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Soft Tissue Injury

When it comes to treating soft tissue injuries, many patients will seek medication first. Although medication may help to decrease the pain initially, often patient will complain that once the medication wears off, the pain is persistent. Soft tissue injuries or sprain/strains of the neck and back are commonly treated by chiropractors. Chiropractic offers a unique approach to these injuries that many other health care providers do not, and that is the re-establishment of “joint function”.

Think of your ankle or your knee or your wrist or shoulder. Have you ever “sprained” or “strained” these joints? I can recall in my early adolescent years, playing baseball. I was covering second base, the throw came in from the infield, I placed the tag on the runner with my non-glove hand. The runner’s foot proceeded to hit my finger and push that finger to my index finger. As you can imagine, this startling incident caused me to almost immediately grab my finger and re-align that finger, however the pain and swelling that proceeded was excruciating. The doctor merely put a split on my finger, told my mother to wrap it in ice, and prescribed a pain medication. Years would pass that my finger would never be the same. Needless to say, the Major Leagues never came calling for Tyler Nelson to play second base.

However, osseous-callous formation did come calling, and the inability to flex that finger normally for years continued. It wasn’t until I finally sought a chiropractor for back pain, that I mentioned my finger. The chiropractor explained that the body responded to this “soft tissue injury” by laying down calcium, that a “callous” of osteo-formation around the joint had set in and the only thing that I could do was to continue to work the finger to reduce or possible absorb the calcification.

Soft Tissue Injury to the finger? What about what occurs to the neck, back, upper back, leg, shoulder, knee and ankle. If left un-treated what occurs long term. A day does not go by, when our doctors are told during examination that they can pin-point the specific day when “injury” occurred to their neck, back, shoulder, hip, knee. Why? Because they recognize that the treatment that ensued did not perfect the healing process or it was never treated beyond medication.

Physical Injuries, such as falls from ladders, work injuries, accidents suffered on the field of play, or in car accidents- often require PHYSICAL applications in order to re-establish joint function.

Although the Pharmaceutical Companies have come up with a pill for just about any aliment today, no mater what pill they may introduce for structural insult to the human body, no pill can help to re-establish joint function and motion. Had I had my finger adjusted, re-aligned years ago, or possibly immediately following my accident, maybe today that finger wouldn’t’ still be significantly appear deformed. The neck, the back the human skeleton is no different. The difference is that a neck sprain a back sprain, a shoulder sprain, a knee sprain an ankle sprain/strain-there joints are much more complicated.

Chiropractors are highly educated and clinically effective in treating such injuries. Chiropractic care for soft tissue injuries should be the FIRST stop for patients.

Chiropractic treatment indispensable for soft tissue injuries
For quite awhile it has been known that chiropractic treatment is an indispensable tool in the treatment of soft tissue injuries. There is a new paradigm in the treatment of soft tissue injuries. Just using muscle relaxers, anti-inflammatories and pain relievers has never been supported by the literature. Other than pain relief these do nothing to improve the outcome of an injured tissue. What is supported by the literature is the use of passive motion and techniques to increase joint mobility which will relax muscles and allow an increase in rehabilitation in a pain free setting. Putting motion into healing soft tissues is perhaps the most important piece of the puzzle when treating an injury. How scar tissue forms is very important to the treatment and the avoidance of a lifetime of chronic pain with an injured individual. With approximately 80 percent of people having low back pain from time to time, maybe this is why.

There is a lot of misunderstanding regarding soft tissue injury and its repair. The most common misconception I hear is that injured tissue will heal in a period of time between four to eight weeks. I frequently hear that damaged soft tissue will heal spontaneously leaving no long term residuals and that health care is not required. This typically is a myth perpetrated by insurance companies of workers compensation managed care organizations. This type of misinformation is misleading, confusing and just plain wrong.

So, let’s take a look at what contemporary literature has to say about this. Literature clearly indicates that damaged soft tissue healing is approximately a one year process and this is why. Healing of damaged soft tissue takes place in three specific phases. The first phase is called the acute inflammatory phase. This phase lasts approximately 72 hours. During this phase there is continuous bleeding of the damaged tissues. This is why you use ice in the initial phases following the injury. Ice should only be used for short periods of time and always with a cloth between the ice and the skin. I like to use 10 minutes on and one hour off. Therefore, it is not uncommon for the injured person to feel worse for each of the first three days as increased bleeding occurs. I typically hear my patients say they feel worse the second or third day. This is due to the injured person’s own pain killers called endorphins. These endorphins are secreted into the blood stream to help us get by the initial pain.

After approximately 72 to 96 hours following the injury, the damaged blood vessels repair. This begins the second phase of healing called the regeneration phase. During the regeneration phase the tear in the damaged muscles and ligaments is repaired. This is where there is a lot of confusion about the timing of healing. The repair is done by cells called fibrocytes that secrete collagen protein glues in order to bridge the gap in the torn tissues. This phase lasts approximately 6 to 8 weeks. At the end of this phase, the gap in the torn tissues is totally bridged. This is where the confusion begins and where real science begins, because this is clearly not where the healing ends. This is where the third and final phase of healing begins. This phase is called the phase of remodeling.

The phase of remodeling begins near the end of the phase of regeneration. During the phase of remodeling the collagen glues that have been laid down for repair are remodeled in the direction of stress and strain. This means that the fibers in the tissue will become stronger and will change their orientation from an irregular pattern to a more regular pattern; more like the original undamaged tissues. Proper treatment during this remodeling phase is very necessary if we are to get the end product of healing. It is during this phase that the tissues regain strength and alignment. It is well established that remodeling takes approximately one year after the date of injury. Research also shows that remodeling takes place as a direct product of motion. Chiropractic healthcare puts motion into the tissues in an effort at getting them to line up along directions of stress and strain, thereby giving a stronger, more elastic end product of healing.

As you can see, there is scientific proof to show that putting passive motion by way of using a chiropractor is important in the treatment of soft tissue injuries. Chiropractors not only adjust joints to accomplish this. Other techniques such as flexion distraction, active release technique, Graston and Cross friction massage help to make the injured tissue resemble the healthy tissue. Injured tissue is never as good as the original tissue, and it is because of this that an injury needs to be treated in the correct manner so the patient will not have a chronic problem. In my next article I will discuss how the chiropractic adjustment works and its key role in the treatment and rehabilitation of the soft tissue injuries.

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