Whiplash 101

The little brain that could

Life has been amazing and I wanted to update those who have wondered what happened to me.

I matriculated at Oxford October 15th. As the physician from Cambridge standing beside me so aptly stated, it was my ultimate screw you, I made it anyway statement to the world… from a person with a TBI… Others can make it too, the race does not always fall to the fastest and the brightest. The determined ones that persevere also have a place but they procure it at great cost, almost never without opposition and always with help from those that surround them with hope and compassion. The greater price in my eyes was to remain a dependent victim without respect or autonomy. I was spurred on to not accept the victim mentality but to reach higher just as I was until I could do better, with the help of God I shall continue… Really thankful to Oxford for accepting me, their kind ,helpful support is awesome…

I got here through some unusual circumstances which just goes to show that even when you think it is over destiny  is waiting to be claimed.

My first challenge  came when I was dumped without pay by a spinal organization who decided to focus on being a patient’s rights org to promote non FDA approved  stem cells paid for by vulnerable patients. There was ethical  disagreement and I was devastated. I was later to take neuroscience, genomics, bioethics  and some cell biology  courses where I learned how fortunate I was to escape. At the same time the university I applied to had funds cut and the department that welcomed me was phased out.

My sponsors and friends urged me to apply to Oxford. At first I was too discouraged to try but then  I saw the Center for Evidence Based Medicine. This was exactly what I was looking for  as I determined to find ways to put evidence into practice. I applied and was accepted.

It is interesting here at Oxford, they are gracious and incorporate an atmosphere of learning without disdain. It is a haven for curious outspoken people to share ideas and an Oasis for those of us who want to do science and medicine with ethics and excellence.

Aaron and Thomas, our classmates arranged for us to go to a lovely dinner at St Cross…my first. I ended up sitting next to the college Master,  Sir Mark Jones,  he was a great dinner companion and very charming. His friend was a medical professor who has also taken some EBM classes. We shared with them that EBHC was positioned to benefit and influence the world even to third world countries.

From this meeting I learned ways in which insulin could be kept cold in villages in Asia with no electricity. We can build solar refrigerators for very little money and the people can run them. It will save lives. In my life patients, principles and people matter.

Those of us from EBHC shared how we got there and some of our backgrounds it was beautiful to see how each of us will have the opportunity to be a change maker in our corners of the world.

I want to encourage you all to follow your dream and  remember there is a place for you!

 By Richard DonTigney

The lack of movement in the sacroiliac joint is a myth. When walking the pelvis moves obliquely to the line of travel, to increase the length of the stride. The sacrum moves on the asymmetric pelvis to drive counter rotation of the trunk to decrease loading forces. Pelvic dynamics has profound effects on normal gait.  

The joint is vulnerable to injury through minor trauma only in anterior rotation of the innominates on the sacrum.  Idiopathic low back pain is a commonly overlooked, reversible dysfunction in anterior rotation, usually bilateral.   A diagnosis of dysfunction can be made simply by identifying a single painful point at the posterior inferior iliac spine that is caused by a vertical shear on the conjoint origin of the piriformis muscle and tearing of the capsule at S3. See pain patterns here. The anterior rotation will loosen the iliolumbar ligaments, destabilize L4,5-S1 and increase shear and torsion shear to the disks.  Correction restores stability.

Full correction in posterior rotation will provide immediate relief of pain.  More than three treatments are seldom necessary.  Stabilization of the unstable SIJ can be obtained with five to six sessions of prolo specifically to the long posterior sacroiliac ligaments.  Prolo to the iliolumbar ligaments without correction of the SIJ first can tighten the joint in the uncorrected position and may prevent correction.

Anyone not properly treating dysfunction of the sacroiliac joint is perpetuating chronic low back pain.  X-rays of innominate movement on the sacrum are published on-line at www.thelowback.com/how.htm#movement

Pool Spine Workout

By Amy Price PhD

Chronic pain and balance can be improved with water exercise. Exercise releases feel good chemicals in the brain that are powerful mood booster and pain fighters. These neurochemicals help balance mood swings and the other benefits are looking better and having a body that burns fat more effectively. Many spinal patients can’t get the exercise they need because they find exercise painful torture so they lied down on the couch with a snack until feelings (mostly guilt) about exercise go away. This perpetuates the cycle as muscles and joint get stiff and lose flexibility, loss of muscle means less fat is burned and guilt and low energy levels steal that feel good feeling.  

