Sprain/Strain of the Soft Tissue

By Dr. Richard L. Cole, DC, DACNB, DAAPM, FICC

DIAGNOSIS: 

Your doctor has diagnosed your condition to be a soft tissue injury called a sprain/strain injury.  ConservCare doctors are well versed in this type of injury and will only carry out the treatment that is necessary for your recovery.  If your injury is determined to be outside their expertise, you will be referred to the appropriate physician.  When you hear the word sprain or strain, many people think that they are interchangeable.  This, however, is not quite true.  A strain with a “T” describes injury to muscle tissue or tendons.  Tendons attach muscle to bone.  A strain usually occurs when a muscle has been overloaded thereby causing damage to the muscle fibers or the tendon attached.  A sprain with a “P” describes an injury to the ligaments of the joint.  Ligaments attach bones to bones, usually across a joint surface.  A sprain normally occurs when a joint has been taken past its normal range of motion. When this occurs there is tearing damage in the ligament structures.  Many injuries involve both components of sprain and strain and therefore the terms are often used interchangeably.  The following will be a discussion of the current scientific understanding of tissue reaction to injury.

TREATMENT:

As doctors begin to understand how the body reacts to injury, then they can begin to understand how to assist the body in the normal healing process.  When you have soft tissue damage in the body, there is a normal healing process that the body will follow.  For the first 48 to 72 hours, the normal body response is an increase in swelling, pain, and muscle spasm in the area.  These three act as a protective mechanism to stabilize and protect the joint from further injury.  Although, these mechanisms are supported to the joint, it is imperative to use ice treatments to limit the swelling.  If too much swelling occurs, then the recovery time is lengthened.  It is also important to evaluate the injured body part and wrap it, if you can.  The acronym “rice” spelled R-I-C-E is good to remember during this phase.  It stands for rest, ice compression, and elevation.  The tissue has usually reached maximum swelling by the first 72 hours unless re-injury occurs.  The body then will pool the swelling in the area.  This is known as passive congestion.  This second phase normally lasts anywhere from five days up to three weeks depending on the severity of the initial injury.  During the first three weeks, a scar is being formed in the soft tissue structure.  Exercises are usually used in the last three phases to guide the repair process.  Physical therapies are also often used in the clinic during this phase to assist the healing process. Protection from re-injury is essential in this phase of care.  Many patients are feeling better and want to resume a normal life style.  It is essential that the doctors’ orders are followed to the letter.  Re-injury at this time will usually result in a permanent painful scar.  One of the primary concerns during scar formation is that we work diligently to prevent adhesions and a phenomenon called cross linking whereby you will lose the flexibility and the contractibility of muscle structures.  If not properly cared for, you may also lose the stability of ligament structures.  It is important to follow instructions from your doctor.  The third reaction in a normal sequence is the repair

phase.  During this time, the body removes the swelling and damaged tissue and is forming the scar mentioned earlier.  This phase will last from three to six weeks.  The final healing reaction that the body has is the remodeling phase.  During this phase, the primary portion of the scar has been formed and now that scar can be reformed and remodeled.  This will determine if the scar will be strong enough to stabilize the joint in place of the ligament structures that were damaged. 

The protocol that your doctor will use to manage the different stages of healing will be discussed with you.  It is imperative that at any time you experience a soft tissue injury you immediately contact your doctor.  He/she will be able to instruct you in proper home care.  If you have any questions for your doctor regarding your condition, please, do no hesitate to ask.