Massage and Acute Injuries – Part 1: The Healing Process
Injuries are unfortunately a part of sport and while we attempt to train and do everything we can to prevent them sometimes they just happen (be it a freak incident or a traumatic injury that you had no way of preparing for).
Motivated athletes will often seek out any method possible that will allow them to rush back to play in the shortest time possible. Obviously, when dealing with an individual’s health there are a number of things that need to be taken into consideration and that being said there may be things we can do, as massage therapists, to help facilitate the recovery process and get the athlete into the best state for healing to occur.
Over the next couple of blog articles I will talk a little bit about some ideas on massage and acute soft tissue injuries. There may be a number of things affected by an acute injury (labrum, disc, meniscus, fractures, etc) but the purposes of this blog series we will only talk about soft tissue injuries such as ligamentous sprains or musculotendious strains (pulls, tears, etc).
Disclaimer: To be clear, this is not to suggest, in any way, that massage is the only thing that needs to be done – it is only a small piece of the puzzle. The athlete should ALWAYS be encouraged to see a medical professional and then massage therapists should be encouraged to work as part of the team of professionals (Dr., PT, DC, ATC, Strength Coach) to ensure the athlete has a safe and healthy return to sport.
The Healing Process
Acute injuries are characterized by a three step process of recovery with each step being represented by a general time frame:
- Inflammatory phase (0-5 days)
- Regeneration phase (5-21 days)
- Remodeling phase (21-360 days)
The Inflammatory Phase
Following an acute injury there is often a significant amount of bleeding/inflammation in the tissue and various chemical mediators (e.g., cytokines, prostaglandins, etc) are released in order to jump start the healing processes. The inflammatory phase can be broken down into two smaller phases: A Vascular Phase, where the bleeding is at its highest and then a Cellular Phase where myofibroblasts are called in to begin the wound healing process.
This phase is often accompanied by pain, swelling, and redness, which then begins to become black and blue or purplish in color over subsequent days. Additionally, there is a certain amount of guarding that takes place in order to protect the area from further damage. This guarding can be seen as an individual limping when they have a sprained ankle or holding their arm close to their body when they just sustained a shoulder injury. It is important to keep in mind that the guarding taking place at the injured site is not the only guarding to consider. The individual may alter several other motor functions in this time of damage and pain.
The Regeneration Phase
The regeneration phase, sometimes called the proliferation phase, is characterized by the formation of new collagen – a weak, less mature type III collagen. Type III collagen is the start of the tissue beginning to regain its strength and integrity but there may be reduced mechanical stability and damage if the tissue is overloaded in this phase. However, some stress may be needed in order to ensure that the tissue is remodeled in a way that is similar to its normal physiological stress. There may be residual swelling, pain, and reduced function and range of motion in this phase (guarding). Additionally, the tissue may still appear to be discolored.
The Remodeling Phase
During the remodeling phase stability begins to return as type I collagen is now synthesized. Along with this stability may also come a significant amount of scarring within the tissue – which type I collagen is often associated with – and may present chronic dysfunctions if not addressed. Pain is often decreased once the athlete has progressed to this phase but may still persist for a variety of reasons (range of motion restrictions limiting normal movement on the field of play and altering function, psychological hang ups with the previous amounts of pain, etc).
This brief intro into the healing process will serve as the basis for the subsequent blogs in this series which will delve deeper into each phase and discuss potential areas where massage therapy may be used intervene and help facilitate the healing process and (potentially) be a factor in speeding up recovery.