Water provides a safe medium for joints and working in water improves balance. Be sure to choose a warm place for your water workout to avoid muscle spasms.  Afterwards a hot bath with a couple of cups of epsom salts included can provides an inexpensive muscle soothing experience. The NCPAD  has some great information on how to get started and exercise in water safely. Here are more aquatic exercises   . If you are a swimmer add some power to your water workout with swim fins for the feet and  hands.  

The buoyancy of water reduces the “weight” of a person by about 90%, (at least while in the water!) which means that the stress on weight bearing joints, bones and muscles is lessened. That’s why aqua exercies are good for people with arthritis or back problems. You still get a great work out, it just doesn’t hurt! Water exercise can encompass all of the components of fitness: cardiovascular fitness, muscular strength and endurance, and flexibility. And, when done regularly, water exercise can help reduce body fat 

Need some help with diet too? Check out this information on diet for pain relief and clear thinking here 

Richard Don Tigny , used by permission

Richard DonTigny SI Solutions used by permission

This  SI Joint information was graciously supplied by  Richard DonTigny, a well known leader in this field from Havre Montana.  Many individuals constantly go to a chiropractor to have them adjust this area but it can be very effective to learn how to gently and accurately self correct with the advantage of bringing almost immediate pain relief. Richard DonTigny has a great website where you can get detailed well explained  information and even purchase  video materials on how to get these corrections working for you.  

On the right are basic  techniques to reset the SI area. The first one will look familiar to those of you familiar with post-isometric relaxation or muscle energy technique. This series of images, shows different positions in which to do the same basic exercise. They can even be done standing up in an airplane corridor! 

 The instructions are to bring your leg up to the chest, grasp the leg with both arms, and push outward with the leg against resistance. DonTigny recommends pushing outward hard for five to 10 seconds, then alternating legs, doing each side three to five times. Note that this can be done supine, sitting, standing using a chair, or in a doorway 

 The next offering is a self traction correction.  I like this one as it can even be done lying in bed. When doing any of these exercises in the supine position be certain to hold your abdominal muscles tight when raising or lowering your leg to prevent anterior rotation of the pelvis.  There is a first class video  available for Richard Don Tigny with print out exercises which is available from the  Dynamic Core Program CD for patients. 

 Richard DonTigny  makes excellent additional  seldom heard points regarding SI dysfunction.1)Periarticular injections are superior to intra-articular injections for diagnosis of SIJ dysfunction.(2) Murakami Fukushima (3) found that many times cervical strain will not release until the SIJ is corrected. (I have certainly found this to be accurate) 

 The last form of correction is in the color photo on the left hand side. You can  self-correct any time during the day no matter what position he happens to be in at the time. Just by pulling the knee into the axilla or bringing the axilla down to the knee. Stretch firmly several times on each side, alternating sides each time. Remember to hold those abdominals tight as you raise and lower your leg for protection against an anterior pelvis rotation. 

  Stretching the psoas is usually counter productive as a dysfunction of the SIJ will cause the psoas to become tight while correction of the dysfunction will loosen it.  If you stretch the psoas you will increase the dysfunction in anterior rotation of the psoas. Similarly the SIJ dysfunction will cause a vertical shear on the piriformis at the S3 segment. Correction of the dysfunction corrects and relieves the vertical shear.  The piriformis, the G. max and the iliacus all have origins on both the sacrum and the ilia.  The shear is the cause of the piriformis syndrome.   Similarly the sacral origin of the G. Max will tend to separate from its ilial origin and the ilial origin of the iliacus will tend to separate from a small slip on the sacrum. 

