The Healing Process
Following injury, our body follows a set process of healing which is the same in all of us. If there is an impact or large force, there may be some bleeding initially which largely finishes in 24 hours but may take 48 hours to completely stop. Where there is not a large force involved, the injury may be more due to micro tears and not have local bleeding. The uninjured blood vessels open up around the injury to carry in extra oxygen, nutrients and the various cells and ingredients for repair during the first three days.
Inflammation begins within thirty minutes of injury and provides the environment for healing to take place. It is a vigorous process and causes swelling, pressure and stretch which is painful, so we keep still, will rest the area and seek treatment when there is sufficient pain. Inflammation is a normal part of the healing process and if it proceeds normally, it will end between four and six weeks after the injury.
We do not regenerate injured tissue like a lizard would grow a new tail, instead we grow fibrous tissue to join the injured tissues back together. This process continues over the same period as the inflammatory stage. By the third week, the scar is tightening up and beginning to become stronger. From the third week following injury, a process of maturing and remodelling of the healing begins and we can find evidence of this in lab tests for up to two years following injury.
Definition of Chronic Pain
Most injuries are pain free within four to six weeks of injury and proceed along the normal healing path. Chronic pain is present when pain lasts more than three months from the original onset. Healing has not resolved in the normal way and that can happen for many reasons. It is important to understand that chronic pain may arise from many types of tissues and may still be present even following previous treatment.
The management of chronic pain can be further complicated when there is a fresh injury of the original problem, resulting in a new acute episode of the underlying chronic injury.
Pain rarely occurs for no reason, so accurate diagnosis is critical. Only with accurate diagnosis can specific treatment be provided. Physiotherapists have a range of tests which can test any injury which is painful on movement. This ability to differentiate between tissues is very useful. We do not treat pain directly, we identify the piece of anatomy at fault and determine what has happened within it. Then it is possible to develop a specific and targeted treatment to restore the structure and function so there will be no reason for the pain to continue.
Treatment has several components. Initially protecting the injury and reducing any ongoing damage is very important, so the damage rate is slower than the healing rate. Physiotherapy is directed at restoring normal function in the damaged structure and as healing occurs, the pain will reduce in frequency and severity. This is usually achieved with mobilisation, stretches and exercises.
When there is chronic pain, frequently there are two or more coexisting tissues which have been injured and as the dominant pain subsides with treatment, other problems become clearer. It is like peeling an onion, once one problem is fixed, the remaining problems are clearer. If you have pain in different areas or pain that moves around, often it is because there are several structures involved.
The Physiotherapist will identify and correct any factors which have contributed to the development of the injury.
The diagnosis of Chronic Pain and the choice of treatment will need to be made by a Physiotherapist. A thorough examination is usually sufficient to diagnose the major problem and other investigations such as scans will be arranged if extra information is required.
Options for treatment:
Anti-inflammatories and pain killers
Protection of the problem
Direct Physiotherapy Treatment
Ultrasound and other electrotherapy
Soft tissue treatment
Exercises to regain strength, movement
Correction of biomechanical issues
Sporting technique modification
Provision of orthotics and footwear advice
Providing a return to activity plan
In the event of a severe injury where Physiotherapy is not appropriate, the patient will be referred directly to a doctor and on to the appropriate professional for further investigation and treatment. In the event surgery is required, Physiotherapy rehabilitation will be arranged afterward.
PROGNOSIS OF CHRONIC PAIN MANAGEMENT
Chronic pain often recovers well with specific Physiotherapy management, even though pains has been present for months or years. The goals of treatment are to achieve the best quality healing with a pain free, full range of movement and normal function, so there is a minimal likelihood of a recurrence in the future.