Stages of Healing of a Soft Tissue Injury


What is Soft Tissue?

Soft tissues are any of a variety of tissues that support, connect, or surround other structures in the human body, and that are not rigid like bone. There are many types of soft tissues, such as fat, muscle, fibrous tissue (tendons, ligaments, fascia), synovial tissue (found at joints and other structures), blood vessels, lymph vessels, and peripheral nerves (nerves outside of the brain and spinal cord).

What is a Soft Tissue Injury?

A soft tissue injury is the damage that can occur at a localized area of soft tissue as the result of some sort of physical trauma or repetitive abuse. Soft tissue injuries can be classified into two categories:

  • Acute
    • Occur when there is a sudden, abnormal stress placed on the tissues, such as a physical blow or a rapid movement that the body is unprepared for. Some examples of acute soft tissues injuries include muscle or tendon strains, contusions, and ligament sprains.
  • Overuse
    • Occur over an extended period of repetitive stress that is placed on the tissues, such as overtraining or monotonous hobbies and/or jobs. Some examples of overuse soft tissue injuries include tendonitis and bursitis.

There are countless scenarios in which an individual might receive a soft tissue injury. Perhaps you ‘rolled’ your foot while hiking or stepping off a curb, which resulted in the spraining of a ligament in your ankle (an acute soft tissue injury). Or, maybe you have been going for a long run every morning on hard, flat pavement for the past several weeks. However, if you have poor footwear, or you simply don’t give your body enough time to recover, eventually you may find yourself suffering from medial tibial stress syndrome (‘shin splints’), patellofemoral pain syndrome (‘runner’s knee’), or Achilles tendinitis. All three of these are examples of overuse soft tissue injuries.

Nova Active Rehab specializes in recovery from injuries sustained in car accidents – acute soft tissue injuries (which often become chronic if not dealt with). This will be the focus for the remainder of this post.

The Stages of Healing of a Soft Tissue Injury

Once a soft tissue injury has occurred, the body will respond by initiating the healing process. There are three stages (or phases) of healing, which occur in the following order:

  1. Inflammatory stage
  2. Repair (proliferation) stage
  3. Remodeling (maturation) stage

The Inflammatory Stage

In the first stage of healing, the inflammatory stage, the body is responding rapidly to the onset of a soft tissue injury. Typical signs of inflammation include warmth, redness, pain and swelling, the latter two of which will serve to limit the function of the damaged tissues. This limitation is a protective mechanism, as it will help reduce the chance of further injury to the site.

Your body will also release a number of chemicals during this phase, which will cause a cascade of events that lead into the next stage of healing – the repair stage. The inflammatory stage is brief, lasting up to about five days. This phase of healing ends with the clotting of blood vessels, the mechanical protection against the entry of foreign bodies (if our internal system was exposed to the external environment, such as with a cut or scrape; scab formation), and the subsiding of the inflammatory response.

Following a car accident, here are some suggestions for recovery during this stage:

  • Visit your family doctor as soon as possible (or the hospital if your injuries are severe enough)
  • Focus on letting your body rest and heal (avoid any intense physical activity or movements that result in pain)
  • If cleared by a physician, undergo some gentle, pain-free range of motion activities
  • If cleared by a physician, utilize PRICE (protection, rest, ice, compression, elevation) to the injured site

The Repair Stage

The purpose of the repair stage of healing is to remove the dead tissue and debris from the site of the injury, and to replace it with new tissue. However, when the new tissue is formed, the structure of it is much less organized. This is largely because the new fibres are being deposited in random directions (as opposed to being neatly lined up, as in healthy tissue), resulting in a less functional tissue. This is referred to as scar tissue.

This phase begins shortly after the initial injury and can last several weeks (or longer) depending on the extent of the injury and the response from the individual’s body. As the inflammatory phase ends and the new tissues begins to form, there should be a gradual increase in function (strength, mobility, etc.). However, as mentioned prior, this scar tissue is still not as functional as the healthy tissue that existed prior to the injury, and so you should not expect to regain all your strength and mobility during this phase of healing.

