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Scar Tissue and Its Role in Injury and Recovery

By Dr. Young Pham Texas Sports Medicine & Wellness Center o you've pulled or strained your muscle. You've rested for a few weeks only to find that once you've resumed activity again, the injured muscle still hurts. You've seen your Family Doctor and Orthopedic only to realize that they can't help you. Scenarios like this occur too often and can be very frustrating. What do you do? Muscle, ligament and tendon sprain/strains are the most common types of soft tissue injuries that occur on and off the field. Certain sports and activities lead to an over-stretch or overexertion of soft tissue structures. A lack of conditioning, flexibility and warm up can also contribute to these soft tissue injuries. Once injured, scar tissue plays a vital role in recovery and healing of the injury. Without scar tissue, your body won't heal. However, too much scar tissue or an improper foundation of scar tissue can lead to re-injury and prolonged recovery.

1. The Acute Stage

Also called the inflammatory stage, the acute stage occurs at the time of the injury, and may continue for up to 3-4 days. During the acute stage, inflammation occurs. The purpose of this process is to neutralize toxins and to clean up damaged tissue so that the repair process (which occurs in later stages) can begin. Although this stage is an important process of healing, studies show that too much inflammation or swelling can prolong and inhibit healing and recovery. Scar tissue begins to form during the inflammatory stage. Ice, rest and gentle movement, along with therapy procedures and anti-inflammatory drugs are generally recommended during this stage of healing.

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2. The Sub-Acute Stage

The sub-acute stage of healing takes place between the 4th to the 21st day after the injury. By now, repair of the injury has already begun and is marked by new growth of connective tissue and capillaries. Scar tissue continues to grow during this time. Injured soft tissues in this stage are very fragile, so placing stress on the area is best limited to a therapist or doctor. That is why visits to a therapy specialist, and adherence to specific care instructions are crucial for healing. Treatment protocols, which may include tissue manipulation, massage and ultrasound, will help to promote proper healing of the injured site. During this stage physiotherapists or doctors may recommend that the patient begin with gentle movement and gradually build up intensity. Mild isometric exercise may be appropriate. Because heavy lifting or activity is still restricted during the subacute phase, muscle weakness or atrophy may occur.

Stages of Healing

Healing of an injury occur in 3 main stages. In each, different things are happening at the injury site, and specific treatment protocols are administered at certain stages to ensure proper healing and resuming of normal activities.

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3. The Chronic Stage

The chronic stage of healing begins after 21 days, and may continue for some time. This is the period when the patient takes the most active role in his/her recovery. During the chronic stage of injury healing, scar tissue is remodeled by the stresses placed on it. This means that the activities and exercises the patient is taken through will affect where scar tissue strength will be located.

The Problem with Scar Tissue

When a muscle is torn or strained, scar tissue begins to form. Untreated scar tissue is the major cause of re-injury, sometimes months after the initial injury. Scar tissue once formed, binds itself to the damaged soft tissue fibers in an effort to draw the damaged fibers back together for repair. You can say that scar tissue is like the bodies natural "super glue" that binds broken pieces together. However, what results sometimes is a bulky mass of fibrous scar tissue completely surrounding the injury site. Scar tissue is a very weak inflexible material and has a tendency to contract and deform the surrounding tissues. So what does this mean for the athlete? First, it means a shortening of muscle, tendon or ligament, which results in a loss of flexibility. Second, it means a weak spot has formed within the soft tissues, which could easily result in further damage. It is much easier to properly heal an injury by creating a good foundation early, as opposed to treating the injury once improper healing has taken place. Studies have shown that therapy protocols administered early reduce recovery time and decrease risk of re-injury. Certain tissue techniques and therapy modalities will be used by the physiotherapist or doctor depending on the injury, severity, and location of the injury. With this brief overview of the different stages of healing and the role scar tissue plays in recovery, it can easily be understood how administering proper treatment of soft tissue injuries early and aggressively provide a proper foundation to build on. This promotes proper healing, minimizes recovery time and decreases the risk of re-injury. Setting yourself up for success rather than failure should be paramount in injury recovery. After all, who wants to be sidelined with an injury when all it takes to get better is a little bit of knowledge, commitment, determination and of course a little bit of TLC. n

The First 72 Hours and Getting rid of the Scar Tissue

Without a doubt, the most effective, initial treatment for soft tissue injuries is the R.I.C.E. regime. This involves the administering of (R) rest, (I) ice, (C) compression and (E) elevation. The early application of the R.I.C.E. technique during the acute stage of healing has been shown to significantly reduce recovery time. R.I.C.E. forms the first, and perhaps the most important stage of injury rehabilitation, promoting the early foundation for proper healing and recovery. To limit and remove the unwanted scar tissue, it is vital that therapy procedures are administered early and a course of deep tissue massage is started during the sub-acute phase of healing.

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