So you’ve gone and hurt yourself, huh? You’re a gung-ho weekend warrior with a twinge in your back and aren’t sure what to do about it. This isn’t unusual.
We get all kinds of people coming through our doors who’ve injured themselves in brilliant and creative ways.
As I sit here compiling this literary masterpiece, a client walks in with back spasms that are causing him visible discomfort. “How’d that happen?” I say. “I was choking on some long grain rice and coughed so violently that I threw my back out” he replies. Believe me when I say we’ve seen and heard it all. You may find yourself asking “What kind of treatment am I supposed to get?” With all the various types of sprains and strains you may be unlucky enough to receive, where to start can be an overwhelming decision. Here are a few things to consider:
“Yer aff yer heid!”
1.What is your level of pain?
If you’ve got a full-scale broken back, you’re going to want the emergency room and not deep tissue massage. An honest evaluation of the pain you are in/damage you have done is important at this stage. Open wound? Hospital. Arm dangling at a weird angle where you KNOW there isn’t a joint? Hospital. Tightness in the lower back after trying the caber toss for the first time? Whole Therapy! While our therapists are often told that they have magic hands, they cannot perform lifesaving surgeries or repair broken bones. We’ve had people come in to see us that could barely move let alone stand being touched or physically manipulated in any way. Not being a hero at this point and seeking medical attention is best. On the reverse side of the coin, going and waiting in an ER for 10 hours only to have a Dr. tell you to see a physiotherapist isn’t a lot of fun either.
It can be tricky sometimes to gauge the type of potential damage that may have been done after you landed on your back in the middle of the Rideau Canal whilst distracted by that delicious Beaver Tail in your hands. We get that. While it’s always best to err on the side of caution, be realistic. The hospital staff won’t thank you either for taking up their time with a minor scrape or the proverbial bobo.
Now that you’ve determined you don’t require immediate medical attention, you’re looking for some pain relief, rehabilitation, and a plan of action for your recovery. The next step is to..
2. Consider the type of injury.
Chances are, if you’ve rolled your ankle you’re going to want a more rehabilitative and active treatment; most likely a visit with our physiotherapist, or our chiropractors. If you feel the situation is more muscle or tissue related, you could also consider our team of massage therapists.
One of the great things about our multi-disciplinary approach is how perfectly our services complement each other. We often have clients come in for “the double”. This usually consists of a massage treatment to soften you up followed by a chiropractic adjustment to straighten you out! We also double up on the physio and acupuncture fairly often. Perhaps the most effective combination of all though, is the combination of our minds. Each practitioner here will view things in a slightly different way as their training and expertise dictates. It’s common practice amongst them to pick each other’s’ brains for answers to tricky questions involving your rehabilitation. It’s this collaboration upon which the Whole Therapy philosophy is based.
3. What can I afford?
Another thing to consider when booking an appointment is your insurance coverage. Many of you will have private insurance that allows for some spending on different types of clinical services. Maybe you’ve got coverage for physiotherapy but not chiropractic. Perhaps it’s the other way around. Perhaps you’ve only got coverage for one type of service or perhaps you’ve got everything under the sun covered. It’s worth finding out before you call in so that we can better serve your budget AND your needs. That being said, sometimes your maintenance program will continue after your benefits have expired. Don’t worry. We want to see you as little as possible but as much as necessary. That means finding out together what a maintenance plan looks like for you. The initial treatment and following few appointments will likely be closer together, but as you progress from injured to pain-free to functional, the frequency with which you attend will likely decrease. Benefits are wonderful in that they can mitigate the cost of rehab, but they should not dictate the extent of your rehab. Consider this.
So don’t worry. Hurting yourself happens, whether it be from coughing up rice, tossing around cabers, or falling while skating. We’ve seen it all, remember?
Hopefully this information helps you figure out where to start. If you’re still stumped, give me a call. We can figure out together how to get the ball rolling.
Pat Moore is the office manager at Whole Therapy. Pat works alongside a team of dedicated professionals and is here to help ensure that your visit at Whole Therapy is as pleasant as possible. For more about Pat, click here!
Anyone who knows me knows I am a big believer in staying up-to-date on the most current literature and eating icing on cake. It’s important to know when the scientific community supports the crazy things we get our clients to do in clinic. I think it is also important to stay on top of controversial topics. So prepare yourself for the controversial topic of… ICING!
RICE (Rest. Ice. Compression. Elevation) has been perpetuated as the gold standard for acute injury management. You would have a difficult time finding someone who hasn’t used RICE in the management of some sort of ache or pain at some point in their life. It has been proposed that RICE will help limit the amount of inflammation in an area, allowing you to return to normal faster. Is this actually the case though?
Here are 3 beliefs you may want to reconsider when it comes to the application of icing. This information is solely meant o make you think critically on why we do what we have always done.
- Swelling is really bad and can prevent a speedy recovery. When we first injure a tissue, there is an initial vasodilation (opening of the blood vessels) to allow blood and white blood cells to enter the area. Their job is to help begin the initial cleanup of the area. So, the easiest way for the white blood cells to get to the injured tissue is through the swelling! Swelling also increases our sensitivity to pain, reduces movement and progresses the inflammatory response. This is all in an effort to keep us from further injuring ourselves. How can the body come up with an appropriate plan of care if we continue to subject the injured tissue to forces it isn’t ready to handle?! We have evolved to swell. Maybe our evolution regarding swelling isn’t necessarily wrong?
