Managing an acute injury

Knowing how to immediately look after an injury for the first few days can speed up its recovery. In this blog we look at a more up to date protocol on how to help you manage it.

Many of us are well versed on the R.I.C.E acronym (Rest, Ice, Compression, Elevation). Which eventually was upgraded to P.R.I.C.E (P = Protect). Over the last few decades the advice on the management of acute injuries has rarely been contested. However, with growing research there has been a change in the way clinicians deliver advice on acute injuries to patients. With more recent research there is a new acronym called P.O.L.I.C.E. Standing for Protect Optimal Loading Ice Compression Elevation.

What’s changed?

The term REST can be completely misinterpreted. While it’s important to have a balance of rest AND loading. Too much rest can lead to
deconditioning of tissues, stiffness and weakness. By OPTIMALLY LOADING tissue it provides the right levels of stress to encourage tissue healing, while assisting with the drainage of swelling.

What is the right amount of load?

Firstly, you must listen to the pain and not try to push through it. But if in doubt seek advice from a health professional, whether it be a Dr or Physio. Assessing the injury will help clear any serious problems, like fractures or ruptures. After having the serious issues cleared, you can be guided on the appropriate movements or weight bearing exercises to perform.

If in doubt seek advice from a Health professional

Additionally, to help provide the right loading you may require a moon boot, crutches, brace or strapping for support. Before being gradually weaned off.

Ice

I’ve previously questioned the value of applying ice for reducing swelling. There is growing evidence that shows that we need some swelling to aid in the healing process and  by using ice to minimise swelling, we could be slowing down the rate of tissue healing. 

See: hold the ice in RICE

But using the ice instead to reduce pain, by limiting nerve conduction and lowering tissue temperature. This can be effective within 5-10 minutes of application. Doing this every hour will bring pain levels down allowing you to move or load the tissue as tolerated.

Side note: Make sure you regularly check tissue quality while icing to avoid frost bite.

Compression and Elevation

These two are the least controversial in their benefit of recovery from acute injuries. Having compression helps maintain swelling to a manageable level and the area can still move normally. Making sure the compression is tight but not causing pain or numbness. You can use crape bandaging or a tubigrip.

Elevation, particularly for the lower limb helps again at minimising excessive swelling. While elevated it helps to be gently moving the
area, which also assists with tissue healing and swelling.

Anytime you’re dealing with a new injury it’s important follow the most up to date advice to help you recover as quickly and safely as possible. By seeking physio, we can offer you that guidance and support as you progress. At Fundamental Physio Newmarket, you’ll be thoroughly assessed to identify the extent of your injury, then put on the right treatment plan to help you return to normal activity. 


References

Bleakley et al 2012 PRICE needs updating, should we call the POLICE? Br J Sports Med 

Algafly et al. 2007. The effect of cryotherapy on nerve conduction velocity, pain threshold and pain tolerance. Br J Sports Med

Malanga et al 2015. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgrad Med

Top 5 Posts of 2017

Entering the new year here’s a look back at last years 5 most popular blogs.

Happy New Year – 2018 is already under way. Hope you all had a great break.

Last year was a busy year with the blogs. Here are the top 5 posts from last year in case you missed them.

5. The Office WOD

  • How many of us at work get stuck in the same position and forget to move?
  • This post was offering some general strengthening and postural awareness exercises to follow regularly at work.
  • Try getting into a routine with these types of exercises. It should help prepare you better for training.

4. Trigger Points – what are they?

  • Those knots felt in your traps after a busy day at work are more than likely trigger points.
  • This blog goes into explaining what they are, how they’re caused and how they’re treated.

3. Recovering from DOMS

  • This was a popular topic as we all love a bit of DOMS.
  • Understanding how to manage your recovery and training while in the DOMS phase will make it more tolerable.
  • Also knowing the difference of pain between DOMS and an injury will help avoid making anything worse.

2. Improving front rack position

  • After doing many mobility assessments, the front rack shape is what most people struggled to hold passively without a bar.
  • This was one of a 4 part series of shoulder shapes we should be achieving to help make movement more efficient.
  • It offered a range of mobility exercises to open the shoulder into the front rack.