Following a car accident, here are some suggestions for recovery during this stage:

  • If cleared by a physician, undergo some passive and active range of motion activities that are within a reasonable pain tolerance (to avoid joint contractures, scar adhesions, and other issues that can limit your recovery)
    • Consider seeking out some or all of the following professionals at this point: physiotherapists, chiropractors, massage therapists, occupational therapists
    • Eventually this could be advanced into some progressive resisted exercises, as well as neuromuscular and proprioception retraining

The Remodeling Stage

The final stage of the healing process, the remodeling stage, begins once there is a sufficient amount of scar tissue in place. The purpose of this phase is to remodel the scar tissue over time into a more healthy, functional tissue. In order to ensure this occurs properly, the individual will have to introduce appropriate stimuli for the injured soft tissue, including a variety of movements or exercises that are gradually progressed in intensity.

From the onset of the remodeling stage at about a few weeks post-injury, this stage should last anywhere between about one to eighteen months. This is a massive range of time, which again will depend on a number of factors, such as the extent of the injury, the intervention of any professionals working with the individual, and the motivation and body responses of the individual during this phase. The goal at the end of this phase, and thus the end of the healing process, is to once again have a healthy, functional soft tissue at the site of the once-injured soft tissue. However, if the remodeling stage is not concluded successfully, then the individual may be bothered by pain, reduced mobility, and an overall limitation in function in the tissue long after the healing process has concluded.

Following a car accident, here are some suggestions for recovery during this stage:

  • If cleared by a physician, begin a progressive return to all pre-injury activities by gradually restoring normal mobility, strength, conditioning, and proprioception through active rehabilitation
    • This can be done with assistance by the previously mentioned professionals (physiotherapists, massage therapists, etc.) as well as kinesiologists, who are specialized in creating a structured, progressive, active rehabilitation program

References

Soft Tissues – http://www.cancer.ca/en/cancer-information/cancer-type/soft-tissue-sarcoma/soft-tissue-sarcoma/the-soft-tissues-of-the-body/?region=on

Soft Tissue Injury and Healing Stages – https://www.doctorsconvey.com/physical-therapy/soft-tissue-injury-healing-stages

Functional Assessment of the Spine and Extremities (FASE) Manual (2009 Edition)

What Happens if I Can’t Go Back to Work After an Accident? Vocational Rehab Explained


What is Vocational Rehabilitation?

Vocational rehabilitation (or vocational rehab) is defined as a process which enables persons with functional, psychological, developmental, cognitive and emotional impairments or health disabilities to overcome barriers to accessing, maintaining or returning to employment or other useful occupation. People who have suffered a brain injury from a car accident may benefit from Vocational rehab. Vocational rehab can require a number of things such as:

  • Assessment and appraisal
  • Goal setting
  • Support for health conditions
  • Referral to other services or service providers
  • Career counselling
  • Workplace evaluations

Vancouver based Vocational Consultant, Dennis Shaw, from Vocational Solutions (http://www.vocationalsolutions.ca/) says “early intervention is key to a timely and effective return to work”.

What happens during a vocational rehab assessment?

  • The assessment looks at questions that arise after employment is interrupted due to an accident, illness, or an injury
  • Aptitude testing
  • Achievement testing
  • Job search assistance
  • Making a list of possible career options for someone
  • Mood and anxiety inventories (these may influence a return to work)
  • Determining the appropriate levels of assistance

Returning to Work

WorkSafeBC notes that if you are injured on the job, one of the best things you can do for your recovery, is to return to work as soon as it is safe to do so. Going back to your daily work and activities can help you to recover more successfully.

According to a 2008 study, published in the Journal of Occupational Rehabilitation, 62 percent of the clients in the study were gainfully employed, after receiving vocational rehabilitation services (U.S. study, using American data).

