Managing soft tissue injuries

We all get soft tissue injuries from time to time – whether you’ve gone over on your ankle while out walking, or have had a mishap with a childrens toy! The end result is the same – bruising, swelling and plenty of pain. So most of us are familiar with RICE treatment: rest, ice, compression and elevation. More recently, the R-part (rest) has been debated, as completely resting an injury can actually make things worse – often the best plan is to rest immediately, but then to re-start gradual movement again.

This new approach has been captured into a new mnemonic – POLICE – which stands for:

Protection – Optimal Loading – Ice – Compression – Elevation

You can see that the last 3 are exactly the same as in RICE, but the new bits are:

Protection makes us think differently about the injured area – it makes us think that we need to avoid damaging it anymore, but it doesn’t make us think that it has to be wrapped up and immobilised indefinitely.

Optimal loading means working out what you can do, without injuring yourself any more. These non-damaging movements are known as optimal loading. Keeping tissues moving allows proteins and hormones to be released which actually promote faster healing.

The difficulty is that patients often find it hard to work out what is optimal loading, what is doing more damage, and what is resting too much.

This is where a Physiotherapist is really valuable. We can use our experience, and the feel of a tissue, in addition to what you tell us, to help you find the perfect balance – which in turn will get you back on track much sooner. We can also help to advise on protection, such as braces, crutches and supports. We will help you to build up your movement – as you heal, your optimal level of loading will change, so you need to change the intensity and power of any exercises. This needs to be done gradually and will also depend on your personal rate of healing (and general well-being).

To complement POLICE we also need to AVOID HARM for the first 48 hours!

HARM stands for:

Heat - Alcohol -  Running/exercise - Massage

HARM represents four factors that you should avoid in the early stages of injury in order to maximise healing and recovery. Whilst the concepts behind POLICE all tend to focus on minimising bleeding and swelling, the acronym HARM covers factors to avoid – all of which will increase circulation to the damaged area.

Heat will cause blood vessels to dilate which in turn will increase the flow of blood to the area.

Alcohol also has an effect of dilating blood vessels, which in turn will increase the flow of blood to the area. 

Running/exercise will cause an increase in heart rate, which in turn increases the flow of blood around the body causing blood to accumulate in the area faster. 

Massage is also thought to increase bleeding and swelling, so avoid massaging directly over the injured area. A Physio may choose to massage distal to the swelling (further down the limb) to help reduce swelling, they may also massage to help acute low back pain so there are some exceptions.

 

Physiotherapists love treating acute injuries, as they improve so quickly compared to older injuries, so it's best to get in touch sooner rather than later if you’ve hurt yourself. 

 
Kinesiology Taping

Kinesiology taping is a rehabilitative technique that is designed to facilitate the body’s natural healing process while providing support and stability to muscles and joints without restricting the body’s range of motion. It was developed in the late 70's by Dr Kenzo Kase, wo wanted a tape that provided support but didn't limit movement in the way traditional tapes do. Kinesio taping has become increasingly popular since the 2008 Olympics when one of the USA Womens Beach Volleyball members was seen using the brightly coloured tape.

Flex Physiotherapy uses 66fit branded kinesiology tape, and strongly believes this is the most effective tape available - it has a greater elasticity and adhesive, so it gives stronger support and stays on longer.

How does Kinesiology Tape work?

When the tape is applied to your body, it recoils slightly, gently lifting your skin. It is believed that this helps to create a microscopic space between your skin and the tissues underneath it.

Kinesiology taping can:

- improve pain by changing the information your sensory nervous system is sending about pain and compression in your body

- improve circulation and help with bruising

- help re-train muscles that have lost function or that have gotten used to an unhealthy way of working (eg posture)

- be used to add extra support to muscles or joints that are weak or injured

- some athletes use kinesiology taping to help them achieve peak performance and protect against injury when they’re competing in special events

66FITKTAPE5_GROUP.jpg
 
Physitrack exercises

Gone are the days of hand drawn, stick figure exercise programmes! Aimee Feck Physiotherapy uses the latest technology to enhance your treatment and motivate you with your home exercises.