1. Anterior knee pain in CrossFit

  • One of the most common injuries in sports and top 3 with CrossFit athletes is a knee injury.
  • This blog looked at anterior knee pain and the common causes. It offers some basic suggestions to self managing the injury.

The purpose of these blogs has been to provide a wider understanding of your body and give you more control of it. Wishing you all an injury free 2018 and keep checking for the new blogs.

What’s causing my muscle tightness?

Muscular tightness is one of the disruptions to normal movement and if not managed well can lead to possible injury. Identifying your tightness and using specific strategies will help relieve tension.

One of the main issues patients struggle with is muscular tightness. They get a feeling of pain or tightness and an inability to relax the muscle.

What is tightness?

When looking at patients I need to find out if they have mechanical stiffness or the “feeling” of tightness or a combination of both, as this would direct my treatment plan.

Is the range of movement limited? does it have a soft or hard end feel? Are movements a struggle at end range, feeling heavy? What’s the rest feeling like, is it a constant tightness?

While we can have mechanical tightness of a joint or muscle, there are also the “feelings” of tightness. You might get your hands to the floor with your legs straight and feel the hamstrings tightening. While another person could do the same, get to their knees and not have tightness.

What causes the feeling of tightness?

Tightness is a sensation like many others, including pain. What we understand from pain is that this is not always brought on physically, but also by the perception of threat.

pathway-of-a-pain-message-via-sensory-nerve-in-injured-muscle,2324600

So like pain, tightness is a protective mechanism from the central nervous system to avoid danger. On a number of levels it detects stressor’s that expose the whole body or specific region to threat.

Examples of this…..

  • Prolonged sitting, without movement we often notice tightness in certain areas, possibly through reduced oxygen supply and increased metabolic toxicity.
  • Stressful situations cause rising cortisol levels and increased activity of the Vagus nerve leading to muscular tightness.
  • Repetitive movement over a period of time causes increased tension.
  • Posture muscle tightnessInjury or pre-existing weakness can cause a guarding response from the nervous system.

Using tightness as a warning sign for these potential threats might allows us to acknowledge the situation and quickly act upon it.

What will help my tightness?

Like all movement patterns, we improve with practice. The same goes for muscle tightness. If we regularly bombard it with neural messages to remain tight we develop trigger points and chronic tightness through a process called central sensitisation. Which makes the tissues more sensitive to pain and tightness.

If we can regularly supply our nervous system with input that is non-threatening we can slowly help desensitise the muscle. But this takes time and regular repetition.

Stretching

Most people with tightness, especially after prolonged rest feel the need to stretch out. But depending on our intended goal there are different types of stretches.

  • Static stretches
  • Active stretches
  • Dynamic stretches
  • PNF (Contract-relax)

While these stretches will help, it might only be temporary without regular repetition and reinforcing the nervous system with good movement.

Strengthening

There is a misconception that resistance training causes our muscles to feel tighter. Mainly due to the effect of DOMS. That feeling of soreness you have the day after a hard workout. But some recent studies have shown that strengthening can be equally, if not more beneficial than stretching.

Improvements in flexibility coming from improved ability to handle higher levels of metabolic stress and lower levels of inflammation. By lowering the threat to the nervous system through increased strength, it allows you to work the muscle through a wider range, without getting a stretch reflex.

Massage and other soft tissue work

Another way to help desensitise these tight muscles is to apply pressure. This could be with the use of a foam roller/lacrosse ball or other manual therapy techniques like deep tissue massage, myofascial release, trigger point release, dry needling.

Relaxation techniques and breathing mechanics

Like in the previous blog, an overactive or dominant sympathetic nervous system can cause muscle tightness. Finding ways of breaking poor postures or shallow breathing using a range of methods like kapalbhati, wim-hof, meditation, yoga etc. Using these methods are just part of the process to lowering overall tightness.

Usually, just following one of these methods individually is not going to be as effective as combining them together. Try to deal with the tightness from all angles.

If guidance is required or manual therapy techniques feel free to call 09 5290990.

Lets stop calling it tennis elbow

This injury affects more than just tennis players. Unlike its name the treatment for lateral elbow pain has advanced.

