Written by Team Juggernaut
Kevin M. Pierce, DC, DACBSP
Ever wonder why it takes so long to heal from a muscular tissue injury (strain/tear)? Lets ‘s break down the informational side of the injury; what is occurring on a cellular level, grades of muscular injury, timetables to healing, what should be avoided and strategies to assist the healing process, including soft tissue approaches and what the Doctor’s at Paradigm Performance Chiropractic do to optimize our athletes elite potential and recover quickly from injury.
The Grades
There are three grades of muscular tissue injury (Strain/Tear):
Grade 1 – Minimal damage to a few muscle fibers, the muscle sheath remains intact.
Grade 2 – Moderate damage to a larger group of muscle fibers accompanied by bleeding into the tissue. The muscle sheath is partially torn and a palpable gap is noted in the muscle.
Grade 3 – Complete rupture of the muscle and the sheath, with a large amount of bleeding and noted muscular deformity.
The Mechanism
There are multiple locations within the muscle where an injury could occur. The most common location is at the mid-belly of the muscle. Tears in the muscle belly are also more difficult injuries to return back to normal activity from. The reason being, mid belly muscle injuries appear to be healed much more quickly than a more proximal or distal injury where the boney attachments and tendons are involved. Because the injured region appears to be healed when it in fact is not, athletes will often return to play too early, perpetuating the soft tissue strain.
A common scenario for an athlete who returns to sport too soon includes: one week post mid-belly muscular tear, the athlete feels better and returns to play. While the athlete feels that he has recovered, the damaged area where tissue healing is occurring has not matured and is therefore not strong enough to withstand the demands of the sport and the injury re-occurs and most often worse than before. This leads to a long nagging injury. Let’s look into what is happening on a deeper level.
The Process
After any injury or trauma to a muscle, the injury site is bombarded with many physiological properties starting the protective and healing process part of which helps you avoid further harm to the involved tissue. The protective mechanism occurs not only to the injury site, but also to the surrounding tissue; creating internal support and muscular contracture for overall protection. The actual site of injury begins to accumulate bleeding from damaged tissue and inflammatory mediators accumulate. Within a few hours the injured tissue is infiltrated with inflammatory cells to control bleeding and debris in the area. The acute inflammatory process and tissue cleanup occurs for 48 hours giving leeway to the repair processes.
The repair process is typically lengthy; all dependent upon the grade of the tearing and location. For the next several days, repair to the injured area begins to scar; attempting to close the gap between the two ends of the tear. The scaring and internal wound closure will last anywhere between 14-21days, given there is not too much force and stretch on the particular area of injury. Within this period, days 7-10, the tear and immature scar tissue undergoes massive muscle regeneration to the neuromuscular junction, myotendon junction, and neuromuscular stump. This massive muscular regeneration is ongoing for 35 days and continues to mature for several weeks or even months; until the scar is mature and capable to contract without further damage occurring with typical and sports specific forces applied.
The Plan
When it comes to muscle injuries, not much has changed from the old ways of thinking. The acronym PRICE: Protection, Rest, Ice, Compression, and Elevation are still used. PRICE alters the chemical properties associated with a muscle tear and is critical to limiting the amount of cell death due to the increased and prolonged inflammatory properties at the injury site without it. PRICE should be used early and often; initiating muscle regeneration which is typically delayed by the prolonged inflammatory cells at the area of injury.
Things to be avoided early in scar formation and wound site closure include excessive salt in the diet, heating the injured area, and excessive vibration. All will break the weak bonding of muscle tissue and scar formation; prolonging wound healing further and reinitiating the scar tissue phases developed earlier.
The Paradigm Approach
At Paradigm Performance Chiropractic our approach involves treating the area of injury and dealing with all the properties associated with muscle healing. We use soft tissue techniques to address the entire muscular complex associated with protection of the injured tissue. We mobilize associated joints affecting muscular contraction and give progressive (conservative to aggressive) rehabilitation during proper phases of healing. The majority of our tissue treatments include instrument assisted tissue mobilization or Graston technique. Graston treatment is designed to treat the scar tissue matrix, increasing cellular activity in the injured tissue and stimulating proper growth. The instrument assisted mobilization assists the tissue alignment; strengthening the bonds of scar tissue and muscular regeneration to help more quickly and stronger bonds. This technique coupled with rehabilitation speeds the healing process, getting athletes back to sport much quicker.
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