Trauma: MVA, Sports & General Accidents
What ties these injuries together is their sudden onset; and tissue damage. This can range from minor muscle strain and ligament sprain injuries, to fractures and the more serious extensive injury profiles; and it can involve just one or many tissue types - muscle, ligament, bone, nerve etc. These injuries require different management than either the repetitive strain & posture pain or the chronic pain presentations more commonly seen in most private physiotherapy clinics.
With severe injury, the first stop in care is usually the Emergency Department of your local hospital, which initiates assessment and important early care measures. While this provides effective care for the most seriously injured, the very long waits at most emergency departments can discourage those less seriously injured from seeking care they would benefit from. We see the results of delayed care when clients present in the weeks and months following injury with persistent pain issues.
Physical injury benefits from early intervention
First actions following injury should be to apply the RICE principles as soon as possible. These have long been taught in first aid courses and remain relevant today. These principles are part of a home program of physiotherapy care, and supplement in-clinic care.
- Rest and protect the injured area
- Apply Ice or a cold pack as soon as possible
- Compress the injured area by applying an elastic bandage
- Elevate (prop up) the injured area
If the injury is more extensive on assessment, or if a minor injury fails to recover as expected, a collaborative treatment plan is recommended.
Within our clinic, we would always recommend low intensity laser in the early days following injury. The photobiomodulation effect of the laser provides pain relief, settles inflammation and significantly speeds tissue healing. It also minimizes scarring which can be a reason for relapse and/or recurrence of the injury.
Pre-existing health issues can impact healing
Common examples of under-lying but silent, pre-existing issues are early arthritic changes in the injured joint and poor posture or alignment of the injured area. Of their own accord, these conditions can take a long time developing before they become symptomatic, but injury can provoke an earlier manifestation of related symptoms. The appearance of these under-lying conditions will complicate and likely delay healing. A physiotherapist is trained to observe or watch for these anomalies; and to adjust a treatment plan to accommodate them.
Delayed care can lead to poor recovery and chronic pain
We can observe signs of persistent inflammation (redness, warmer, tender to touch, swelling) when a client comes for treatment weeks and months following an injury. Delayed healing can relate to pre-existing health issues as above, but may also relate to poor care immediately, and in the days following injury. Two examples of poor care are continuing to overstress an injured body part when it is still inflamed; and not managing swelling.
Early or excessive strain can disrupt a developing scar formation
Tissues of all types - muscle, ligament, nerve, etc - are all vulnerable to excessive strain/stress as they heal. Disrupting a healing injury delays the process and increases scar formation. A poorly resolved scar may cause an early return of symptoms or reappear to cause pain months or years later. Strong exercise or sudden movements are two examples of activities that can cause late recurrence of symptoms. Healing and rehabbing under the care of a physiotherapist will eliminate most issues related to delayed and poor healing.
The psychological impact of sudden injury
Sports, MVA and general accidental injuries are all of sudden onset, and depending upon the circumstances, could have a psychological dimension to the manifestation of the injury. There have been many news-worthy examples that have sensitized us to the signs and consequences of post traumatic stress disorder, or PTSD. Within the clinic, we are quick to refer clients who present with PTSD symptoms to providers who can provide them with the care they need. Similarly, pre-existing complex mental health disorders can complicate recovery following physical trauma; and an inclusive treatment plan must include assessment and care by a qualified mental health professional.
There is another aspect to the overlap of mental and physical health that we frequently observe in the clinic; and which is important following physical injury. In good health, all our physiological processes are balanced and interconnected; homeostasis is achieved. Injury of any type challenges this balance; but under normal function can also be accommodated and homeostasis restored. Within the clinic, we often observe the deleterious effect that personal stress, anxiety and poor sleep have on healing, and the restoration of pre-injury physical activities.
While these stressors are not unique to sports and MVA injuries, they can first appear following sudden injury. The American Posture Institute provides an explanation of the effect of stressors on homeostasis; and chronic pain. In very simple terms, the effect of stressors is cumulative. There are many, many possible stress candidates, but injury, poor posture, poor alignment, poor sleep, anxiety, poor health, poor nutrition etc are all common stressors. The more stressors present, the greater the potential for a chronic pain presentation. Physiotherapists are not trained to deal with psychological stressors, but it is most rewarding to observe the effect that eliminating the physical stressors can have! Our clients often report better sleep and less stress as their physical injuries heal and strengthen.
We consider all these issues as we create, with our clients, a treatment plan for all stages of recovery; and designed to achieve their personal goals.