Lateral elbow pain is a regular complaint from athletes to manual workers, even office workers are exposed to the risks of these injuries. Sometimes this injury can be difficult to shake off without the necessary changes being made.

Why tennis elbow and what should we call it?

The diagnosis of “tennis elbow’ dates back to 1882 described as “lawn tennis arm”. While it effects up to 50% of tennis players throughout their careers there are many other activities other than tennis that cause this problem.

Lateral Elbow Tendinopathy (LET) is a more appropriate and clinical description of the injury. It encapsulates both a tendinitis (inflammation of the tendon) and tendinosis (micro-tears of the tendon).

With repetitive use of the arm, whether you’re doing a swing, cleaning a 60KG barbell, hammering together a fence or typing up endless reports. As the muscles in the forearm are being used continuously without rest the immune and metabolic bi-products cause micro tears in the tendon, leading to scarring, swelling and lateral elbow pain over time.

What can cause LET?

Forearm anatomny.jpg

The most common cause for LET is mentioned above, the small tearing of tendon inserting into the lateral epicondyle (outer elbow). Most commonly the tear occurs with the small muscle Extensor Carpi Radialus Brevis due to its weak insertion into the extensor tendon. But there are several other wrist extensors that can also overload this tendon complex.

For a long time, it was thought the sole problem was with the tendon and its connecting muscle. But the most recent model of LET suggests that as well as inadequate muscle power and endurance, there are also external factors influencing the pain.

These external factors could be…

  • Neck and mid back dysfunctions – Particularly the lower Cervical spine, the nerves that supply the lateral elbow have nerve roots at this level (C5-6). If nerve roots are irritated at these levels it can enhance the feeling of pain in its pathway down the arm, into the elbow. Following the Law of Denervation (This is a whole other blog!).
  • Posterior shoulder trigger points – Following that same C5-6 nerve root into the shoulder, it supplies posterior shoulder muscles. The development of trigger points in these muscles can irritate the nerve branches travelling down the arm causing enhanced pain into the elbow.
  • Thoracic Outlet Syndrome – This is another condition that effects the nerves supplying the arm. The pressure places on these nerves can also cause pain in the elbow.

As you can see all these external factors add a nerve component to the elbow pain and should be cleared in assessment to ensure they’re not involved or treated appropriately.

How long it takes to recover?

Like all injuries, it will vary. Depending on the severity and how irritable you are this could be a few weeks to a few months. Following the guidance and management of the injury from physio you will have greater success than treating it on your own.

If symptoms persist, with no overall improvement over 12 weeks an ultrasound scan may be indicated, followed by an assessment from an orthopaedic specialist.

How do I prevent LET?

LET is a silent assassin, it’s one of these conditions that develops unknowingly (with scarring and tissue inflammation) until it’s too late (when you feel pain).

If you’re involved in sport or work that uses repetitive motion at the elbow, you’re already a candidate for this type of injury. Consider that your warning and take control.

Firstly, those forearm extensors need to be managed. Taking regular breaks to stretch and strengthen the wrists will help. Rolling the lacrosse ball into the forearm and back of the shoulder to reduce tightness. Consider your posture when sat at work or in the car, aim for your head to be over the shoulders.

For those in the gym, look at your wrist position. Most movements other than front rack and press positions, you want to maintain a neutral wrist. Look at your kettle bell swing or pull up, keeping the wrist close to neutral will reduce the force through the muscles of the forearm.

How can physio help?

Depending your presentation when assessed there are a range of treatments that could include…

  • Soft tissue manipulation of the wrist extensors, neck and shoulder
  • Joint mobilisations to the elbow, cervical and thoracic spine
  • Dry needling of forearm wrist flexors/extensors, deep neck extensors, posterior rotator cuff.
  • Mobilisations with movement for the elbow, neck and shoulder
  • Strapping of rigid or kinesio tape
  • Prescription of elbow brace/clasp
  • Specific exercises to strength and stretching exercises for the wrist, shoulder and cervical spine
  • Mobility exercises for thoracic and cervical spine

There are many treatment options available but to help with a quick recovery it’s important to provide a tailored treatment plan to meet your individual needs.

For an appointment, call on 095290990