3. The Osteopathic Recovery Process For Acute Injuries
If you move and feel a sharp, acute pain somewhere in your body, consider the options that are available to you:
(a) Do nothing or take some pain-killers and hope it recovers fully giving you no problems in the future
(b) Seek expert help and contact your osteopath (or other healthcare professional trained in differential diagnosis and treatment of musculo-skeletal conditions)
It is usually easier to offer a prognosis for acute injuries rather than chronic (more than 6 weeks of pain) or postural complaints because of the type of inflammation and repair process that is involved. Here is a typical prognosis:
After the initial pain, a local bleeding of the damaged structure typically occurs for anything between 1 to 8 hours.
The inflammation process reaches its peak by around 24-48 hours after injury. This is why the application of ice over the first 24-48 hours is important to help control pain and excessive swelling. Too much heat should be avoided at this stage.
After 48 hours, new tissue starts to be laid down and the pain from inflammation should be at a peak.
After 2-3 weeks, the inflammation should be ceasing and tissue replacement is now peaking.
At 6 weeks most injured areas are now stable, stronger and generally pain free. If inflammation is still persistent it is now termed 'chronic'.
After 2-3 months, tissue deposition is complete and re-modelling of the new tissue continues for a year or more.
With acute injuries, pain is associated with inflammation, and stiffness is associated with oedema or new tissue deposition as it tries to re-model itself to function more effectively. Inflammation is very important, as this is the process that heals the injured area. Without inflammation, healing will not take place, so this early acute inflammatory phase is the "high quality" process that we need to harness and attempt to optimise. Anti-inflammatory drugs can decrease pain and inflammation, but they do not "heal" the injury as such (and if you are receiving low level laser therapy, they will counteract each other).
After excluding serious pathology, the first osteopathic treatment session will create a stable base for the injury to recover and make it more comfortable. Severe or strong techniques are usually avoided at this point as we do not want to 'rip' an already damaged tissue. Developing directions of movement, increasing appropriate mobility and decreasing swelling are more important.
The second treatment session is typically 2-5 days later as the response from the initial treatment and the inflammation process will be passing through their peaks. Sharp pain should have improved, but stiffness will still be present. The continuing inflammation process lasts for about 2-3 weeks, so there is still ample opportunity to make the best of it.
There is a window of time that usually gives me cause for concern at 10-14 days when the inflammation has nearly resolved itself and the pain is reducing. At this point, the area may be stiff and vulnerable and the patient becomes too careless or over-confident and then damages it again. This is usually before the time of the 3rd appointment at around 14 days.
By the start of the 3rd week, inflammation should be almost complete. The next treatment stage is to continue the management of the new tissue deposition which is peaking as the inflammation subsides.
Treatment is now gearing towards re-modelling this new tissue and consequently the time between appointments is now increased. For example, if there is sufficient improvement, the next appointment could be "doubled-out" to 2-3 weeks, the following session then becomes 4-6 weeks and then the final session is 2-3 months.
These re-modelling sessions are the fine tunings of the injured area and its compensations after the inflammation and repair process has ceased.
No tissue becomes truly 100% perfect as some scar tissue will always prevail at the original site of injury, but 99% should be achievable. Also be aware that if an area has been injured once, it can be injured again. So if it was at 99%, next time it may reach 98% with appropriate treatment. If an area has not been rehabilitated quickly or effectively, other structures in the same area will have greater loads placed upon them and then they too can become susceptible to injury. A common occurence is "second injury syndrome" whereby another structure fails as the original injury has not yet been fully rehabilitated.
One final thought... have you ever said the following to yourself?
"I should have done something about this pain sooner..."
Marc Jones, BSc(Hons) Ost,
Registered Osteopath & Clinic Principal
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