Healing

By Ryan Hickling – Staff Physiotherapist 

As physiotherapists, a common question that a lot of our clients ask us is ‘how long will this take to heal?’ Unfortunately, the answer to this can be complicated and differs between individual’s due to various reasons. It also requires some understanding of how the different tissues in the body heal. 

Each of the tissues of the body, including muscles, tendons, ligaments and bone, heal at different speeds and this can be dependent on the individual and their specific health status/history.

Understanding the type of tissue injured and their different healing times is an important part of how your physiotherapist determines the treatment plan and goal setting for each client. On an client-specific  level, a patient’s age, the location and severity of the injury and the way the injury was managed in the acute/early stage (approximately 72 hours) will all affect the healing times of your injury. 

As we age, injuries do tend to heal more slowly than when we are young. Any medical conditions that reduces blood flow to an area, such as peripheral vascular disease, can also reduce the body’s ability to heal at its usual rate. 

There are some guidelines that can be followed when predicting how long an injury will take to heal based on the tissue type affected. Muscles are full of small capillaries, giving them a rich blood supply, and as such, they have a comparatively fast healing time of about 2-4 weeks for minor tears. For larger tears and more complicated injuries this timeframe is usually longer. 

Ligaments and tendons have less access to blood supply, therefore tears/sprains to these tissues generally take longer to heal. Complete tears of many soft tissues, may not be able to heal themselves and in rare cases and will then require surgery to mend the tear back together. 

Similarly, cartilage, the flexible connective tissue that lines the surface of joints is avascular, which means it has little or no blood supply. To heal, nutrients are supplied to the cartilage from the joint fluid that surrounds and lubricates the joint. This tends to take a longer period of time to heal compared to muscle strains.

While the different tissues of the body all have different healing times, they do follow a similar process of healing with three main stages, an initial acute inflammatory phase, the proliferative stage and lastly, the remodeling stage. The inflammatory stage occurs immediately after an injury and is the body’s primary defense against injury. This stage is identifiable by heat, redness, swelling and pain around the injured area. During this phase, the body sends white blood cells to remove damaged tissue and reduce any further damage. This stage usually lasts for 3-5 days. The proliferation stage is the phase where the body starts to produce new cells. Swelling and pain decreases and scar tissue is formed which then regenerates into new tissues. This stage usually occurs after the acute phase and lasts up to 2-3 weeks following the injury. The final stage, known as the remodeling stage is when the body completes healing with the reorganization of scar tissue and the laying down of new and more mature tissue. This stage usually occurs roughly 2-3 weeks after the initial injury is sustained. 

At each stage of the body’s natural healing process, a different treatment approach is required and your physiotherapist can help to guide you through your recovery. Goals are usually set by your physiotherapist by keeping these healing time frames in mind.
North City Physiotherapists will endeavor to put together your individual rehabilitation plan to guide us and you towards your goals and optimal physical health.This will follow healing times and your injury or condition.

 Ryan Hickling is one of our staff physiotherapists working out of our clinics in Porirua.

Would you like to see Ryan, why not book online now:
https://northcityphysio.co.nz/booknow
or call us on 0800 627497 for a booking

Grind, Crack, Creak – Why are my knee’s noisy?

I see a lot of clients in the clinic who come to me for knee pain or in fact I am seeing for something different and state their knee’s make noise, like a crack, or a creaky sound. I’m sure I speak on behalf of our team and in fact many health professionals we get asked this a lot.

So let’s consider the below info-graphic…have a look

So the real take home message is the majority of people without any knee problems have noisy knees, so lets consider this to be actually normal. Noise does not mean arthritis and neither does pain for that matter.

Even researchers and clinical people are undecided really whether this noise (known as crepitus) signals the beginning of arthritis.

So what exactly is joint crepitus? Most importantly does crepitus really matter? We need to determine what this cracking, grinding, creaking, clicking, clunking, popping and other adjectives used for the phenomena of joint crepitus is.

Loud isolated cracks and pops.

These are often seen during warm ups and activities involving crouching down. Some people even feel better after the knee has cracked. This will either be bubbles of gas popping, just like when someone cracks their knuckles, (which by the way does not lead to arthritis!), or the patella locating into the groove underneath as the muscles warm up. Neither are a case for any concern whatsoever, and should be seen as entirely normal.

Pathology

People will very often associate their joint noise with a diagnosis of osteoarthritis (especially if someone in their family has osteoarthritis). A true osteoarthritic joint creak almost resembles a creaky door. This is indicative of bone on bone advanced osteoarthritis. This noise is quite different from the fine grating that often originates from a non-arthritic patellofemoral joint. Ironically clients with advanced degenerative disease rarely complain of this as their pain, deformity and or functional loss is normally a much bigger problem.

It is much more likely that many of our clients will have fine crepitus of a non-arthritic origin. Some of these people may have chondromalacia patellae,(CMP) of the patellofemoral joint, an extremely common finding indicating fissuring of cartilage on the back of the patella but not a loss of vertical cartilage height.

