What you need to know about injuries
I am often asked about the differences between sprains, strains, and various pains, so I’ve decided to make that the subject of this newsletter.
Let’s start with some basic anatomy. Our skeleton is held together with connective tissue that includes ligaments which connect bones to bones, tendons which connect muscles to bones, and cartilage which is in the joints between bones. We also have fascia which is a type of connective tissue that varies from thin membranous tissues within out bodies to thick sheets that transmits forces between the various parts of our bodies. All these structures contain collagen which is a protein structure.
Basically, Sprains occur when a ligament that straps two or more bones together gets pulled. This comes in various degrees. First degree is a minor pull which may cause overstretching of the ligament and some slight tearing of the collagen fibers. Second degree includes some rupturing of the ligament fibers but there are still some fibers “hanging on”. Third degree is a complete rupture of the ligament which can lead to a decrease in stability of the joint that ligament was supporting. Sprains tend to hurt more when the joint is put in a “stressed” position either actively or passively. You do not have to be contracting a muscle to have pain from a sprain.
Strains occur to tendons or muscles. Unlike ligaments, which don’t contract, tendons and muscles contain fibers that do contract. This is what allows us to move our bodies and provides strength and support to our skeletons. Like ligaments these structures can also be damaged. You can strain a muscle or tendon when you over contract it. This can happen, for example, if you lift something too heavy or overexert or overuse the muscle. The difference from a ligamentous sprain and a muscle or tendon strain is the contractile nature of tendons and muscles. They tend to hurt when you contract the muscle even if the joint is not moving. Strains are graded similarly to sprains with first, second and third degree strains. Interestingly enough, after the initial pain from the injury, third degree sprains and strains may not hurt much as there is no longer a pull on the injured tissue.
That brings us to Pain.
Pain is a very complex issues and lots of research in recent years has led to new understanding about pain and how we react to it. For the purposes of this article, I am going to keep things simple and discuss acute, subacute and (briefly) chronic pain.
Understanding the stages of tissue healing will help us understand our bodies response to injury. In the initial stage of tissue injury your body produces an Inflammatory response. This bring in more blood to the area which is produces redness and swelling. Your immune system releases a bunch of chemicals into the damaged area that help to get rid of dead tissue and to start the healing process. These Inflammatory chemicals also stimulate the pain fibers in the tissues and produce pain. The Inflammatory stage typically lasts from 12- 48 hours.
After that we enter the Fibroblastic stage. At this point the body begins to make new collagen tissues to patch up the area that is injured. Typically, this lasts about two weeks.
Next comes the Maturation stage where the newly formed collagen becomes stronger and more resilient. It is becoming more like the tissue it is repairing.
Acute and subacute pain is experienced in the first two stages of healing and can progress into the third stage. Chronic pain is pain that persists beyond the three month mark when the healing should be complete. The reasons for why some pains becomes chronic others do not is a complex area of pain science and a bit beyond this current topic.
Physiotherapy treatment varies according to what stage of healing you are in. In the initial inflammatory stage treatment is mostly supportive, this includes pain relief modalities, mechanical support of the injured area through bracing or taping and techniques to decrease swelling. The acronym RICE is used to help guide treatment during this phase. Rest, ice, compression, and elevation. While recent research is questioning the use of ice in acute injury recovery, as long ice is not over done it can still be an effective tool to help decrease acute pain.
In the Fibroblastic stage of healing the body is laying down new collagen fibers. Initially these fibers are laid down in a haphazardous manner and are not aligned. Treatment at this point includes range of motion and muscle contraction exercises. This helps align the new formed collagen along lines of stress and helps build strength and flexibility in healing tissue.
Once the body progresses into the Maturation phase of healing we can then progress to exercises to help build strength, flexibility and return to normal activities and function.
Physiotherapy can help support you through this healing process and can guide you along the journey. While injuries can be a part of an active lifestyle, it is important to remember that it is healthier to be active and exercise than to be too cautious and get deconditioned. Our bodies have an amazing ability to heal, repair and strengthen throughout our lifetime.
