In 2010, I summarized the three phases of muscle injury & healing as described by Jarvinen (2005) in AJSM.
Now, a number of years have passed and a number of journal articles have been published since then but indeed, the science still remains relatively the same.
Recent and relevant articles published:
Since my thought processes and clinical experiences have evolved over the years, what I would like to do below, is provide a brief summary of practical "healing method" applications (that have worked for me) to the phases as an update to my original post. My updates will be in red.
Initial rupture and necrosis of myofibers
Hematoma formation occurs between the ruptured stumps of the myofibers
Blood vessels tear and release inflammatory cells
*Note: Repair and Remodelling Phases Are Concomitant – simultaneously supportive and competitive
In this phase, my primary objective is to protect. For protection, I want to ensure that the hematoma between the ruptured stumps do indeed form so that the two "detached ends" can reconnect if you will. The simplest method is protect from further damage. In most cases, this occurs naturally (i.e. athlete voluntarily or involuntarily removes self from competition or training). In some cases, the athlete will continue but once the activity is completed, protection should be the first priority. Additionally, it is important to incorporate lateralizations and regressions in training to minimize deconditioning and facilitate positive humoral and hormonal responses.
Relevant resources on training during injury:
Phagocytosis of necrotized tissue
Regeneration of myofibers
Production of a connective tissue scar
Capillary in-growth into injured area
My next goal is to preserve. For preservation, my goal is to initiate the healing process as soon as possible and NOT prevent inflammation from actually occurring. Traditionally, we have been trained to think that inflammation is bad yet in order for step 2 (repair) to occur, inflammation is necessary. But more specifically, what we want is "good in, bad out". Only now are we gaining insight into the negative effects of rest, icing and cryotherapy on tissue healing rates and sooner or later we'll be enlightened with the negative effects of compression as well. Those who are well read already know the value of muscle contraction on lymphatic circulation and hormonal responses post-injury. My current approach is to promote as frequent muscle contractions as possible, in as safe and protective manner as possible. Whether via simple distal extremity ABCs, digit contractions, bicycle riding, or non-fatiguing electrical stimulation, my goal is to initiate the healing process rather than delaying it (by ice and/or compression).
Recent and relevant resources on the role of inflammation on tissue healing:.
Maturation of the regenerated myofibers
Contraction and reorganization of the scar tissue
Recovery of the functional capacity of the muscle
Last, but not least, my objective here is to promote remodelling. Thanks to my friend and colleague, Dr. Andreo Spina, I have gained a better appreciation for role manual methods in influencing tissue remodelling. Research tells us that cells turn over but respond secondary to stimuli. This is common knowledge. However, from a manual therapy standpoint, applied and controlled forces applied to tissue lead to chemical signalling, interaction and communication. So whether it be via force application with our hands or progressive angular isometric loading (or other), tissues are influenced and remodelled along the lines of applied stresses. Remodelling certainly does not end with manual therapy or isometric loading but from my recent experiences, I believe it should start there. What transpires next should be left up to the discretion of the rehab clinician and/or strength coach and based on the particular athlete at hand.
Relevant resources on therapeutic application for tissue remodelling:
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