So if you are concerned about your crepitus or noisy knees then for sure it is of interest to us the physios. Though a really good assessment looking at you thoroughly we hope to empower you and alleviate your concerns.

 Atif is one of our senior physiotherapists working out of our clinics in Porirua.

Would you like to see Atif, why not book online now:
https://northcityphysio.co.nz/booknow
or call us on 0800 627497 for a booking

When can I return to sport?

BY MAU KEELAN – SENIOR PHYSIOTHERAPIST

If you’ve had an injury, one of your main concerns may be when can I go back to sport?  This is a tough question to answer and every injury is unique depending on its severity.

If you return back too soon, there is a risk of re-injury or developing a chronic problem that will lead to a longer recovery time.  If you wait too long you can risk deconditioning or take on poor compensatory movement behaviours. This can be a very frustrating time for most athletes but the earlier you seek intervention, the smoother your recovery will be.

Here are some “tips” to help allow a safe return back to sport:

1. Get professional advice EARLY:When an injury happens it is important that you get professional advice early preferably from a Physiotherapist or a Sports GP.  From here they will be able to give you:

  • A diagnosis (What the injury is?)
  • Timeframes (How long you will be off sport)
  • Recommendations (Guidance on what you can and cannot do)
  • Education on the injury with regards to healing

Most of us go straight to A&E where we are rushed through an Xray to clear a fracture, then given pain relief/ anti-inflammatories, crutches/moonboot and sent home with no further advice.  Poor information is given to us on what to do after this.  Seek help from a Physiotherapist.

2. If ACUTE, don’t wait! Start rehabilitation EARLY:
Early intervention is always the best way to faster recovery. Below I have listed common injury types including a Joint sprain eg: Knee/Ankle or a Muscle strain eg: Calf/Hamstring

Acute joint sprains (Shoulders/Knees/Ankles – Average timeframe 4-8 weeks):

  • We are used to the R.I.C.E principle. Try the P.O.L.I.C.E principle
  • Please take note of the “Optimal Loading” segment which encourages and promotes recovery:

Acute Muscle Strains (Average timeframe 4-8 weeks):
Evidence suggests that commencing rehabilitation early (2 days after injury, rather than waiting 9 days) shortened the interval from injury to pain-free recovery and return to sports by 3 weeks without any increase in the risk of re-injury.
Regular and controlled mechanical loading early after trauma is needed to reduce the adverse effects of protracted immobilization on muscle and tendon structures. (Bayer, Magnusson, Kjaer. NEJM, 2017).

3, Get a plan and set some goals:
It is important to make a plan! This will assist with “acceptance” of your injury and faster recovery times.  Your Physiotherapist will help you design a “return to sport” plan and set some realistic goals considering the speed at which you need to recover and what can be done to prevent the injury from coming back.
Here are some general goals to consider:

  • Normal range of movement. Compare the injured side to the non-injured side
  • Decrease in pain to zero, decrease in swelling
  • Strength of the injured part is 80-100% of the un-injured part
  • To return to training at 80-100%
  • To run or jump without pain

4. The dreaded “Waiting Game”

Here are some tips to help get you through “waiting game” of rehabilitation:

  • Stay positive!
  • Do not “break” the plan! Be patient!
  • Continue to be involved in your sport.  Being injured does not mean that you can’t move! Go to trainings and help out with these.  Be a post, set up a cycle or just watch and do your physiotherapy exercises.  There are plenty of things that you can be doing to remain active. Your physio should encourage and guide you with this.
  • Don’t forget you can still continue training the un-injured areas.
  • Now is a good time to work on “fine tuning” and working on your balance and stability
  • You can also chat to your physiotherapist about “Mental Skills” eg: using imagery, self-talk and visualization to help with rehabilitation.
  • Give back to the sport and offer to speak to the younger athletes in your chosen sport.
5. Functional testing 
Your physiotherapist will carry out different types of fitness tests to determine whether you are capable of returning to play.Here is a basic progression of exercises after a lower limb injury that tests your ability to return back to sport:
  1. Walk with no limp
  2. Jog with no limp
  3. Sprint with no limp
  4. Figure 8, jog and run with no limp
  5. Quick zig-zag running with no limp
  6. Double leg hop
  7. Single leg hop maximally
  8. Non-contact sports specific drills comfortably
  9. Contact sport specific drills comfortably
  10. Return to full training at 80-100%
  11. Return to sport

Overall, your Physiotherapist wants you to return back to your chosen sport as safely as possible without having a re-occurrence.This requires for you to be patient and trust in your plan.

Recovering from an injury cannot be sped up!The best tools to make your rehab progress quickly are actually taught before you get injured. Making sure you are fit and strong for your chosen sport helps! You can recover faster and prevent more injuries if your body is conditioned for your sport.

 Maumahara Keelan is a physiotherapist working out of our Johnsonvile clinic.

 Want to see Mau?
Why not book online now at: https://northcityphysio.co.nz/booknow
Or call us on 0800 627497