When it comes to injuries, If you’re an athlete, you hope that it’s broken and not torn. Why? Because most breaks heal the bone stronger than it was before (depending on age and the bone) and in a shorter time than most soft tissue injuries, whereas most soft tissue strains will take significantly longer to heal and will heal much less than perfect.
Louisville guard Kevin Ware who we all watched fracture his leg on national TV during the NCAA final-4, will be back playing next season. Even with the gruesome nature of his tibia piercing through the skin for all to see and it being an orthopedic emergency, his injury will heal well and he will be back. Good enough so that I believe we’ll be seeing him in an upcoming NBA draft.
Now, had that injury been a torn Achilles, a torn ACL, A pulled hamstrings or quad muscle, although he may be back, now we’re suddenly in the world of chronic re-injury and reduced level of performance.
When soft tissues heal, they do so with a haphazard array of connective tissue.
When ligaments, tendons and muscles are torn, the body replaces a rather neat, organized network of a combination of yellow elastic, and dense white non-elastic collagen fibers, with a rather haphazard array of dense white connective scar tissue. This scar tissue will help hold bones together (aka: Joints), but doesn’t have the same type and combination of strength and resiliency that the original connective tissue had. At the junction of the original tissue and the new scar tissue is a transitional zone that is more prone to tearing & re-injury as are most transitional zones in the body. The new scar tissue being less resilient causes a loss of range of motion at the joint level of the injury and therefore increases the stress upon that joint due to reduced and altered biomechanical function. Loss of range of motion also causes aberrant afferent input into the nervous system which can become painful as well.
Ultimately, the resultant scar tissue and adhesions from the healing process is sufficient to patch up the injury, but not optimal for normal function due to the lack of strength at the transition zone and lack of resiliency of the scar tissue itself. Thus restricting range of motion and causing the patient to become more prone to re-injury.
This is why I pay particular attention to soft tissue injuries and apply specialized techniques for soft tissue injuries.
Instrument Assisted Soft Tissue Mobilization techniques such as Graston Technique help transform the healing scars into a more well organized neat matrix that works much more like the original tissue. As seen here in these pictures, you can compare the non-injured to the injured without IASTM to the injured with IASTM. Notice the scar lines, cells and fibers are much more well organized and neat and ultimately have much improved function. It’s the function that this is all about. A broken bone will heal solid and strong, which is what a bone is supposed to be. Soft tissues have the dual task of being flexible to provide movement yet strong to provide stability during movement in a variety of planes and vectors and under various loads. This is why proper attention must be paid to soft tissue injuries as they heal. Scar tissue that heals haphazardly will make scar tissue weaker and more painful.
Proper IASTM treatment coupled with strengthening (initially eccentric deceleration) coupled with stretching and anti-inflammatory modalities are critical to the proper formation of the new scar tissue. Rest after an injury (for most injuries) simply doesn’t cut it anymore. The right stresses at the right time with the right nutrition it where it’s at.
For most soft tissues, you can’t simply put them back in place, slap a cast on it and let it heal for 8-12 weeks and expect it to be shiny and brand new again. When the healed fracture is long since forgotten, the soft tissue injury marches on and often becomes chronic and debilitating for a lifetime. It’s simply the nature of the best. Put this in context of a person involved in a car accident that suffers a whiplash injury? The scenario is no different. The ligaments, muscles, joint capsules and tendons in the upper back, neck and head are strained and sprained; they heal the same way and are subject to the same scarring and adhesions process. It’s no wonder why whiplash suffers have prolonged periods of suffering. Break a bone and it heals. Strain or sprain soft tissue and it’s like trying to glue a piece of plastic back together. It just never comes out as good as the original, is weaker and prone to breaking again.
IASTM therapy along with appropriate antiinflammatory nutrition, antiinflammatory therapeutic modalities, proper stretching and rehabilitative exercise are crucial to the soft tissue injured patient having a chance at working normally again. It’s something we do quite a lot in our office as do many other sports chiropractors as sports PTs and ATCs.
Hopefully this explanation gives you a new perspective when it comes to the healing hard (bone) versus soft tissue (muscle, ligament, joint capsule, tendon) injuries. And let’s point out that a heart attack and stroke are both soft tissue injuries. Makes you re-think how serious soft tissue injuries can be, doesn’t it?
Dr. Todd M. Narson
Diplomate of the American Chiropractic Board of Sports Physicians
Miami Beach, FL
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