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Continuum of Injury and Treatment

Continuum of Injury and Treatment
by Dr. Christopher Notley

So you are dealing with an injury. It is a frustrating time being in pain and not being able to do the activities you love doing. You may be planning on seeing someone for this injury and you are wondering, “What type of care should I expect to receive?” The answer to this question depends on how long you have been injured before you seek out care and who you are going to go see. There are typically 3 phases of care; acute, sub-acute and chronic phases. The phase you are in depends on the signs and symptoms that you are experiencing which are associated with length of time since the injury occurred.

Acute Phase – Days 1 to 3

What are you experiencing?

If you are in the acute phase you are experiencing pain, inflammation, the area is warm to the touch, it is likely swollen, and there is a decrease in range of motion and strength.

What type of treatment?

The goals for this phase are to reduce pain and inflammation. Minimizing the amount of inflammation allows for a quicker rate of recovery. During this time, treatment consists of following the PIER or RICE principle. To decrease pain the use of TENS, acupuncture and chiropractic adjustments will also be used to assist with pain reduction.

Sub-acute – Day 3 to 3 months

What are you experiencing?

During the sub-acute phase active inflammation is likely over but there might be some residual active inflammation. With inflammation comes scar tissue, this is inevitable, but if taken care of during the acute phase this is kept to a minimum. Adhesions may form between muscles, muscles and nerves, muscles and ligaments. Muscles may be tight and develop trigger points (hypersensitive spots in muscle). Your pain will be decreasing and your strength and range of motion will be improving.

What type of treatment?

The goal for this phase is to continue to reduce pain, improve range of motion, slowly start strengthening injured tissues, and limiting the amount of adhesions. Acupuncture can be used to help with pain relief. Pain can also be managed with the use of ice or heat depending on whether or not active inflammation is present. A different form of acupuncture, called dry needling, can be effective in reducing adhesions and treating trigger points. Active release technique is excellent for stretching out tight muscles, reducing trigger points, and breaking up adhesions. Chiropractic will help with improving range of motion of the joints affected and well as reducing pain. The start of remedial rehabilitation exercises such as range of motion exercises and mild strengthening exercises are incorporated. Your health care practitioner will be urging you to continue with work as long as your work isn’t likely to cause aggravation of your symptoms. In addition, ergonomic changes to your work space will be incorporated to limit aggravation of the injury.

Chronic – 3 weeks and on

I am going to break down the chronic phase into two types of presentations. They are very different and depend on whether your have taken care of the injury throughout or you have just started to pursue care.

Chronic phase – Type I

What are you experiencing?

This is the ideal case of the chronic phase. You have gone through treatment since the beginning of your injury. You are not experiencing as much pain except during events that over stress it. Pain is under control. This is likely the phase you will choose to stop coming in for care. Sadly this may very well be the worst time for you to leave. I see this happen way too often. The reason this is the worst time is that your body has not yet developed the strength and flexibility to withstand the stresses of your daily life. Considering that most people will re-injury their neck or back within a year of their first injury taking an active approach to prevent further re-injury makes sense.

What treatment should you expect?

For those small areas that are still a problem active release technique, chiropractic and dry needling is still used. The major components of this phase it to develop strength, flexibility, balance and stability to aid in preventing further injuries. This phase should not be ignored. Your injury isn’t stronger because you are pain free. It takes a year for scar tissue to develop and strengthen so it can manage the stresses of our daily lives. Going through a rehabilitation program helps to stress and improve the area that bothers you. Sadly many people, once they are out of pain, leave their healthcare practitioner until the injury is aggravated again. They are missing out on a crucial phase of care which is designed to prevent the reoccurrence of injury.

Chronic Phase – Type II

This type of the chronic phase is seen quite often. This phase is those of you who have been dealing with an injury for longer than 3 months and most often is seen in people who have been dealing with it for more than a year. There are a few reasons why people reach this phase. One reason is that they had an injury and they did not take care of the injury. Another reason is that they may have experienced this problem on and off over the years and never did anything about it until it wouldn’t go away. For example, each day you sit at your computer at work and once in awhile, after a long stressful day, you have tight shoulders which give you a headache. You take some pain medication and the next day you wake up and you feel fine. It doesn’t happen again for several weeks later. Time goes by and slowly the tightness comes on quicker and lasts for longer periods of time. Not only that, but the tightness is occurring more frequently. Finally, you are so tired of experiencing this pain you finally decide to have someone take care of it.

Over the course of this time you are experiencing small trauma to the areas that are bothering you. Inflammation has occurred and scar tissue forms. The scar tissue has glued itself between the muscle and the skin, muscle and muscle, muscle and nerves all of which can further cause pain. Trigger points have also formed because of the chronic stress on the areas. Pain comes on with certain activities. Range of motion is reduced and because of chronic postural habits certain muscles are weak while others are inflexible. All of these problems slowly accumulate until the problem becomes a focus of your life.

What type of treatment do you expect?

Treatment during this phase starts similarly to the sub-acute phase. During this phase treatment consists of dry needling, active release and chiropractic to break down adhesions and improve range of motion. Chiropractic adjustments are used to ensure proper movement of joints. As pain becomes better controlled a rehabilitation program is incorporated which will be used to strengthen the weak muscles and stretch the tight muscles. Postural exercises will be given to improve posture. Ergonomic changes at work, in your car, or while being active will be addressed.

Wellness Phase– Enhanced Life Beyond Injury

This is the phase we all strive for. This is where you are enhancing your life beyond your injury. Your pain occurs less frequently or doesn’t occur at all. Your postural muscles are strong and your tight muscles are flexible. You are living beyond the pain. Your rehabilitation program has changed from injury care to health enhancement. You are able to be active without pain. Your choices of food have changed from poor choices that stress your body to healthy choices that enhance your body. During this phase, treatment by your health care provider, is less frequent. During your treatments, leading up to this phase, you will have learned the tools that will help you manage the pain yourself. You will only come in for a “tune-up” when your body feels the need for it.

Conclusion

Care for your injury should be a multi-facetted approach. No one form of care is better than the other. They all have benefits but only when used at the appropriate time. Be active in your care and don’t be afraid to ask questions.

Originally posted on May 17, 2022 @ 4:37 pm