Friday, December 9, 2011

Massage & Soft Tissue Injury



I think it’s probably safe to assume that we’ve all had a soft tissue (muscle or tendon, for the sake of this blog) injury at some point, to some degree or another (hopefully it’s a lesser degree for most of us).  We’ve probably all heard the acronym R.I.C.E., at some point, too.  For those who haven’t heard this before (or who have forgotten), R.I.C.E. stands for Rest, Ice, Compression & Elevation.  In some way, or another, each of these things aides the body in reducing inflammation and circulating waste out of the injury area, while most efficiently delivering nutrients to the site for repair of the damaged tissues.  But let’s not put the cart before the horse, just yet.  There is a purpose for the inflammation that happens, as well.  The inflammation will help to somewhat stabilize the injured area, and it does indicate an initial rush of additional blood and nutrients to the area, to get it started.  So, if you can’t rest your injured bits right away, it may be best the let the inflammation hang out, a little.  “Rest” comes before “Ice” in that acronym, after all.
(Let me take this time to offer my disclaimer…the information in this post is not to be taken as gospel. It’s based on established rehabilitation protocols, which all have notable exceptions, and sometimes even controversy.  So, pay attention to your body and the things it seems to be “saying” to you, and honor that feedback.)

Back to the regularly scheduled post…

The inflammation starts the beginning of the 3 phases of soft tissue injury repair/recovery, which are: Inflammation, Repair, and Remodeling/Maturation.  The “resting” and “icing” mark us being able to aide in the second phase (repair).  When the body is in this phase, it is doing whatever it can to most quickly and effectively repair the damage.  This means it’s laying down scar tissue as quickly as possible, and in multiple, random, fiber directions.  Laying down scar tissue in multiple directions provides wonderful strength, but it doesn’t provide the greatest or most efficient function – particularly in muscles.  By reducing inflammation, & resting the injury, we allow the body to get that waste out and lay that scar tissue down as quickly as possible, and speeding up the overall recovery process. 

Once the body has laid down enough scar tissue, things might start to feel better, but you may notice that they still aren’t “the same.”  This could very well be because of some atrophy, as a result of giving the muscle proper rest - good for you!  It’s probably healed faster, and despite the rest, you’ll likely get it back up to speed more quickly than if you hadn’t rested it enough).  There could also be some element of the scar tissue just not being terribly efficient in performing the functions it’s supposed to perform as muscle tissue.  This is when the remodeling & maturation phase begins, and this is a place that massage can begin to assist, as well.  The body will gradually begin to re-orient the fiber direction of the scar tissue fibers so that they will be more efficient at its work.  This is a slow process, but massage has a way to help address this and speed up this portion of the healing process. 

There is a massage technique called Deep Transverse Friction (DTF), which is just what it sounds like – deep friction, across the muscle direction.  It was developed around the turn of the 20th Century in England, and has proved very effective.  It involves working deeply and aggressively, right on top of damaged tissues and that makes DTF an unpleasant protocol, despite its effectiveness.  The theory behind DTF is to break apart the scar tissue fibers, and then apply a gentle stretch to allow the fibers to re-orient themselves in a more optimal direction.  Luckily, in recent years, there has been some research and anecdotal evidence that DTF is not the only way to aide in the maturation phase, and that other techniques need not be so deep and painful.  What is being found is that any specific friction techniques on the injury site can achieve the same results, even without being too deep.  The mechanism is still somewhat the same – to break the fibers apart from one another (much less aggressively than DTF, though) while increasing circulation, and then gently stretching to help reorient the muscle fibers.  

Depending on where your injury is, you may be able to apply one of these techniques on yourself.  If you have some sort of injury, and you think that this may be helpful for you, feel free to email me, or just stop me when you see me, and I’m always happy to discuss.