Being Off Work

Not working can have a number of impacts:

  • Not working has shown to have elevated rates of physical and mental health problems
  • Can lead to higher levels of depression
  • It can be difficult to return to work after a long period of time
  • Unemployment can lead to a lower life expectancy
  • Can also have impacts on the wider community around you

Positive things about working:

  • Working can improve your self-confidence and self-esteem
  • Working can bring structure and purpose to your day
  • It has shown to be good for physical and mental well-being
  • Work can add to your sense of belonging and personal identity

What Happens if You Cannot Go Back to your Original Job?

The first outcome of a vocational rehabilitation assessment is that the accessor would attempt to place you back in exactly the same job that you had before the accident and/or injury.

If that’s not possible, then next steps are taken:

It may be an option, to return to your old workplace, but doing a different role.

The next step would be to look at employment with a new employer. At this point, work is done to create a suitable return-to-work goal.

The ultimate goal is to get you back to suitable, long-term work. Labour market research can be conducted to help establish what type of job would be appropriate.

The research done can determine what kinds of positions exist, and if re-training is needed, and what kinds of retraining. Each type of return-to-work plan is unique and designed specifically for each individual.

Useful resources:

Vocational Solutions Inc. http://www.vocationalsolutions.ca/

WorkSafeBC resources: https://www.worksafebc.com/en/claims/benefits-services/vocational-rehabilitation

The Province of B.C. information on vocational rehabilitation: http://www2.gov.bc.ca/gov/content/employment-business/employment-standards-advice/personal-injury-and-workplace-safety/factsheets/vocational-rehabilitation-5645

10 Tips For Recovering From Car Accident Injuries


Are you recovering from car accident injuries? It’s important that you take the appropriate steps to recover quickly. Too often I see people whose recovery has been drawn out needlessly over several years. It’s important to incorporate active rehabilitation when you can tolerate gentle movement. Performing light stretches, core exercises and simple strengthening exercises early on accelerates the rehabilitation process.

Brain Injuries From Car Accidents


Did you know that anyone can suffer from a brain injury? It can happen in many ways, but one common way is a brain injury sustained from a car accident. The CDC (Centers for Disease Control and Prevention) defines a traumatic brain injury (TBI) as a disruption in the normal function of the brain that can be caused by a bump, blow, or jolt to the head, or penetrating head injury.

Brain injuries can range from mild to severe. The most severe would be when a patient suffers from an extended period of unconsciousness or amnesia after the injury.

In British Columbia, between 21 and 38 people sustain a brain injury each day (http://brainstreams.ca/learn). In Canada, about 50 percent of acquired brain injuries come from falls and motor vehicle accidents (www.braininjurycanada.ca).

Symptoms

  • Loss of consciousness for a few seconds to a few minutes
  • No loss of consciousness, but a state of being dazed, confused or disoriented
  • Headache
  • Nausea or vomiting
  • Fatigue or drowsiness
  • Difficulty sleeping
  • Sleeping more than usual
  • Dizziness or loss of balance
  • Memory or concentration problems
  • Mood changes or mood swings
  • Feeling depressed or anxious

Symptoms (moderate to severe brain injuries)

  • Loss of consciousness from several minutes to hours
  • Persistent headache or headache that worsens
  • Repeated vomiting or nausea
  • Convulsions or seizures
  • Dilation of one or both pupils of the eyes
  • Clear fluids draining from the nose or ears
  • Inability to awaken from sleep
  • Weakness or numbness in fingers and toes
  • Loss of coordination
  • Profound confusion
  • Agitation, combativeness or other unusual behaviour
  • Slurred speech
  • Coma and other disorders of consciousness

Brain Injury and Car Accidents

Over half of reported traumatic brain injuries are the result of an automobile accident. The injury can occur from any force that penetrates or fractures the skull. The trauma to the brain can happen during a car accident when the skull strikes, for example, an object, like the steering wheel.

When the injury happens, there may or may not be an open wound. However, in the case of a car accident, it is important to note that the skull may not necessarily need to have been penetrated for a traumatic brain injury to occur. The force of the car accident may have a caused the brain to collide with the internal hard bone of the skull.