- Ice will prevent excessive swelling. Well, maybe not. What if I told you that icing may actually increase fluid in the affected area? It has even been hypothesized that icing an injury may restrict lymphatic flow and promote fluid build-up. The natural swelling process isn’t bad, but excessive swelling is! Our lymphatic system is responsible for getting rid of the excess fluid in the area. Long periods of icing may increase permeability in our lymphatic system. This means fluid has an easier time leaking out of the vessels into the injured area! This makes clean-up nice and sluggish. Icing also has been shown to temporarily reduce skeletal muscle activity. We need the squeezing of our muscles to assist the lymphatic system in pumping out excessive fluid.
- Icing improves the body’s capability of healing itself. A pilot study by Takagi et al 2011 wanted to see how icing affected injured skeletal muscle in rats (obviously we can’t just start hurting humans for the sake of science!). A specific muscle group of the rats was crushed using forceps. The rats were then divided into 2 groups: one group iced the muscle group and the other group did not. The rats were then sacrificed (muffle tears) and their muscles were investigated. The icing group had significantly less regeneration of healthy muscle tissue. The regenerated tissue also had abnormal collagen formation, making it overall weaker compared to normal collagen. There were also fewer cells in the area, known as macrophages, cleaning up the injured and necrotic tissue.
I know this is controversial. I am only suggesting that one consider some of the newer theories out there surrounding the efficacy of icing. When it doubt, go talk to your health care professional!
Here is the link to the original article by Bahram Jam, PT: http://aptei.com/articles/pdf/Ice-NSAIDs-Paper.pdf
Bailey Gresham is a registered physiotherapist for Whole Therapy. She specializes in manual therapy and movement-based therapy. She likes bridging the gap between rehabilitation and performance training. More about Bailey here.
So you went over on your ankle. Now, a black and blue softball currently resides where your ankle used to live. It’s painful, swollen, hot and difficult to walk on. When is this going to get better?!
This is probably the most frequently asked question I get as a physiotherapist. Generally speaking, a moderate sprain/strain can take upwards of 8+ weeks to resolve. HOLY CRAP! 8 WEEKS?! Yes, 8 weeks, give or take. I cannot expedite the body’s ability to heal tissue (I wish I could just place my hands on someone and heal them, I would make a lot of money!). I can merely help create an environment in your tissues conducive to healing. So if you have a swollen, black and blue body part, chances are it’s going to take 8+ weeks to heal itself (And compared to the 20 odd years it took you to become an adult, 8 weeks is pretty fantastic!). Understanding what happens during these 8 weeks, however, can really help prevent re-injury and decrease your risk of things becoming chronic.
1. Inflammatory phase (3-5 days)
There is not much we can do during this initial phase short of resting, elevating and compressing the affected area. Trauma to your tissues (also known as collagen) cause bleeding. Fluid and other cells (your body’s knights in shining armor) travel to the area to help assess the damage that has been done. The pressure from the fluid, in addition to the chemical soup now residing in the injured area, stimulates nerve endings causing more pain.
Pain limits function. And from an evolutionary standpoint this makes sense. The brain needs to assess the area to figure out what it needs to do to heal itself. It doesn’t want you walking on that sprained ankle, you might hurt it some more! So get those crutches ready and take it easy for those 3-5 days, you have my permission!
2. Repair Phase (3-21 days)
Remember those knights and shining armor I talked about in the inflammatory phase? Well these cells initiate a chemical response which causes blood clotting to stop the bleeding. Fibroblasts also make their presence known in this blood clot. Fibroblasts are cells in your body which essentially act like little carpenters. They come in and help build new tissue. Unfortunately in this stage, Type 3 collagen is laid down. This type of collagen is very weak and has little tensile strength. Its goal is to essentially help plug up the injury!
It’s important to recognize that this new tissue is really weak. Your injury may start feeling a lot better in the next 2-3 weeks. It doesn’t take much to tear this new tissue. Tearing this plug will only bring you back to the inflammatory phase, starting the 8 week process all over again! Re-tearing the tissue over and over again can cause disrepair, which can leave you with an ugly chronic issue.
3. Re-modeling phase (21+ days)
This phase can last up to a year if the injury was severe enough. In this phase, the weak Type 3 collagen is replaced by much stronger Type 1 collagen. Type 1 collage has a lot more tensile strength and makes the tissue more resilient. Type 1 collagen is still not as strong as the surrounding tissue, however, due to its plug-like nature. Most of our tissues are composed of parallel fibers which oppose the forces we put through them. The new tissue is literally a shredded-wheat of fibers, all criss-crossed in a haphazard formation.
In this phase, we can start aligning the fibers in the optimal parallel formation using controlled stretching and strengthening. We also need to work on other important things, but I can’t give it all away in one post! Haha!
Source: http://www.physioroom.com/injuries/supplements/ligaments2.php
Bailey Gresham is a registered physiotherapist for Whole Therapy. She specializes in manual therapy and movement-based therapy. She likes bridging the gap between rehabilitation and performance training. More about Bailey here.