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Continuum of Injury and TreatmentPosted on May 8, 2013

Continuum of Injury and Treatmentby Dr. Christopher NotleySo you are dealing with an injury. It is a frustratingtime being in pain and not being able to do the activities you love doing. ou may beplanning on seeing someone for this injury and you are wondering! "#hat type ofcare should I e$pect to receive%& The answer to this 'uestion depends on how longyou have been injured before you see( out care and who you are going to go see.

There are typically ) phases of care* acute! sub+acute and chronic phases. The phaseyou are in depends on the signs and symptoms that you are e$periencing which areassociated with length of time since the injury occurred.

,cute Phase - Days to )#hat are you e$periencing%If you are in the acute phase you are e$periencing pain! inflammation! the area iswarm to the touch! it is li(ely swollen! and there is a decrease in range of motion andstrength.#hat type of treatment%

The goals for this phase are to reduce pain and inflammation. /inimi0ing the amountof inflammation allows for a 'uic(er rate of recovery. During this time! treatment

consists of following the PI12 or 2IC1 principle. To decrease pain the use of T1NS!acupuncture and chiropractic adjustments will also be used to assist with painreduction.Sub+acute - Day ) to ) months#hat are you e$periencing%During the sub+acute phase active inflammation is li(ely over but there might besome residual active inflammation. #ith inflammation comes scar tissue! this isinevitable! but if ta(en care of during the acute phase this is (ept to a minimum.,dhesions may form between muscles! muscles and nerves! muscles and ligaments.

/uscles may be tight and develop trigger points 3hypersensitive spots in muscle4. our pain will be decreasing and your strength and range of motion will be improving.#hat type of treatment%

The goal for this phase is to continue to reduce pain! improve range of motion! slowlystart strengthening injured tissues! and limiting the amount of adhesions.,cupuncture can be used to help with pain relief. Pain can also be managed with theuse of ice or heat depending on whether or not active inflammation is present. ,

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different form of acupuncture! called dry needling! can be effective in reducingadhesions and treating trigger points. ,ctive release techni'ue is e$cellent forstretching out tight muscles! reducing trigger points! and brea(ing up adhesions.Chiropractic will help with improving range of motion of the joints affected and well asreducing pain. The start of remedial rehabilitation e$ercises such as range of motione$ercises and mild strengthening e$ercises are incorporated. our health carepractitioner will be urging you to continue with wor( as long as your wor( isn5t li(elyto cause aggravation of your symptoms. In addition! ergonomic changes to your wor(space will be incorporated to limit aggravation of the injury.Chronic - ) wee(s and onI am going to brea( down the chronic phase into two types of presentations. They arevery different and depend on whether your have ta(en care of the injury throughoutor you have just started to pursue care.

Chronic phase - Type I#hat are you e$periencing%

This is the ideal case of the chronic phase. ou have gone through treatment sincethe beginning of your injury. ou are not e$periencing as much pain e$cept duringevents that over stress it. Pain is under control. This is li(ely the phase you willchoose to stop coming in for care. Sadly this may very well be the worst time for youto leave. I see this happen way too often. The reason this is the worst time is thatyour body has not yet developed the strength and fle$ibility to withstand the stressesof your daily life. Considering that most people will re+injury their nec( or bac( withina year of their first injury ta(ing an active approach to prevent further re+injury ma(essense.#hat treatment should you e$pect%6or those small areas that are still a problem active release techni'ue! chiropracticand dry needling is still used. The major components of this phase it to developstrength! fle$ibility! balance and stability to aid in preventing further injuries. Thisphase should not be ignored. our injury isn5t stronger because you are pain free. Itta(es a year for scar tissue to develop and strengthen so it can manage the stresses

of our daily lives. 7oing through a rehabilitation program helps to stress and improvethe area that bothers you. Sadly many people! once they are out of pain! leave theirhealthcare practitioner until the injury is aggravated again. They are missing out on acrucial phase of care which is designed to prevent the reoccurrence of injury.Chronic Phase - Type II

This type of the chronic phase is seen 'uite often. This phase is those of you whohave been dealing with an injury for longer than ) months and most often is seen in

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people who have been dealing with it for more than a year. There are a few reasonswhy people reach this phase. 8ne reason is that they had an injury and they did notta(e care of the injury. ,nother reason is that they may have e$perienced thisproblem on and off over the years and never did anything about it until it wouldn5t goaway. 6or e$ample! each day you sit at your computer at wor( and once in awhile!after a long stressful day! you have tight shoulders which give you a headache. outa(e some pain medication and the ne$t day you wa(e up and you feel fine. It doesn5thappen again for several wee(s later. Time goes by and slowly the tightness comeson 'uic(er and lasts for longer periods of time. Not only that! but the tightness isoccurring more fre'uently. 6inally! you are so tired of e$periencing this pain youfinally decide to have someone ta(e care of it.8ver the course of this time you are e$periencing small trauma to the areas that arebothering you. Inflammation has occurred and scar tissue forms. The scar tissue has

glued itself between the muscle and the s(in! muscle and muscle! muscle and nervesall of which can further cause pain. Trigger points have also formed because of thechronic stress on the areas. Pain comes on with certain activities. 2ange of motion isreduced and because of chronic postural habits certain muscles are wea( whileothers are infle$ible. ,ll of these problems slowly accumulate until the problembecomes a focus of your life.#hat type of treatment do you e$pect%

Treatment during this phase starts similarly to the sub+acute phase. During this phasetreatment consists of dry needling! active release and chiropractic to brea( downadhesions and improve range of motion. Chiropractic adjustments are used to ensureproper movement of joints. ,s pain becomes better controlled a rehabilitationprogram is incorporated which will be used to strengthen the wea( muscles andstretch the tight muscles. Postural e$ercises will be given to improve posture.1rgonomic changes at wor(! in your car! or while being active will be addressed.#ellness Phase- 1nhanced 9ife :eyond Injury

This is the phase we all strive for. This is where you are enhancing your life beyondyour injury. our pain occurs less fre'uently or doesn5t occur at all. our postural

muscles are strong and your tight muscles are fle$ible. ou are living beyond the pain. our rehabilitation program has changed from injury care to health enhancement. ouare able to be active without pain. our choices of food have changed from poorchoices that stress your body to healthy choices that enhance your body. During thisphase! treatment by your health care provider! is less fre'uent. During yourtreatments! leading up to this phase! you will have learned the tools that will help youmanage the pain yourself. ou will only come in for a "tune+up& when your body feels

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the need for it.ConclusionCare for your injury should be a multi+facetted approach. No one form of care is betterthan the other. They all have benefits but only when used at the appropriate time. :eactive in your care and don5t be afraid to as( 'uestions.