PhysiTrack is a video-based exercise prescription programme that can be either printed or viewed on your own smartphone or computer. At your physio session, Aimee will prescribe your individual exercises and either print out a copy of the programme or give you your unique code to access the programme from home.

Either login to physiapp.com and enter your access code, or download the free PhysiApp (iOS and Android).

You can then view each exercise video to ensure you are performing it correctly. You can track your progress in terms of exercises completed and pain, and there is the option to set up reminders.

 

Pelvic Floor Exercises

Following is a basic example of how to perform pelvic floor exercises. If you are having trouble with this or to progress, make an appointment to discuss.

Lie on your back with your knees bent and feet flat on the floor. 
Focus on steady breathing throughout the exercise. 
To activate your pelvic floor, imagine you are trying to stop yourself from passing wind or passing urine. Squeeze and lift the pelvic floor, this is a subtle movement - the stomach and bottom muscles should be relaxed.

Try to hold for 3 - 10 seconds, rest for 10 seconds, then repeat 5 - 10 times. This is one set.

As you get the hang of this exercise, try to work up to 3 sets a day.

Following is a basic example of how to perform pelvic floor exercises. If you are having trouble with this or to progress, make an appointment to discuss.

Lie on your back with your knees bent and feet flat on the floor. 
Focus on steady breathing throughout the exercise. 
To activate your pelvic floor, imagine you are trying to stop yourself from passing wind or passing urine. Squeeze and lift the pelvic floor, this is a subtle movement - the stomach and bottom muscles should be relaxed.

Try to hold for 3 - 10 seconds, rest for 10 seconds, then repeat 5 - 10 times. This is one set.

As you get the hang of this exercise, try to work up to 3 sets a day.

 
Massage

 

Therapeutic massage seeks to obtain a therapeutic benefit. While therapeutic massage is often relaxing, the end goal of the session or series of sessions is not relaxation.

Therapeutic goals can vary considerably between massage therapists and clients. In some cases, massage is recommended by a health professional and may be performed as part of a larger treatment plan. For example, someone attending physiotherapy for an injury might have a regular therapeutic massage to loosen muscles, improve muscle tone, and increase their flexibility. Likewise, therapeutic massage can be used to supplement wound care, cancer care, and a variety of other treatments.

Therapeutic Massage is a combination of Relaxation Massage and Remedial Massage to not only relax your whole body but at the same time, work through some of the muscle issues or “tight spots” you may be experiencing.

Massage therapy may also improve your circulation, which enhances the delivery of oxygen and nutrients to muscle cells and helps remove waste products or reduce swelling. These circulatory effects of massage may have value in the treatment of some inflammatory conditions, such as arthritis.

Massage therapy induces a relaxation response, which lowers your heart rate, breathing rate, and blood pressure; plus boosts your immune system; and generally decreases the physical effects of stress.

 
Older Adults

As we age our body inevitably goes through many physical changes. These natural age related changes include reduced bone density, reduced muscle strength, increased body fat, poorer coordination and stiffer joints. These normal effects of ageing can affect older people’s mobility and balance and make them more likely to fall and break bones. Older people also become more susceptible illness such as heart disease, high blood pressure, stroke, diabetes, arthritis and lung diseases such as chronic obstructive pulmonary disease. All of this can have a big impact on their daily lives and reduce their independence. For example elderly people often feel that they are not as quick and steady on their feet as they used to be and find that stairs are more difficult. This can then affect their ability to get out and about and lead to reduced independence.

 

However, we do not have to accept this as an inevitable part of ageing. While physiotherapy cannot stop ageing it can help to reduce the impact that it has on our bodies and our lives. Physiotherapists are trained to identify physical and other factors that prevent people from being as active and independent as they can be, and then they find ways of overcoming them. This makes them ideally placed to help older people stay as active as they can be. In fact physiotherapy has been shown to improve many of the factors associated with ageing including strength, balance, coordination, flexibility and pain levels. Ultimately physiotherapy has been proven by research to help older adults to maintain their health, well-being, functional ability and independence.