 References: 

 1.DonTigny, RL: A detailed and critical biomechanical analysis of the sacroiliac joints and relevant kinesiology: the implications for lumbopelvic function and dysfunction.  In Vleeming A, Mooney V, Stoeckart R: Movement, Stability& Lumbopelvic Pain: Integration of Research and Therapy. 2nd edition. Edinburgh, Churchill Livingstone, 2007, Chapter 18, pp 265-278 

 2.  Murakami E, Tanaka Y, Aizawa T, Ishizuka M, Kokubun S: Effect of periarticular and intraarticular lidocaine injections for sacroiliac joint pain: Prospective comparative study.J of Ortho Science  12(3):274-280, May 2007 

 3.  Fukushima M: Radiographic findings before and after manual therapy for acute neck pain. International Musculoskeletal Medicine, 30(1): 1-19, 2008

cold light laser

 By Amy Price PhD

Laser  therapy has been reported helpful in wound healing and chronic pain. It is a fast, painless modality which can be administered by a medical professional or self administered in some localities by a patient trained and licensed in laser protocol. The light that the laser uses is not visible to the naked eye and special laser light spectrum goggles are needed. They are sensitive to the spectrum of the laser used. According to the Cochrane report results for wound healing and chronic pain relief are evident however more study is needed to determine protocols for effectual wave lengths and time exposure 

What is a cold light laser?

Low-level laser light is compressed light of a wavelength from the cold, red part of the spectrum of electromagnetic radiation. It is different from natural light in that it is one precise color; it is coherent (it travels in a straight line), monochromatic (a single wavelength) and polarized (it concentrates its beam in a defined location or spot). These properties allow laser light to penetrate the surface of the skin with no heating effect, no damage to the skin and no known side effects. Rather, laser light directs biostimulative light energy to the body’s cells which the cells then convert into chemical energy to promote natural healing and pain relief. 

These are ways laser treatment has been found to help

Speeds Up Tissue Repair:   Increased energy to the cells means increased cellular activity for all of the cell’s components that rely on this energy including collagen formation. Speeding up tissue repair  means less scar tissue formation. 

Increases Endorphins: Endorphins can  produce analgesia (pain relief) and feelings of well-being. They are known as the bodies natural  pain killers. 

Increased Lymphatic Drainage:  Studies have shown that cold laser therapy can increase the size of the lymphatic ducts thus facilitating protein waste removal. 

Increased Blood Flow: to the tissues because of increased capillary formation. This helps healing. The laser affects deeper tissues as well including  muscles and tendons. 

It appears Laser can generate  relief for chronic pain treatment

Relieve nerve pain and trigger points without surgery or chemicals

By Amy Price PhD

IMS is similar to acupuncture except that the treatment does not rely totally on meridians but is based on a physicians training in anatomy. trigger points and the central nervous system. It can be treatment orientated as well as a useful minimally invasive diagnostic tool for neuropathic muscle pain.

Trauma and chronic pain often produces muscle shortening. These shortened muscles can press on and irritate the nerve. Even though this pressure may seem slight and be difficult to measure it can be the source of excruciating pain. This pressure builds up over time causing all kinds of problems like making the nervous system super sensitive. This can cause sensitivity to pain in other areas of the body. To get an idea of how this works think about wearing a pair of slightly snug shoes. At first you feel nothing but as the day goes on that slight pressure becomes something that can not be ignored. With the shoes you can rip them off and toss them into the trash, but when pressure mounts inside the muscle pushing on the nerve there is nowhere for it to go.

IMS works on the premise that supersensitive area can be desensitized. IMS releases muscle shortening by dry needling the sensitive areas with tiny acupuncture needles. Penetration of a normal muscle is relatively painless however an afflicted muscle responds to the needle with a slight cramping sensation. This stimulates a ‘stretch receptor’ which produces a reflex relaxation response resulting in a lengthening of that muscle fiber. The needle also causes an electric potential which travels to the nerve and potentially resets it to normal function. The other thing that happens is the needle produces a minute wound which causes increased blood flow to the area to enhance circulation and initiate healing. For FAQs about IMS or research links click here Does it work? The answer seems to be that for some people it does. For research links  New treatments with prolotherapy and adult stem cell treatment may produce results. Diet can help with pain Specific supplements can help ligaments and tendons heal to take the stress off overworked muscles

