Your muscles heal very differently than other structures, like your bones. If you fracture a bone, as long as it is set and fixed in place properly, it will tend to heal so thoroughly that it will become stronger than it was before! Bone tissue heals with calcium and other minerals, components of bone, in a process that creates a bond that is as strong or stronger than the original bone structure.
If the injury is minor then your muscles can actually regenerate to repair themselves. An intense workout, for example, can create micro-tears in muscle fibres that cause soreness and pain. With enough recovery time, however, the muscle heals with new muscle tissue and function better than before. Larger injuries, however, do not actually heal with muscle tissue, but with “foreign” substances including collagen. The initial repair process creates a “patch” of random scar tissue fibres that is weaker, less elastic and consequently highly prone to re-injury. In order for your injured muscle to fully recover, the scar tissue needs to become aligned and integrated with the surrounding healthy muscle fibers without compromising their flexibility. This is called remodeling and requires movement and a certain amount of stretching (just the opposite of what bones need to heal.)
The right amount of movement, (which varies according to the injury) at the right time and intervals, repeatedly breaks up the scar tissue fibers in a beneficial way, and they gradually become realigned in the same direction as the rest of your muscle. Unfortunately, even with all the best rehab. exercises and stretches, it can be a slow and painful process that remains incomplete after weeks or months of hard work. There are ways you can accelerate this process but first, there is another issue that needs to be understood and addressed, if you want to be assured of the fullest possible recovery.The reality is that, even when the scar tissue integration process is complete, your problems can continue, because….
YOUR MUSCLE ISN’T THE ONLY THING THAT GETS DAMAGED!!
Traditional forms of rehabilitation often fail to restore full function, because they tend to fixate on the individual muscles (and other tissues) that have been injured. (The “hardware”, so to speak.)
It’s not enough to focus solely on trying to stretch, strengthen or otherwise rehabilitate your injured muscles, because the “damage,” or disruption, is also to your “software,” or the movement programs in your brain’s Motor Control Centre (MCC). This center is simply the part of your brain that coordinates all your body’s movements, as well as your alignment and balance.
When you injure a muscle, it gets reflexively “shut down” to protect it from further harm and your MCC begins to adapt your movements to avoid overusing that muscle. This is the beginning of a distorted movement program or compensation pattern and it can be like a bad habit. Once you develop one, it can be very hard to break.
One consequence is that you lose full conscious control of your injured muscle… not totally, of course, you can still move it, but you don’t have your full strength or flexibility. Although movement is essential in realigning the scar tissue, (which we talked about earlier) trying to get your full power and mobility back by way of strength-building exercise can easily become an exercise in futility because your nervous system is keeping the muscle in a shortened, inflamed, and usually painful state.
Even a small muscular injury can lead to a chronic pain pattern which persists for months or even years, because the nervous system stays ‘on alert’, waiting for the scar tissue to heal completely and become aligned with the surrounding muscle tissue. Fortunately, you don’t have to go on struggling this way, once you understand that unless the distorted movement programs in your brain (the “software glitches”) are corrected, any progress gained by treating your muscles alone will often continue to be temporary or incomplete.
HOW TO ACCELERATE HEALING
FOR A NEW INJURY: Begin with R.I.C.E. ( Rest, Ice, Compression and Elevation). Right after an injury occurs is the ACUTE phase when there’s pain, swelling, bruising, redness and weakness.
- Rest as much as possible especially at the beginning. And resist the temptation to dive back into your activities as you improve to avoid re-injury.
- Ice in 10 minute applications several times per day to reduce inflammation. Be careful not too ice for longer than 20 minutes or so, after which time circulation can be increased.
- Compress the area with a bandage or tensor to add stability and further reduce swelling. Bear in mind that the goal isn’t to eliminate inflammation but merely to help control it, so wrap lightly.
- Elevate the area whenever you’re not in motion. Continue until inflammation and pain are reduced by at least half.
