We’ve all “pulled a muscle” at some time in our life. Many of us have “rolled an ankle”. These are examples of a strain and a sprain respectively. A strain is damage to muscle and or tendon. A sprain is damage of the ligaments which connect bone to bone. Of the two, the sprain is the worst injury because it can really compromise the integrity of joints.
Muscles and tendons are active tissue that produce contractile forces. A strain can interfere with the ability to produce an action when that muscle or tendon is recruited. This is painful, and scarring can cause a decrease in the functionality of that muscle resulting in weakness.
Ligaments are fibrous tissue that create stability in a joint. Their job is to keep the joint centered and make sure that the joint doesn’t slip out of place during motion. If a ligament is damaged, you run the risk of having an unstable joint which can easily lead to grinding in the joint and damaging the cartilage. This sets you up to have some serious problems in the future and will likely lead to arthritis down the road.
Both muscles and ligaments can help to center a joint and keep the two bone surfaces of the joint in approximation. When it comes to protecting a joint against excessive motion that may result in damage, the body’s first line of defense is actually the muscle groups that cross and surround the joint. Strong muscles create stability, especially if they are well balanced around the joint. If this line of defense is broken (usually due to a strong outside force like a fall or accident or sports injury), then the motion will continue until it loads up on the ligaments. If the force is strong enough to get to this point, then continued motion can create breakage in the fibers of the ligaments. This is why strains can occur alone, but typically sprains occur along with strains.
If injured, both of these important tissues will go through phases of healing. The inflammatory process is essential for this healing to occur. However, in our society, our diets often create an inflammatory reaction that is actually stronger than needed. Therefore, it is sometimes necessary to control the inflammation with medication and P.R.I.C.E. Protection, Rest, Ice, Compression, and Elevation are great ways to control inflammation.
As the healing process continues, blood clots, the body increases circulation to the area, and manages to bring in more nutrients and beneficial elements to the area as well as to dispose of the unwanted waste. Further along in the process, the body lays down collagen fibers which link the tears back together. Normal healthy tissue has its fibers aligned running one or more directions in a pattern that gives the tissue its strength and resilience. This is much like the threads in a cloth. Unfortunately, when there is damage, during the repair process fibers are laid in a random fashion crisscrossing in different directions. Fibers that are not aligned are weaker and so this scar tissue will not be as strong as the original tissue. In fact, scar tissue is presumed to only ever be 80% as strong as the original tissue after even years of healing. On top of this, scar tissue acts like glue that can create adhesions between neighboring structures. This results in some healthy tissue being connected to itself and other structures limiting its extensibility and movement. These two problems of weakened structural tissue integrity and the adhesions can result in life long issues with the functionality of the involved structures. This is why proper rehab is so important. Please allow me to explain this on a microscopic level.
Imagine that these tiny fibers are laid down like very small threads in a cloth. They are deposited slowly, one at a time. The areas where there is shearing (or ripping) causes these threads to break and only the threads that are in line with the movement remain. This motion, even though we are technically doing some damage, results in more of the threads being aligned. This in turn results in tissue that more closely resembles the original healthy tissue. It also helps to break up adhesions that would otherwise cause the gluing together of adjacent structures limiting mobility and functionality. This is why the top experts recommend mobilizing the area and beginning therapy as soon as just a few days after an injury. The sooner we can start breaking up the unwanted fibers that are not aligned, the more your body will produce stronger and healthier tissue. This is a sort of balancing act because we don’t want to rip the fibers that are linking the tissues together in a good way, but only want to rip the unwanted fibers that are not aligned in the correct position or creating adhesions. This is a fine art and it takes a well-trained and well-practiced physician to know just how far to go.
At Tulsa Chiropractic Rehab, we carry our patients through phases of care that pay close attention to this healing process. At first we start with PRICE and possibly some gentle ultrasound to help increase metabolism in the area speeding up the healing process. Then we begin with gentle rehab and move through progressively intensive stretching and finally into a progressive strengthening phase until full recovery is made. Some patients come to us right after the injury and so they enter into the very beginning of this treatment process. Others come to us later in the process, and we enter the patient further along into the plan. The sooner that a patient starts care, the better outcome they will have and the more they will regain their functionality. If you have been injured, please do not wait: even a few days can make a big difference. Make an appointment today. The clinic phones are forwarded to my cellphone after business hours, so I am available to answer your questions and we can get you set up with an appointment immediately. Don’t hesitate to call.