Psoas Muscle Location

By Amy Price PhD

 

Stretching Psoas can alleviate back and hip pain

                                       

The psoas muscle starts in the lower back at which point the paired psoas muscles act as anchors on either side of  the spine. These muscles wrap around the pelvic area attaching at the knobby part of the hip with several strong tendons. The psoas muscles are considered to be crucial among the hip flexor muscles. Hip flexors allow people to bend their bodies into their hips and to pull their hips into their bodies. Low back or hip pain can come from  contracted psoas muscles which fail to provide  support. They can gently stretch to elongate their muscles and make them more flexible, as well as seeking medical attention if the pain continues, grows worse, or changes. Engaging in a regular physical fitness routine which includes stretching such as Pilates or Yoga will help to keep the psoas muscle aligned, strong, and flexible, along with other vital muscles of the body.

  A gentle psoas stretch, involves lying on your back on the floor. Make sure that your pelvic position is neutral, your shoulder blades are flush with the floor, with your spine and head aligned, forming a straight, smooth line. Gently bring one knee up to your chest while extending the other leg along the floor, breathing deeply and evenly. Hold the position for 10 breaths before switching sides, and repeat 3 times. You should feel a gentle stretching action but not pain

 For a deeper psoas stretch, adopt a lunging position with one knee forward, forming a 90 degree angle, if possible, between the hip and the calf. Extend the other leg behind you, kneeling slightly, and lower yourself slowly into the stretch, which you will feel in the front of the hip. Make sure you don’t increase the curve in your back as you come forward (the Psoas connects the back with the front of the hip).  Sometimes it helps to tighten the stomach muscles as you come

Please Consult Your medical professional before stretching the psoas, In some cases psoas stretches can be counterproductive

Richard Don Tigney  referenced below states,  “Stretching the psoas is usually counter productive as a dysfunction of the SIJ will cause the psoas to become tight while correction of the dysfunction will loosen it.  If you stretch the psoas you will increase the dysfunction in anterior rotation of the psoas.

Similarly the SIJ dysfunction will cause a vertical shear on the piriformis at the S3 segment. Correction of the dysfunction corrects and relieves the vertical shear.  The piriformis, the G. max and the iliacus all have origins on both the sacrum and the ilia.  The shear is the cause of the piriformis syndrome.   Similarly the sacral origin of the G. Max will tend to separate from its ilial origin and the ilial origin of the iliacus m will tend to separate from a small slip on the sacrum.(1)

Periarticular injections are superior to intra-articular injections for diagnosis of SIJ dysfunction.(2)Murakami

Fukushima (3) found that many times cervical strain will not release until the SIJ is corrected.”

References:

 1.   DonTigny, RL: A detailed and critical biomechanical analysis of the sacroiliac joints and relevant kinesiology: the implications for lumbopelvic function and dysfunction.  In Vleeming A, Mooney V, Stoeckart R: Movement, Stability& Lumbopelvic Pain: Integration of Research and Therapy. 2nd edition. Edinburgh, Churchill Livingstone, 2007, Chapter 18, pp 265-278

2.  Murakami E, Tanaka Y, Aizawa T, Ishizuka M, Kokubun S: Effect of periarticular and intraarticular lidocaine injections for sacroiliac joint pain: Prospective comparative study.J of Ortho Science  12(3):274-280, May 2007

3.  Fukushima M: Radiographic findings before and after manual therapy for acute neck pain. International Musculoskeletal Medicine, 30(1): 1-19, 2008

If you suffer from piriformis syndrome or are seeking to prevent its occurrence it is important to follow the information in this article. In addition, making stretching a part of your fitness regime will have a significant impact.

What is the Piriformis?
The piriformis is a small muscle located deep within the hip and buttocks region. It connects the sacrum (lower region of the spine) to the top of the femur (thigh bone) and aids in external rotation (turning out) of the hip joint.

