Pulled Muscles, Scar Tissue and Re-Injury

How does scar tissue affect recovery and
re-injury of pulled muscles and sports injury?

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Have you ever had an injury that just won't heal? And then when you think it has healed, you go and re-injure it again. You may have a problem with scar tissue.

So you've pulled a muscle? Over-stretched it, torn it, strained it, sprained it. Call it what you want. From an injury point of view, the initial healing process is all the same.

Sprains (ligament) and strains (muscle or tendon) are the most common type of soft tissue sports injury and are often caused by activities that require the muscles to stretch and contract at the same time. A lack of conditioning, flexibility and warm up can also contribute.

While most people are well aware of the importance of applying the R.I.C.E. regime to a sprain or strain in the first 48 to 72 hours, it's after this that most people get stuck. Let's start by having a look at what happens during those first 72 hours and then move onto what's needed for a full recovery.

The First 72 Hours
Without a doubt, the most effective, initial treatment for soft tissue injury is the R.I.C.E.R. regime. This involves the application of (R) rest, (I) ice, (C) compression, (E) elevation and obtaining a (R) referral for appropriate medical treatment.

Where the R.I.C.E.R. regime has been used immediately after the occurrence of an injury, it has been shown to significantly reduce recovery time. R.I.C.E.R. forms the first, and perhaps most important stage of injury rehabilitation, providing the early base for the complete recovery of injury.

The diagram below is a comparison of the same injury treated with the R.I.C.E.R. regime and without. The top row of pictures show the effects of a soft tissue injury when the R.I.C.E.R. regime is not used. While the bottom row of pictures show the effects of a soft tissue injury when the R.I.C.E.R. regime is used.

The first diagram in the series shows a rupture in the soft tissue immediately following an injury. 24 hours later, when R.I.C.E.R. has not been used, there is a large amount of uncontrolled bleeding and swelling. However, in the bottom diagram, the application of rest, ice, compression and elevation has significantly reduced the amount of bleeding and swelling.

Picture courtesy of Dr. Barry Oakes, MB, BS, MD, F.A.S.M.F.
Senior lecturer in the department of Anatomy, Monash University, Victoria, Australia

The Problem with Scar Tissue
When a muscle is torn, you would expect that the body would repair that tear with new muscle. In reality, this doesn't happen. The tear, or rupture, is repaired with scar tissue. As you can see with the final diagram on the right hand side, when the R.I.C.E.R. regime is used, this limits the formation of scar tissue.

Now this might not sound like a big deal, but if you have ever suffered a soft tissue injury, you'll know how annoying it is to keep re-injuring that same old injury, over and over again. Untreated scar tissue is the major cause of re-injury, usually months after you thought that injury had fully healed.

Scar tissue is made from a very brittle, inflexible fibrous material. This fibrous material binds itself to the damaged soft tissue fibers in an effort to draw the damaged fibers back together. What results is a bulky mass of fibrous scar tissue completely surrounding the injury site. In some cases it's even possible to see and feel this bulky mass under the skin.

When scar tissue forms around an injury site, it is never as strong as the tissue it replaces. It also has a tendency to contract and deform the surrounding tissues, so not only is the strength of the tissue diminished, but flexibility of the tissue is also compromised.

So what does this mean for the athlete? Firstly, it means a shortening of the soft tissues which results in a loss of flexibility. Secondly, it means a weak spot has formed within the soft tissues, which could easily result in further damage.

Lastly, the formation of scar tissue will result in a loss of strength and power. For a muscle to attain full power it must be fully stretched before contraction. Both the shortening effect and weakening of the tissues means that a full stretch and optimum contraction is not possible.

Getting rid of the Scar Tissue
To remove the unwanted scar tissue it is vital that you start a course of deep tissue sports massage. While ultrasound and heat will help the injured area, they will not remove the scar tissue. Only massage will do that.

Either find someone who can massage the effected area for you, or if the injury is accessible, massage the damaged tissues yourself. Doing this yourself has the advantage of knowing just how hard and deep you need to massage.

To start with, the area will be quite tender. Start with a light stroke and gradually increase the pressure until you're able to use deep, firm strokes. The more you massage the effected area the harder and deeper you will be able to push.

Use deep, firm strokes, moving in the direction of the muscle fibers. Concentrate your effort at the direct point of injury, and use your thumbs to get in as deep as possible to break down the scar tissue.

A few final points before finishing up. Be sure to drink plenty of fluid during your injury rehabilitation. The extra fluid will help to flush a lot of the waste products from your body.

Also, I recommend you purchase a special ointment to use for your massage called "Arnica". This special ointment is extremely effective in treating soft tissue injuries, like sprains, strains and tears. You can purchase this ointment at most health food shops and pharmacies.

If you enjoyed this issue of The Stretching & Sports Injury Report, please feel free to forward it to others, make it available for download from your site or post it on forums for others to read. Please make sure the following paragraph and URL are included.

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Article by Brad Walker. Brad is a leading stretching and
sports injury consultant with nearly 20 years experience
in the health and fitness industry. For more articles on
stretching, flexibility and sports injury, please visit
The Stretching Institute.
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