Post-injury therapy is key to recovery
Russell Gunner, C.A.T. (C)

Special to CBC News

It's that time of year again when Canadians everywhere begin to head back outdoors. You will begin to see more and more people emerging, after months spent indoors, and starting to do things they haven't done all winter.
As you increase your activity, you increase the risk of injury. When an injury does occur, most of us won't necessarily know what to do, or even what our options are.

Perhaps you've heard some of your more active friends say something like "I went for therapy for my shoulder." You're pretty sure the therapy wasn't psychological, but you might not be sure exactly what kind of therapy a shoulder undergoes.

I've been performing athletic therapy for more than 19 years, and I often see athletes who will wait several weeks or months after injuring themselves before they decide to seek treatment. It might be human nature to say to yourself, "I'll leave it, and it will just go away."

You could be right, but you might be setting yourself up for trouble. It doesn't take a rocket scientist to understand that the sooner you get treatment following an injury, the sooner you will get better.

However, we tend to let things go longer than we should.Astudy done several years ago found that runners have a 60-65 per cent chance of injuring themselves during a season but that only five per cent to 10 per cent of injured runners will actually miss their workouts. This suggests that many runners will run through just about anything until they can't run anymore.

Early treatment is important for several reasons.

Any traumatic injury will cause damage to the cells that make up muscle tissue. For instance, when you pull a muscle like the hamstring, the damaged cells release chemicals, which will then instigate an inflammatory reaction. The tiny blood vessels will be damaged, thereby causing a bleed within the tissue. At this point, the body will then form a small blood clot. This clot will stop the bleeding and then special cells (called fibroblasts) will begin the process of healing. Part of the healing process involves the formation of scar tissue on the muscle.

This is the first stage of healing. However, too much of this early inflammatory response will impede the healing process and delay your return to sport. Treatment by your therapist is intended to decrease your time in the inflammatory stage of the injury, minimizing the formation of scar tissue and thereby accelerating the healing process.

What can I do right away to help?
A physical therapist will often tell you to follow the P.I.E.R. (pressure, ice, elevation and rest) or R.I.C.E. (rest, ice, compression and elevation) principles. If these principles are followed for the first 24-48 hours, the chances of significant swelling and pain are decreased dramatically. This will often also significantly reduce your possible rehabilitation time.

What can you expect when you go for therapy?
The first time you see a therapist will be for an assessment. It will usually last anywhere from 30 to 60 minutes. The therapist will ask you several questions, including:

How did you injure yourself?
How long ago did it happen?
Who — medically speaking — have you seen since the injury?
Why do you think it happened?
Is it traumatic or chronic?
This is extremely important to the therapist, as they can usually use the history of the accident to narrow down what the problem may be. In the therapy world, some say that once you are finished asking the questions, you should already know what is wrong. The rest of the assessment is just to confirm your suspicions.

After the history, the therapist will run you through several tests to determine how your problem affects your strength and range of motion.

Once the main problem is identified, the patient will have a better understanding of what the next steps will be. We will also be closer to answering the ever important question, "When will I be pain-free again?"

After the assessment is done, your therapist will prescribe a plan of treatment, which could include ultrasound, laser, massage or exercises, among other things.

The rehabilitation protocol will vary depending upon which professional you see. No matter what, the therapist's main goal is to decrease pain and increase range of motion. The main reason most people seek help in the first place is to get rid of their pain.

Different professionals will do various things to achieve this goal. Chiropractors might do manipulations while an athletic therapist might use a machine to stimulate the affected area, which is designed to help with pain and swelling.

Whatever they do, make sure you are comfortable with your treatment and you have a basic understanding of it. If the patient doesn't feel comfortable with the therapist or with what the therapist is doing, they will often get frustrated and not follow through on their home regime. This obviously won't help get you better more quickly.

Time is key
The length of time you will be in pain will be based upon the injury itself. Obviously, the severity of an accident will affect the rehabilitation time. However, I have seen several small injuries that have gone untreated and have festered for months. Achilles tendonitis is a prime example. If left untreated, Achilles tendonitis can build up an actual visible scar tissue. If this scar tissue is left untreated, it may lead to a complete Achilles rupture, and then you will need surgery.

When these type of chronic injuries happen, you will definitely have a longer road to recovery ahead. The most difficult part is the prognosis of your particular injury. Now, don't get me wrong, if you have a minor injury, you won't need to call a therapist right away. Your problem might go away with a little rest. But if it persists, it's time to see a pro.

In the next column, we'll look at which professions might be able to help you best, depending on your injury.