Piriformis

As you can see from the diagram to the right, there are many muscles and tendons that make up the hip and buttocks region. The diagram shows the posterior (rear) view of the buttock. The piriformis is the horizontal muscle in the center of the picture running over the top of the sciatic nerve.

What Causes Piriformis Syndrome?
Piriformis syndrome is predominantly caused by a shortening or tightening of the piriformis muscle, and while many things can be attributed to this, they can all be categorized into two main groups: Overload (or training errors); and Biomechanical Inefficiencies.

Overload (or training errors): Piriformis syndrome is commonly associated with sports that require a lot of running, change of direction or weight bearing activity. However, piriformis syndrome is not only found in athletes. In fact, a large proportion of reported cases occur in people who lead a sedentary lifestyle. Other overload causes include:

• Exercising on hard surfaces, like concrete;
• Exercising on uneven ground;
• Beginning an exercise program after a long lay-off period;
• Increasing exercise intensity or duration too quickly;
• Exercising in worn out or ill fitting shoes; and
• Sitting for long periods of time.

Biomechanical Inefficiencies: The major biomechanical inefficiencies contributing to piriformis syndrome are faulty foot and body mechanics, gait disturbances and poor posture or sitting habits. Other causes can include spinal problems like herniated discs and spinal stenosis. Other biomechanical causes include:

• Poor running or walking mechanics;
• Tight, stiff muscles in the lower back, hips and buttocks;
• Running or walking with your toes pointed out.

Symptoms
Pain (or a dull ache) is the most common and obvious symptom associated with piriformis syndrome. This is most often experienced deep within the hip and buttocks region, but can also be experienced anywhere from the lower back to the lower leg.

Weakness, stiffness and a general restriction of movement are also quite common in sufferers of piriformis syndrome. Even tingling and numbness in the legs can be experienced.

Treatment
Piriformis syndrome is a soft tissue injury of the piriformis muscle and therefore should be treated like any other soft tissue injury. Immediately following an injury, or at the onset of pain, the R.I.C.E.R. regime should be employed. This involves Rest, Ice, Compression, Elevation, and Referral to an appropriate professional for an accurate diagnosis.

It is critical that the R.I.C.E.R. regime be implemented for at least the first 48 to 72 hours. Doing this will give you the best possible chance of a complete and full recovery.

The next phase of treatment (after the first 48 to 72 hours) involves a number of physiotherapy techniques. The application of heat and massage is one of the most effective treatments for removing scar tissue and speeding up the healing process of the muscles and tendons.

Once most of the pain has been reduced, it is time to move onto the rehabilitation phase of your treatment. The main aim of this phase is to regain the strength, power, endurance and flexibility of the muscles and tendons that have been injured.

Prevention
Prevention is the key when it comes to piriformis syndrome. The more you can do to prevent it, the better off you’ll be. There are a number of preventative techniques that will help to prevent piriformis syndrome, including modifying equipment or sitting positions, taking extended rests and even learning new routines for repetitive activities. However, there are four preventative measures that I feel are far more important and effective.

First, a thorough and correct warm up will help to prepare the muscles and tendons for any activity to come. Without a proper warm up the muscles and tendons will be tight and stiff. There will be limited blood flow to the hip area, which will result in a lack of oxygen and nutrients for the muscles. This is a sure-fire recipe for a muscle or tendon injury.

Before any activity be sure to thoroughly warm up all the muscles and tendons that will be used during your sport or activity.

Second, rest and recovery are extremely important; especially for athletes or individuals whose lifestyle involves strenuous physical activity. Be sure to let your muscles rest and recover after heavy physical activity.

Third, strengthening and conditioning the muscles of the hips, buttocks and lower back will also help to prevent piriformis syndrome.

Fourth, (and most importantly) flexible muscles and tendons are extremely important in the prevention of most strain or sprain injuries. When muscles and tendons are flexible and supple, they are able to move and perform without being over stretched. If however, your muscles and tendons are tight and stiff, it is quite easy for those muscles and tendons to be pushed beyond their natural range of movement. When this happens, strains, sprains, and pulled muscles occur.

