Muscle Strains and Healing
I love to talk about this topic because it’s something we can very much help to improve but as it pertains to scars - so little is spoken about it at the doctors office post-surgery or after baby if we are relating it to pelvic health.
Let’s Review:
If we tear or strain a muscle, healing and inflammation naturally occur. The good thing is that this healing happens without us thinking about it but that’s also the bad thing - scars created by tissue to help to close the area and sometimes they don’t heal as nice as we’d like. Scar tissue is different than the tissue it is are replacing so we need to do a little work to help our body out and learn how to do that!
Let’s think about a hamstring tear. This seems to be pretty common right? Most of us have “tweaked” our hamstring so, in review, lets talk about strains (Strains happen to tendons or muscle while as sprains happen at a joint or ligament)
First degree tear - mild over stretching to the muscles with minimal loss of strength and motion (typically treated by ice, relative rest but return after 24-48 hours)
Second degree tear - bruising noted with this, some muscle fibers torn; likely to see strength and motion decrease - treat like you would first degree tear but add Physical Therapy and movement to help healing progress.
Third degree tear - complete or significant tearing of the fascia and muscles - can see and feel bump or divot in the muscle or difference between the 2 sides. Often surgically repaired or rehabilitated with Physical Therapy.
How do we heal?
When a tissue heals - it goes through a predictable pattern and it can be slightly different dependent on what is injured and the timeline of each tissue (bone, muscle, skin…)
Inflammation stage: Redness, swelling, pain, heat - Cells come in to deal with infection if any and prepare for healing - leukocytes and plasma proteins
This is a good thing!! It signals to the body we need HELP and gives the good cells a place to go.
Resolution or Repair: Resolution is the return of the tissue to nearly normal structure and function if minor. Repair is healing by scar formation
Resolution can occur with little tissue injury and its fully capable of regeneration (primary intention healing)
Extensively damaged tissues heal by scar formation (secondary intention healing)
Reconstruction phase: new blood supply is formed, new tissue is formed, and fibroblasts that secrete collagen and other connective tissue proteins are present to close the wound.
Collagen - made of high concentrations of amino acids glycine, proline, and lysine - is laid down as the glue to hold us together made by fibroblasts. Type III is laid down first then Type I later which is stronger.
Iron, ascorbic acid (Vitamin C) and molecular Oxygen are necessary for proper formation of scars.
Wound contraction is when the scar closes the injury site and this is done by the myofibroblasts that contract the area.
Maturation Phase - Starts around 2-3 weeks after the injury and continues for years.
At best the repaired tissue regains 80% of its original strength (only epithelial (skin), hepatic (liver) and bone marrow cells are fully capable of 100% regeneration).
**This is when we have the most impact as patients and providers**
When we strain a tissue while it’s developing gently (or optimally load) the new tissue will strengthen to the stress that’s applied towards it.
When scars and healing doesn’t go right -
Different causes can create different issues as caused by different things like:
Impaired collagen synthesis - creates keloids or hypertrophic scarring
Impaired epithelialization - things that keep the wound dry or hurt the growing tissue can prevent it from closing as well
Wound opening or splitting
Impaired Contraction - where the healing tissue creates an increased shortened position on the surrounding tissue crated by myofibroblasts- like burns.
Keep reading and I’ll share how to reduce these negative outcomes!
We want healing to be perfect!
That’s how our body mends itself and several things come into consideration besides the science above:
nutrition,
mobility (lack there of is more detrimental: atrophy to the muscle, osteopenia to the bone around it, reduced joint motion, poor ligament strength, adhesions to meniscus, fatty connective tissue deposits in joint spaces - to name a few)
use of substances like alcohol, tobacco products, or caffeine,
other comorbidities (diabetes for example),
prior tissue levels of health,
patient understanding of circumstances,
compliance of the patient for following directions,
localized inflammation and pain
We know that the new tissue is only about 70-80% as strong as the tissue it is replacing! We want to improve all the ways we can to help get to the top level of healing and rehabilitation.
What can we do to make this better or prevent those poor healing characteristics?
Seek help from a Provider - Physical therapy is one of the best places to start because that’s our superpower - we are musculoskeletal experts!
Scar mobilization - here’s a big write up from Kathe Wallace on the research behind scar mobs (basically do it!!) - I have several posts in my Instagram page about how too…ice after these suggestions to decrease the localized inflammation process as mentioned above.
When the scab is gone and the incision is nice and pink - Start with gentle (firm enough to blanch the skin) pressure on the scar with your fingers rubbing back and forth, side to side or little circles (2-5 min)
After that’s easier - add some more pressure and pull the skin a bit more in different directions
You may add a pinch and hold 30 seconds while moving along the scar if you can tolerate it (sometime this takes a little time to get to)
Manipulation of the scar can be performed with a quick lift of the scar
Finding the spots that move the least are beneficial to help the whole scar move its best.
***NOTE***Some people are not comfortable with this - that is OK!! A physical therapist is trained to work with this and a women’s health physical therapist can help you with your C-section or Perineal scar then will be able to help you manage more easily (see the next blog for more on this).
Good diet and hydration with well rounded meals, increase Vitamin C consumption, iron, protein - see Registered Dietician for more specifics on dosages; My friend at (www.gracegoodwindwyer.com) is amazing :)
Moderate load when appropriate to the tissue - Physical Therapists can help you with this…we need optimal loading to encourage that type 1 collagen to be laid down appropriately especially for the bigger tears/scarring which helps to strengthen the new tissue to its best level.
Decrease inflammation and pain with scar mobilizations
POLICE:
We all know the RICE principle right? Rest, Ice Compression and Elevation. This is awesome for most injuries but we are now adding another level to it:
P: Protection - healing tissue needs protection if it is acute - sometimes a walking boot will be prescribed, crutches used, or other equipment
OL: Optimal Loading - giving the healing tissue some activation is one of the best ways to heal.
Adding some isometrics (squeezing a muscle without movement or applying an external force and resisting it like a wall or your own hand has been reported to reduce pain and help bring blood flow in and out appropriately).
Adding some active range of motion exercises (moving the ankle or knee in all the directions it can go gently)
Gentle stretches at end range but not getting the pain higher than 4-5/10 scale can help
I: Ice - we all know this can help with inflammation and pain (10-20 min a couple times a day can help reduce swelling and improve range of motion)
C: Compression - applying compression as we typically think using ace wrap or an external specific wrap for a thigh/hamstring. I love using Rocktape for this as a supportive and assistive tool.
E: Elevation - raising the body part above the level of the heart to help reduce the swelling and pain.
This is not an exhaustive write up! If you’d like my sources - let me know! Most were books from Physiology and a hodgepodge of readings over the years.As always - ask questions and reach out if you need help!
Please share with others(I mean this is applicable to anyone who’s fallen or had surgery!) Best wishes!!