Strained muscle, sprained ligament, tear or bruise – The first 72 hours are critical and can mean the difference a season ending injury and a few weeks out. A few simple things that you can do will make the world of difference to any muscle strain or ligament sprain. Here I will give you all the information you need to look after your injury in the first 72 hours, including whether to use ice or heat for acute inflammation.
Why is the first 72 hours so important? Because of inflammation. Acute inflammation is your body’s natural response to harmful stimuli and occurs whenever an injury happens where there is tissue damage, whether it is from a bruise to a full-blown ligament or muscle tear, it happens every time. There is a lot of stigma against inflammation but really it is a natural mechanism and there for a reason: It is the first stage of the healing process and so very important. So yes we do want it to happen, but it can also cause a lot of secondary damage and prolong healing and so we need to control it.
After tissue damage occurs, the inflammatory process moves in to kill and remove any infectious agents, remove the loose debris and then last, but not least lay the foundations for and activate the healing process. So not only is inflammation needed, but if you do not have it then the injury is never going to heal as strong as it can.
The healing process following soft tissue injury:
Phase 1: Inflammatory phase
This phase usually lasts up to 72 hours depending on how you look after the injury and is often called the protective phase as this is the time when our body is really trying to protect itself from further damage. The main signs of inflammation are heat, redness, pain and swelling.
When injury occurs soft tissue fibres are ruptured (to varying degrees depending on severity of injury) and then break down. A haematoma(blood clot) is formed from blood escaping out of damaged blood vessels filling the space between the torn fibers. At the same time, inflammatory cells enter the tissue from the damaged blood vessels. The inflammatory cells have a few jobs. The first job is to get rid of the broken down ruptured fibres and the second is to really turn up the dial on the process by producing chemical signals that dilate the blood vessels and increase their permeability so more calls can get to the tear. The third job is to attract fibroblasts, these guys are the builder cells that produce collagen – this is laid down at the tear to act as a natural band-aid.
Phase 2: Repair
This phase takes from 2 days to 6 weeks and pain can be intermittent throughout.
This is the phase where the tissues are re-built and regenerated. The initial re-builder cells, the fibroblasts have proliferated and produce more collagen into scar tissue. A new blood vessel system is also starting to form in this phase, bringing with it essential nutrients for healing. The injury is now a scar and so at this stage is still not very strong (even if it feels it or is painfree!). Because of this – this is a very risky phase of healing. As healing progresses we start to feel good about the injury, less pain, more mobile etc and we are tempted to go back to running, sport etc – Be warned it is not very strong!
Phase 3: Re-modelling
This final and very important phase takes 3-6 months and sometimes longer. This stage is essential because up until now, all the new fibres produced have been irregular, just laid down all over the place into an inflexible scar instead of aligned nice and straight and strong. So the main aim in this stage is for the new scar to get strong and more flexible
So why do we need to control the inflammatory process? If inflammation is left to run wild, the inflammatory chemicals can cause secondary damage and bleeding to the initially un-damaged tissue surrounding it. Also by applying the following principals we will decrease the amount of scarring and give ideal conditions for healing.
So here is what you should and should not do in the first 72 hours
RICE to reduce extent of bleeding, swelling and injury
- Rest, stop all aggravating injuries.
- Ice, 10 minutes at a time every hour you are awake.
- Compression, an elastic compression bandage or tubing should be worn and only removed if needed for icing.
- Elevation, if possible rest the injured area above the level of your heart.
Early mobilisation: it is important to begin moving the damaged area early, but gently as to avoid causing further damage. This early mobilisation means that normal muscle patterns are preserved, stronger new fibres are laid down, more scar tissue is re-absorbed, improved new blood vessel generation and last but not least there is less muscle wastage. Our bodies are amazing things that continually adapt to the forces that are out through them. So if you use the area functionally and normally, putting safe forces through the injured area, the body will heal according to these forces, making a much new tissue. Where as if you use crutches for a week or make yourself couch-bound you will end up with a weak, tight dysfunctional scar that could come back to bite you in the future.
- Running/Exercising the injured area
All of these things cause the blood vessels to dilate (open up)and increases the blood flow to the area, increasing the bleeding in the injured area. This is harmful to the repair process and will mean a drawn out recovery process.
Immobilize – unless it is a very significant tear or a suspected fracture. This is because immobilization can cause early and significant negative effects on various body systems. For example, metabolic processes leading to muscle atrophy(shrinking), and weakness of the quadriceps muscle start as early as 6 hours.
Immobilization does accelerate formation of new blood vessels and tissue, limits scar size, but as mentioned earlier unless it is a very significant tear or suspected fracture the benefit of early immobilization is much higher
NSAIDs (Anti-inflammatory medication): when used improperly these can hinder or even stop the first essential stage of healing and cause the tissue to be weaker in the future.
Final tip: If it is a lower limb injury you have (eg. Ankle sprain, calf tear, quad tear) then try to walk as normally as you can early. Just remember to walk heel-to-toe, heel-to-toe.
Whether you have a groin strain, sprained ankle or pulled muscle anywhere in your body, if you look after your injury right in the first 72 hours, you will be back to doing what you love faster and stronger! And remember if in doubt, go get it assessed by your local Physio.
If you are a trainer, coach, parent etc this is a great little resource to have around for quick information: Soft tissue injury info sheet.
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