To keep your muscles and tendons flexible and supple, it is important to undertake a structured stretching routine. I’ve included two effective piriformis stretches below.

	Sit with one leg straight out in front. Hold onto the ankle of your other leg and pull it directly towards your chest.
	Lie face down and bend one leg under your stomach, then lean towards the ground.

Stretching is one of the most under-utilized techniques for improving athletic performance and getting rid of those annoying sports injuries. Don’t make the mistake of thinking that something as simple as stretching won’t be effective

———————————————————–
Article by Brad Walker. Brad is a leading stretching and
sports injury consultant with nearly 20 years experience
in the health and fitness industry. For more articles on
stretching, flexibility and sports injury, please visit
The Stretching Institute.
———————————————————–

Ligament injury refers pain see chart

 By Amy Price PhD

The ligaments act like duct tape to hold our bones and joints together.  When ligaments lose their elasticity the bones and joints move too much and irritate the structures around them. Ligaments provide boundaries for movement.  For example when we bend our fingers backwards the ligaments will stop us from pushing them too far back and breaking the bones. It is this way with most of the joints in our bodies. The ligaments cause them to work within a safe range of motion. When one of the ligaments is torn or stretched, the excess movement will cause pain and swelling. In an injured joint and you may notice more popping, cracking or even a grinding feeling.  The joint may have become unstable.

 In the neck and spine, ligaments are crucial for holding vertebrae together. Spinal ligaments are especially vulnerable to overstretching or tears in a car wreck.  If you experience these symptoms after a wreck you may want to be examined for a ligament injury:

•             popping, cracking, or grinding in the neck with movement

•             pain or spasms that get much worse with activity

•             Numbness or tingling into the hand(s) or feet that gets worse with activity or accompanied by popping, cracking, or grinding.

 Flexion-extension x-rays, or digital motion x-rays can be a good way to help diagnose ligament instability.  A good physician will want to test the spine segment by segment to test for stability and this is  an essential step for enabling accurate treatment. The diagram above shows some of the ways ligament pain is referred in the neck area. For referred pain in other body areas look at our dermatome pages

Treatment usually proceeds as follows:

•             Specially trained medical practitioners such as Chiropractors or Osteopaths can mobilize any stiff segments that may be overloading the unstable segment

•             Posture Training can improve stability, injury can increase tightening of muscle structures which can cause guarding of the painful area. This throws posture off balance and  can aggravate instability.

•             Strengthen any weak, deep supporting muscles (like multifidus) that may be allowing too much movement. Core strength exercise like modified Pilates with the guidance of a trained physiotherapist can be helpful

•             Don’t be talked into mobilizing or manipulating an unstable segment as this can bring a temporary improvement but over time can make things worse. Sometimes bracing is used and while this may seem like a good solution to reduce pain initially prolonged bracing can cause further weakening of the surrounding muscles and later slow recovery.

•             Prolotherapy may prove helpful, adult stem cell therapy using your own cells has been reasonably successful in initial trials.

•             Surgical stabilization is sometimes used when no other treatment brings improvement.

 Can scar tissue affect recovery & re-injury
of pulled muscles and sports injuries? 

So you’ve pulled a muscle? Over-stretched it, torn it, strained it, sprained it. Call it what you want. From an injury point of view, the initial healing process is all the same.

Sprains (ligament) and strains (muscle or tendon) are the most common type of soft tissue sports injury and are often caused by activities that require the muscles to stretch and contract at the same time. A lack of conditioning, flexibility and warm up can also contribute.

While most people are well aware of the importance of applying the R.I.C.E. regime to a sprain or strain in the first 48 to 72 hours, it’s after this that most people get stuck. Let’s start by having a look at what happens during those first 72 hours and then move onto what’s needed for a full recovery.

The First 72 Hours
Without a doubt, the most effective, initial treatment for soft tissue injury is the R.I.C.E.R. regime. This involves the application of (R) rest, (I) ice, (C) compression, (E) elevation and obtaining a (R) referral for appropriate medical treatment.