This type of incident can result in:

  • Bruising of the brain (also known as a contusion)
  • Internal bleeding in the brain (a brain hemorrhage)

A more serious brain injury can happen, when there is blunt trauma. Here are some of the characteristics of blunt trauma:

  • Can happen in a car accident
  • A moving head strikes another object, like a windshield
  • The head is impacted, causing an open wound
  • When the impact happens, the brain opposite the site of impact, is pulled away from the skull, injuring the brain there

Treatments

How does someone treat a patient with a brain injury? At the very beginning, the initial treatment helps to stabilize the individual. Next, rehabilitative care centre treatment helps restore the patient to daily life. Then, acute treatment is for minimizing secondary injury and life support. Surgical treatment may be used for preventing secondary injury through maintaining blood flow and oxygen to the brain, and minimizing swelling and pressure.

On-Going, Supportive Care

Quite often, patients with traumatic brain injuries need supportive care. They need:

  • Monitoring patient breathing
  • Sometimes they cannot breathe without assistance (may include a breathing tube)
  • Monitoring of heart rhythm
  • Prevention of seizures from occurring
  • Administering fluids to the patient (usually through IV for fluid and nutrition)
  • Monitoring the patient’s blood pressure
  • The doctor and nurses will monitor pressure within the brain
  • An assortment of diagnostic tests:
    • X-rays of the brain
    • CT scans of the brain
    • MRIs  of the brain
    • Neck or back scans, possibly
    • EEG tests (showing the presence of brain waves)

People Living with Brain Injuries

Tracy Morgan

In June 2014, Tracy Morgan was in a motor vehicle accident, the van he was in was struck by a tractor trailer. Tracy Morgan sustained a brain injury from this accident, and one passenger in his van was killed. He was in a wheelchair for many months, and then was able to walk with a cane. He eventually was able to come back to comedy, after two years.

Michael Schumacher

Michael Schumacher is a retired German racing driver, most famous for winning many races in Formula One racing. In 2013, he suffered a serious brain injury while skiing. He was in a coma for six months, from December 2013 until June 2014. In 2014, he was relocated to his home, and receives medical treatments privately.

Resources – useful sources of information

The Mayo Clinic — http://www.mayoclinic.org/diseases-conditions/traumatic-brain-injury/basics/definition/con-20029302

The Mayo Clinic is a well-known resource for medical information. This is a good source for basic information about traumatic brain injuries. Includes information on risk factors, treatments, and drugs. Click through pages on the arrows at the bottom of each page, to get to the next page.

Brain Streams — http://www.brainstreams.ca

This website is a resource for people in B.C., looking for information on brain injuries. Basic brain information is included, a section about what to do after you have the injury and then get back home. Under the Stories tab, see videos from survivors of brain injury, doctors, caregivers, and supporters. The Events tab has information on local events that are coming up, throughout B.C.

Northern Brain Injury Association — http://nbia.ca/brain-injury-statistics

A source of information on brain injuries, including many statistics for Canada and B.C. Includes information on “mild” brain injuries, like concussions, brain injuries in children, studies in Canada on this topic, and the wide scope of brain injuries (in B.C., Canada, and internationally).

Brain Injury Canada — https://braininjurycanada.ca

Canadian information to help people with brain injuries and also to assist their caregivers. Includes the Pathways Ahead newsletter, and a blog with the latest information and news on brain injuries.

References

Mayo Clinic – website on Traumatic Brain Injury

http://www.mayoclinic.org/diseases-conditions/traumatic-brain-injury/basics/definition/con-20029302

accessed on May 3, 2017

CDC – Centres for Disease Control and Prevention

Page on Traumatic Brain Injury & Concussion

https://www.cdc.gov/traumaticbraininjury/

accessed on May 3, 2017

Brain Injury Information and Resources in BC

accessed on May 3, 2017

Traumatic Brain Injury website

http://www.traumaticbraininjury.com/understanding-tbi/car-accident-tbi/

accessed on May 5, 2017

Brain Injury Canada

access on May 5, 2017

Northern Brain Injury Association

accessed on May 5, 2017