brake pads worn, your axel out of alignment, but you just wanted the oil changed.  The car is drivable but more likely to break down at some point if the other things don’t get repaired as well.

Other times, when we only work on the area of pain, it feels better for a short time, but comes back between sessions.  This often means we are not stopping the “bully.”   An expample of this is when treating the mid-back area (up between the shoulder blades), and the symptoms keep coming back.  Well, did you know that the abdominal oblique muscles attach in that area?  Did you know that a lot of people (athletes especially) really overuse these oblique musclses?  I personally have felt the improvement of the mobility of this mid-back area after releasing the obliques. 

DON’T STOP THERE

Now that all the muscles are less tight and joints less stiff, that does not mean we are done yet. But you feel better because joint stiffness and muscle tension is often the reason for the pain someone feels. But what about retraining the muscles to work properly?  Fire at the right time to control the motion of the joint?  

A person with Patellofemoral Syndrome (http://www.aafp.org/afp/991101ap/2012.htmlpain) which is pain in the knee cap typically from improper tracking of the knee cap over the femur bones, whose pain significantly subsided after releasing the quadriceps, continued to have occasional flare ups, especially on stairs.  On examination, the pelvis was rotated (one bone more forwards and the other back) with muscle tension around the sacroiliac joint (SIJ) on the backwards pelvic bone.  This could put more tension on the left knee (which was the more painful side).  But why was the pelvis rotated?  There was tension in the back muscles up to the shoulder blades.  The person also had a weak inner core muscle, under recruitment of the inner thigh and functional weakness of the buttock and thigh muscles when trying to go up a step. What happened when stepping up was the knee fell inwards and there was a noted loss of fluid movement from the hip area. 

What to do? This person needed the pelvis corrected (the thigh muscles actually felt great and had good flexibility because of prior work on them), teach inner core stabiltiy work and work on the timing of turning the correct muscles when stepping up. 

THE POINT OF THE STORY is that treatment should not stop when the pain is gone; but only if you are motivated to get your body functioning the best it can (like a finely tuned race car).  There is no point spending the time or money on getting an exercise program if you are not going to take the time to do it.  There are several goals that can be accomplished through therapy:

1. To get rid of the pain or at least get it to a manageable level

2. To understand why the problem started

3. To improve flexibility of the area (or better yet your whole body)

4. To stabilize the spine or a joint

5. To stengthen a muscle that is truly weak

6. To be able to function in the activity you want to do without the pain and with minimal risk of injury

IF YOU’RE MOTIVATED:

We’re online in every place imaginable! Surf our website www.startlinephysiotherapy.com, then be our friend by moseying on over to our Facebook or Twitter sites by hitting the links there. To book an appointment at Start Line, call the clinic at 250-746-7463.

Have you ever wondered when to apply heat or when to apply ice?  If you have, you’re not alone.  Even us health care providers will tell you differently. 

Who do you believe then? 

I say believe your body. 

Here is what I know about heat and ice.

1. Both are analgesics, meaning their application will help reduce pain. They do this by helping block the pain signal travelling to the tract of the brain. It’s a one-way tract and more intense sensory stimuli (pain versus cold) will find its way to the brain. 

2. If you have signs of inflammation heat is not the best option. 

SIGNS:

Pain at rest

Redness

Swelling

Warmth

Local tenderness (pain on touching the area) that gets worse the more you touch it

3. If you’ve had a recent trauma (within the past 48 hours, including whiplash injury, a fall, or blow to the body) ice would likely be the better option.

4. If you have an ache or pain but did not have any impact trauma (kind of feels like you’ve strained a muscle), heat may do the trick of getting the muscle to relax.

A QUICK TRUE STORY

A middle aged woman who was playing indoor soccer went to kick the soccer ball and her quadricep (front thigh muscle) went into spasm. Then she kept playing (I never said the woman was smart) but only kicking with her left leg,and the same thing happened to her left side. Now she wasn’t able to kick at all. Being a physiotherapist, this soccer player, (well OK I’ll admit it’s me), applied ice to her injury.  Ahh–Not a good idea!  The muscles rebelled and went into more spasms. Heat felt much better.

5. If one, heat or ice, isn’t working (making things feel worse) try the other.

6. Heat tends to work well at relaxing muscle pain (which is why it works well after IMS treatments or before manual therapy treatments) and ice tends to work well when there is joint irritation (which is why some people with arthritic pain prefer ice and why a chiropractor or physiotherapist may suggest ice after a treatment that involves manipulation). 

7.  Even temporary relief is better than nothing at all. 

8. Ice is a great anti-inflammatory agent that does not upset your stomach. Some research has shown that ice application immediately after an injury (I am talking impact or trauma such as a sprained/twisted ankle) will improve recovery as it helps to contain the inflammation. 

9. You should not apply ice directly to your skin (wrap it in a towel or wet towel). Frost bite can be painful as well!

10. Ice application can be 10-15 minutes every hour. Any more time on ice causes the opposite effect (you get increased blood flow to the injured area rather than reduced as the body tries to regulate itself).

11. Heat can be left on longer but be careful not to burn yourself. 

12. Heat and ice do not take the place of a proper assessment and treatment by a health care professional.  If your injured area is not getting better on a daily or weekly basis, see a physiotherapist. I have clients who wait months with an injury that is not getting better before coming in for treatment.  The less time you have with an injury, the fewer treaments you will need.

ANOTHER STORY

A former client phoned in the day she strained her back (just standing up after being bent over). I saw her the next day. She then phoned and cancelled the following appointment as her pain had dissapeared. I would have liked to have seen her, however, one more time to make sure  the muscles that were in spasm I had helped release were working properly again.

***Remember that exercise and muscle retraining are the missing components to preventing recurring injuries and making for a more complete recovery.

IF YOU’RE MOTIVATED:

We’re online in every place imaginable! Surf our website www.startlinephysiotherapy.com, then be our friend by moseying on over to our Facebook or Twitter  sites by hitting the links there. To book an appointment at Start Line, call the clinic at 250-746-7463.