Where the R.I.C.E.R. regime has been used immediately after the occurrence of an injury, it has been shown to significantly reduce recovery time. R.I.C.E.R. forms the first, and perhaps most important stage of injury rehabilitation, providing the early base for the complete recovery of injury.

The diagram below is a comparison of the same injury treated with the R.I.C.E.R. regime and without. The top row of pictures show the effects of a soft tissue injury when the R.I.C.E.R. regime is not used. While the bottom row of pictures show the effects of a soft tissue injury when the R.I.C.E.R. regime is used.

The first diagram in the series shows a rupture in the soft tissue immediately following an injury. 24 hours later, when R.I.C.E.R. has not been used, there is a large amount of uncontrolled bleeding and swelling. However, in the bottom diagram, the application of rest, ice, compression and elevation has significantly reduced the amount of bleeding and swelling.

The Problem with Scar Tissue

When a muscle is torn, you would expect that the body would repair that tear with new muscle. In reality, this doesn’t happen. The tear, or rupture, is repaired with scar tissue. As you can see with the final diagram on the right hand side, when the R.I.C.E.R. regime is used, this limits the formation of scar tissue.

Now this might not sound like a big deal, but if you have ever suffered a soft tissue injury, you’ll know how annoying it is to keep re-injuring that same old injury, over and over again. Untreated scar tissue is the major cause of re-injury, usually months after you thought that injury had fully healed.

Scar tissue is made from a very brittle, inflexible fibrous material. This fibrous material binds itself to the damaged soft tissue fibers in an effort to draw the damaged fibers back together. What results is a bulky mass of fibrous scar tissue completely surrounding the injury site. In some cases it’s even possible to see and feel this bulky mass under the skin.

When scar tissue forms around an injury site, it is never as strong as the tissue it replaces. It also has a tendency to contract and deform the surrounding tissues, so not only is the strength of the tissue diminished, but flexibility of the tissue is also compromised.

So what does this mean for the athlete? Firstly, it means a shortening of the soft tissues which results in a loss of flexibility. Secondly, it means a weak spot has formed within the soft tissues, which could easily result in further damage.

Lastly, the formation of scar tissue will result in a loss of strength and power. For a muscle to attain full power it must be fully stretched before contraction. Both the shortening effect and weakening of the tissues means that a full stretch and optimum contraction is not possible.

Getting rid of the Scar Tissue
To remove the unwanted scar tissue it is vital that you start a course of deep tissue sports massage. While ultrasound and heat will help the injured area, they will not remove the scar tissue. Only massage will do that.

Either find someone who can massage the effected area for you, or if the injury is accessible, massage the damaged tissues yourself. Doing this yourself has the advantage of knowing just how hard and deep you need to massage.

To start with, the area will be quite tender. Start with a light stroke and gradually increase the pressure until you’re able to use deep, firm strokes. The more you massage the effected area the harder and deeper you will be able to push. See a video demonstration and more tips here

Use deep, firm strokes, moving in the direction of the muscle fibers. Concentrate your effort at the direct point of injury, and use your thumbs to get in as deep as possible to break down the scar tissue.

A few final points before finishing up. Be sure to drink plenty of fluid during your injury rehabilitation. The extra fluid will help to flush a lot of the waste products from your body.

Also, I recommend you purchase a special ointment to use for your massage called “Arnica”. This special ointment is extremely effective in treating soft tissue injuries, like sprains, strains and tears. You can purchase this ointment at most health food shops and pharmacies.

To Stretch or not to Stretch
During this phase of the rehabilitation process NO STRETCHING should be used at all! This is not the time to start stretching. Concentrate on the R.I.C.E.R. regime and avoid all stretching or any activity that puts stress on the injured area. Stretching during this early stage of the rehabilitation process will only cause more damage to the injured tissues. Avoid stretching during the first 72 hours. Click here for a more detailed article on how to use stretching for injury rehabilitation.

———————————————————–
Article by Brad Walker. Brad is a leading stretching and
sports injury consultant with nearly 20 years experience
in the health and fitness industry. For more articles on
stretching, flexibility and sports injury, please visit
The Stretching Institute.
———————————————————–