In the past couple of blogs, we have been discussing that situation that arises when you hurt yourself, but you did not do anything out of the ordinary to cause the injury. We talked about stress and how being under prolonged stress can cause predictable responses in the body. These responses to stress can result in disease, organ damage, and even tissue fragility. When the tissues of the body are fragile, they are more susceptible to injury with just the slightest amounts of provocation.
We also discussed how once the damage has been done, the body’s response is inflammation. Inflammation is not the primary cause of the pain that is experienced. Inflammation brings the raw materials necessary for repair of the damage as well bringing immune cells necessary for the cleanup of the debris from that repair process. We learned that premature removal of inflammation as well as uncontrolled accumulation of inflammation can prevent healing and can lead to further deterioration and eventually tissue destruction.
As chiropractors, we want to make use of the inflammation in a controlled manner. We reviewed how taking anti-inflammatories will get rid of the inflammation but in the absence of inflammation, the repair and healing process will stop also. Let’s look at how we treat a patient with that injury that occurred for no reason. Let’s see how with conservative chiropractic care we can help the patient to a level of health that is stronger than before the injury.
The “unknown cause” injury patient will require some detective work to determine. We need to discover the underlying stresses that predisposed this person to the health care problem they now suffer. This is so we can address those issues with their treatment to help reduce recurrences. Therefore, we need a detailed history of the patient. We need to look at posture, past medical history, medications, financial strains, work type, marital status, and family issues as potential sources of “hidden stresses”.
After the introductory history, a thorough physical examination is necessary to determine what specific tissue is damaged and is causing the pain. The inflammation that accompanies the injury will need to be refreshed and controlled. Stagnated and excessive inflammation can be painful and will slow the healing process. Controlled inflammation (refreshing the inflammation) will permit and promote healing.
We utilize ultrasound, electric stimulation, various soft tissue technics, and passive ranges of motion to bring controlled inflammation to the injury site. The latest research shows that passive ranges of motion help produce the body’s own natural pain killers. We use the passive ranges of motion initially and build to resisted exercise as the healing progresses. We utilize strengthening exercises to increase muscular support along lines of physical stress that are associated with movement of the structures in that area.
The transition from pain control to rehabilitation is a difficult time for the injured patient. The memory of the pain from the initial problem is still fresh. That memory instills fear in the patient of reproduction of that pain with movement. The patient needs to be reminded that there is a difference between hurt and harm. The temporary pain that is associated with increasing a small amount of controlled inflammation is healthy and will speed healing process. It is at that time and during that process the damage is being repaired. It is also a critical time because when the pain is mostly gone, and the functional losses of movement and activity start to be restored the patient feels a false sense of complete healing. If the treatment is not taken to a complete repair and strengthening endpoint, reinjury can occur and increased damage is certain.
Once the pain has subsided by at least 50% in the patient’s and doctor’s opinion we begin to increase the resistance in the range of motion exercises. This strengthening process is easy to neglect because it is time consuming, and progress is not rapid. It requires dedication by the patient to stay with the rehabilitative process to maximize the results of healing and minimize the possibility of re-injury. The strengthening exercises are important because certain muscles must be strengthened, and others must be relaxed. The normal motion that is being restored by these exercises must be anatomically correct, otherwise function will be impaired, new stresses will be incurred, and damage will result.
When an astute and aware patient completes the entire treatment process beginning with pain reduction stage of treatment through to a complete repair, we habitually ask our patients to participate in a maintenance process. A lot of hard work by the patient as well as the physician has been put into this process. It would be a shame to not take care of the hard work and effort that went into this process. I like to explain to my patients that we change the oil in our vehicles, we check our furnaces each fall, and our air conditioners each spring. We all should do what we can to keep our homes in good repair. We need to realize the importance of doing the same for ourselves.
In our next blog we will talk about what can be done at home to strengthen and speed up this repair and healing process.
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