Issues with bones and joints are the No. 1 reason for doctor visits, accounting for 15 percent of our healthcare dollars. Nevertheless, musculoskeletal training is less than 5 percent of the medical school curriculum.
Non-specialists are unprepared to deal with issues of the body framework and of course, most general physicians have no training in exercise prescription, nor are they able to help the sedentary individual initiate a program nor help athletes or active workout participants recover.
Whenever you have an acute soft-tissue or bone injury, your body will heal in three phases. The reaction phase, the repair-regeneration phase, and the re-modelling-maturation phase.
The reaction phase is where the body reacts to an injury with vascular inflammation which results in redness, swelling and pain. This is an attempt to limit the extent of the injury, remove damaged tissue from the wound and to initiate tissue repair.
The blood vessels constrict to keep the swelling from getting out of control, and the blood begins to coagulate, causing a bruise or hematoma. This period only lasts a few minutes, after which your blood vessels dilate again, bringing fresh blood back into the area with specialized cells that bring in histamine and serotonin to increase blood vessel permeability and increase the white cell population in the affected area in order to protect against infection.
Other white blood cells called macrophages (big eaters) also congregate on the area in order to eat up the cellular debris caused by the injury. Initial first aid to help reduce swelling and pain can go a long way to reduce further tissue damage.
The acronym RICE —standing for Rest, Ice, Compression and Elevation
— highlights the initial first aid steps that should be applied to any injury.
Rest implies that the injury should be protected from further injury but it doesn’t mean go to bed.
After the initial swelling has receded, under the guidance of your trainer and doctor you should start controlled, protected activity to enhance the healing and recovery.
The key is to initiate activities that do not interfere with healing. Ice may be a modality to use throughout the recovery process. Ice reduces swelling, inflammation, metabolic rate and pain. Don’t apply a freezer pack directly onto your bare skin because it can injure your skin, but place a moist washcloth in between a freezer block, or use a made-for-injury freezer pad that doesn’t freeze solid.
A good guideline is 15 minutes on, 15 minutes off to relieve pain and swelling. If you wrap the ice pack in a tensor bandage and secure it you will accomplish the third criteria of compression as well. Not too tight! The tissue should retain some blood flow.
The last part is elevation, this means above your heart level (not just feet propped up on the ottoman). Elevation is also in order to reduce swelling and the resultant tissue damage. The less swelling, the less time needed for healing.
The repair-regeneration phase starts a few days after the injury occurrence. The clotted swelling around the injury provides some degree of stability and a second wave of cells called fibroblasts begin the process of repair by producing collagen.
About four days after the injury, the new collagen begins to offset the degradation of the injured connective tissue and the wound begins to contract causing stiffness in the surrounding muscles and ligaments.
The remodeling-maturation phase begins as early as three weeks after injury and can continue for as long as a year, and even longer in some cases. Collagen remodels itself dependent on the lines of tensile force imposed on the injured area. Bone does not form scar tissue and is as strong as ever after healing.
However, the ultimate tensile strength of scars in connective tissue may be as much as 30 percent less than that of the original tissue.
As to bone healing, fractures usually heal well, but not always. Certain bones such as the tibia, (shin) the humerus (upper arm), the clavicle (collarbone) and navicular bones of both the hands and feet can take longer to heal in a process called “delayed union.” Sometimes there is a complete non-union of bone especially in adults with more serious shattered or open fractures. Smokers tend to not heal their bones well at all because of their compromised blood circulation.
Therapeutic exercise for tendons, ligaments and muscles while healing results in a better-quality scar rather than being immobilized or carrying on as though nothing happened. During a healing phase you may need more protein, taking it up to 100 grams per day.
Extra vitamin A can help build your tissues including skin, and some increase in vitamin C will ensure that you are combating free radicals and making good quality collagen.If you have a bone injury, extra calcium up to 1.500 mg per day and usually a few extra calories are in order, as long as you are properly weighted to begin with.
Prevention is always better than a cure, but if your do sustain an injury, afterward it is important to get on a fitness program that will fix the weak link and prevent the likelihood of further injury. Aloha!
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Dr. Jane Riley, Ed.D., is certified personal fitness trainer, nutritional adviser, behavior change specialist, and a certified orthopedic exercise specialist. She can be reached at janerileyfitness@gmail.com, 212-8119 cell/text and www.janerileyfitness.com