Use NSAID’s sparingly: Although stemming the body’s inflammatory over-response is important, studies have shown that the use of nsaid’s (non-steroidal anti-inflammatory drugs) can actually hinder healing, at least initially. They body’s response to injury is necessary to overall recovery and some studies have shown that Nsaid’s are best utilized after the first 48 hours have passed to allow initial healing to progress unchecked. However, the body tends to overdo it and, if present for extended periods, swelling can actually irritate healing tissues so go ahead after that.
FOR INJURIES THAT ARE HEALING: After the first few days have passed the SUB-ACUTE phase of healing kicks in. This is when recovery has really started but has a long way to go and may need some help.
Contrast hydrotherapy: As pain and swelling diminishes, usually after 48-72 hours, consider a combination of heat and ice to maximize nutrition, clear waste products and eliminate deeper inflammation. For a step-by-step guide to this refer to the article How Your Joints Heal – Sprains.
Get a massage. A massage can help in every phase of healing but less so in the acute phase. This is when direct palpation of the injury site will be almost impossible and circulation should remain limited so the focus will be on surrounding tissues and compensatory effects. As healing progresses massage of the injury site will help re-align scar tissue, loosen knots and ease muscle tension so you can recover faster.
AFTER THE FIRST WEEK: The REPAIR phase begins about 3-7 days after the injury and lasts several weeks or more depending on the its severity. The scar tissue that is forming has gained enough strength to allow for further intervention. If too much is done too soon, you run the risk of creating a larger scar tissue area that is prone to re-injury. Staying sedentary beyond this point can lead to muscle atrophy, denser scar tissue and slower recovery. Pain is your best guide.
Get moving. Modified activities that will put your joints and muscles through their normal range without any jarring impact will keep muscle structures from stiffening during the repair process. Cycling or swimming is a great choice here – just don’t overdo it. 20 minutes is plenty! Moving will facilitate regeneration, minimize scar tissue formation and help regain strength but only if it’s not done too soon and is PAIN-FREE!!
Establish a warm-up routine. This should always be part of an exercise program but is even more important when recovering from an injury. It can include self-massage, taking muscles/joints through their range-of-motion movements and low-intensity versions of your intended activity.
Stretch muscles that are sore GENTLY. Also, as you begin moving again, you may notice muscles around the injury or on the opposite side are compensating for your injury. Don’t neglect them. Hold each stretch for a minimum of 30 seconds and be sure to keep them static and pain-free.
AFTER PAIN AND SWELLING ARE GONE! After about the 3rd or 4th week the injury enters the REMODELING phase. With little to no pain, this is the time to build up strength and challenge scar tissue into the most organized and functional version possible. Stretching should move into end range now and don’t be shy of a bit of discomfort. Manual therapies can easily work onsite and with deeper techniques to further help with scar tissue realignment and compensatory issues. This stage can last as long as 6 months.
Strength Training. If you’ve been moving and stretching a good part of your range of motion should be in place at this point but your muscles have probably lost a good deal of strength. This is the time to start building but go slow at first. If exercise produces noticeable pain the following day, then back off. Begin with an exercise routine you can do daily without pain the next day. Progressively increase from there to challenge connective tissues, stimulate growth and improve function. Consider seeing a personal trainer or physiotherapist if you need help.
Use a foam roller. Working your muscles with a foam roller reduces muscle tension. It breaks up scar tissue and sore knots, preventing your joints from aching and takes away the soreness faster. Go gently at first and focus on surrounding and compensatory muscle aches until healing is well under way (a few weeks) then play with the pressure onsite. It might be uncomfortable but shouldn’t hurt overmuch.
- Run the foam roller over your sore muscle groups for 30 – 60 seconds each.
- Use the roller when you wake up in the morning, before you go to sleep, and throughout the day when you have time.
All these steps, if done mindfully and with commitment, will greatly lessen recovery time and allow close to full healing to occur. It is important to note, however, that even the best remodeling still leaves us with a patch of ‘foreign’ tissue that will function differently from the original tissue. However, with careful re-patterning of movement, stretching and strength work, the surrounding muscles will rework themselves in such a way that the original injury is almost, if not fully, unnoticed. So take your time and do it right!