Soft tissue and the New, Old Healing Process
Soft Tissue and the New, Old Healing Process
The so-called soft tissue injury is one of the great misnomers of medicine in that there is nothing soft about the pain they cause to the affected area of the muscles, tendons and ligaments.
Soft tissue injuries typically occur in muscles because of increased tension that could be caused by overuse, imbalance or poor mechanics. Muscles that are attached to the skeletal system contract and relax in order to allow you to move. Problems begin to surface when these muscles fail to completely relax and then become stretched beyond their new limit -- this is referred to as a trigger point. The small fibers that make up the muscle could become damaged and torn, leading to pain, restriction of motion (ROM), weakness or asymmetries throughout the skeletal system.
There are two categories of soft tissue injuries: acute injuries and repetitive or overuse injuries. An acute injury is the result of a trauma and includes strains (muscles or tendons), sprains (ligaments) or contusions (due to impact), whereas injuries such as tendinitis and bursitis occur gradually over time from repetitive motions. We classify soft tissue injuries by Grades; Grade 1 (micro-tears of fibers), Grade 2 (partial tears) or Grade 3 (ruptures).
The majority of soft tissue injuries heal without complication in a predictable manner that covers three phases: inflammatory, proliferation (repair) and remodeling.
1. The inflammatory process immediately follows acute trauma or repetitive chronic irritation and involves the body's response to damaged tissue, irritants, or pathogens. This phase may be accompanied by pain, redness, increase in temperature, swelling or loss of function. The result is fibroplasia or scar tissue formation, which occurs two to four days after the injury. The major component in scar tissue is collagen, from the Greek word meaning glue.
2. During the proliferation or repair phase, the production of scar tissue increases rapidly over the first 21 days after the injury and this newly formed tissue will contract. The collagen in the scar tissue is less elastic than normal soft tissue, which could result in reduced range of motion (ROM). It is important throughout this period to employ appropriate stress and movement, thus creating a strong and flexible scar. It is in this repair phase when the most effective improvements can be made in relation to ROM.
3. The remodeling phase lasts up to a year and scar tissue will continue to increase in strength. It is necessary to increase the load of the tissue so it strengthens, and more vigorous ROM interventions should be utilized if required.
The movement and ROM interventions are key to proper healing of soft tissue injuries because they ensure that the quality of the scar tissue will be strong and flexible. Poor scar tissue will cause weakening of soft tissue over time, and when stress is placed on a weakened muscle, tendon or ligament, it could continue to tear or eventually rupture and the cycle sadly continues.
Indeed, mobility is a requirement for tissue health and healing, as muscle activation around passive vessels (the lymphatic system/Venus return) is necessary to reduce swelling. This action pulls the deoxygenated blood and waste out of the body (Reinl 2014). Although some conditions require immobilization, mobilization and progressive tissue loading should be performed when directed by your physical therapist.
There is one more mind-blowing thing to mention about soft tissue care. Yes, medicine and methodology change over time. Take the idea of rest, ice, compression and elevation (RICE), which has been the accepted norm in caring for injuries over the past several decades. But what if we were wrong? Specifically, what if the application of ice to reduce inflammation proved to be counterproductive? "There can be inflammation without healing but there cannot be healing without inflammation," (Leadbetter 1989). If you disrupt the first phase, of inflammation, then you prevent the second and third phases from taking place and completing the healing process (Stovitz and Johnson 2003).
Ice, anti-inflammatories and cortisone shots prevent the body's natural inflammatory response from fixing the problem. Or, as Gary Reinl (2014) put it, if you are using anti-inflammatories that means you believe the body's inflammatory response is a mistake. Otherwise, you would not be trying to prevent it.
Mind blown? Let your body do what it has been designed to do by powers much greater than us.
References:
Reinl, Gary. Iced!: The Illusionary Treatment Option. Place of Publication Not Identified: Gary Reinl, 2014. Print.
Journal of American Academy of Orthopedic Surgeons, Vol 7, No 5, 1999
Leadbetter WB. An introduction to sports-induced soft -tissue inflammation. In: Leadbetter WB, Buckwalter JA, Gordon SL. Sports-Induced Inflammation: Clinical & Basic Science Concepts. Park Ridge, IL, Amer Acad Orth Surg.1989.
The Physician and Sportsmedicine: Volume 31: No.1 January 16, 2003 NDAIDs and Musculoskeletal Treatment What Is the Clinical Evidence? Steven D. Stovitz, MD; Robert J. Johnson, MD