Archive for the ‘Injury’ Category
A bruise occurs when blood vessels are damaged and the blood seeps into the surrounding tissues. This is usually the result of a blunt trauma. Edema is an abnormal build up of fluid in the interstitium; the space between cells. It is clinically shown as swelling. Edema is generally caused by increased secretion of fluid into the interstitium, or by impaired removal of this fluid via the lymphatic system or blood vessels.
The lymphatic system is a part of the circulatory system, comprising a network of conduits called lymphatic vessels that carry a clear fluid called lymph unidirectionally towards the heart (in essence, a type of drainage system of cellular fluid). The purpose of the lymphatic system is to collect and return excess bacteria, fluid, and proteins from the interstitium to the bloodstream. The body will then eliminate these waste products from the body.
Lymphoedema is a condition that is caused by an overload of the lymphatic system. It is often the result of damage to the lymphatic system through radiation, scar tissue, or removal of lymph nodes (lymphatic tissues that act as filters).
To treat edema or lymphoedema, the goal is to assist in the return of the fluid into the lymphatic vessels which flow in a certain orientation leading back to the heart. Compression stockings or garments create light pressure on the skin and are often used in treating this condition. Manual lymphatic drainage (a very gentle massage technique) is also frequently used to assist in the flow of this excess fluid.
Recently, a taping technique has been studied and shown to improve lymphoedema, and it also speeds up the removal of bruises. This taping technique uses a special tape called kinesio tape. Kinesio tape is a thin porous cotton tape that is quite stretchy and has an acrylic adhesive. Kinesio tape was designed to mimic human skin, with roughly the same thickness and imitates the skin’s inherent elastic properties. This tape is claimed to be able to stretch up to 120-140% of its original length. As a result, if the tape is applied to a patient on a stretch greater than its normal length (typically 30-40%), it will “recoil” after being applied and therefore create a pulling force on the skin. It is theorized that this recoil that lifts the skin increases the space below it and allows increased blood flow and circulation of lymphatic fluids. This will in turn speed up the rate of absorption of a bruise or assist in reducing swelling.
Fluid flows from an area of high pressure to an area of lower pressure. The area of swelling will be an area of high pressure, and the lifting of the skin creates an area of low pressure; thus the orientation or direction of the tape job will be important. The orientation of the tape will be from the area of swelling leading to various collector points of the lymphatic vessels throughout the body which lead back to the heart.
Typically a strip of kinesio tape is cut into several long strips along the length of the tape but not the full length. A 2 inch anchor is left at the end (where all of the finger like strips connect or originate from). This is known as a fan strip. The limb or swollen/bruised body part is positioned so it is on a stretch. The anchor of the tape is applied to the region of the body where you want the swelling to flow to. The fingerlike strips leading from the anchor are then put on a bit of stretch and stuck to the skin leading toward and over the area of swelling/bruising. When the limb or body part is returned to neutral position, the recoil of the tape causes a bunching or lifting of the skin and the direction of the pull is thought to be toward the anchor. This is theorized to create a pressure gradient causing the flow of the fluid to move toward the anchor and reduce the area of swelling or bruising.
Since the tape is cotton, it breathes well, and it has a good adhesive, it can last up to 3-5 days even after getting it wet. This allows for a continuous facilitation of drainage over a span of several days. I have used kinesio tape on clients with bruising, and I have seen first-hand that it can speed up the removal of bruising. There is not a large body of evidence out there yet with regard to benefit of kinesio taping for other various conditions. However, reduction of lymphoedema is one area in the research where kinesio tape has shown some promise and the body of evidence regarding this technique is starting to grow.
Thursday, March 22
8:45pm: I trip on the sidewalk while travelling downhill. I scramble not to fall, so as not to injure my arms. I twist ankle instead. Frig! I hobble home.
9:30pm: I arrive home and apply RICE (Rest, Ice, Compression and Elevation). Before that, I did some Manual Lymph Drainage to help clear the debris gathered by the inflammatory process. And, for good measure, I applied some traction to my toes as this was the only time I would get any sense of relief. It helps to be a massage therapist when you hurt yourself!
10pm: Get off couch to go to the washroom, expecting to hobble. But no… I couldn’t even flatten my foot, let alone put any weight on it. Off I go, hopping on one foot, to the washroom then straight to bed.
Friday, March 23
3:30am: After much tossing and turning, and several applications of ice, I can no longer tolerate the weight of my blankets on my foot. I email Jen and ask her to notify my clients that their treatments will be modified to allow me to sit during treatment.
7:30am: I was perhaps a bit naïve in thinking I could still make it to work. Not much sleep or relief of pain. In fact, the pain has done nothing but worsen throughout the night, despite the RICE. I email Jen to ask her to cancel my day all together, as I’ve decided to go for x-rays. I knew, as much as any guess could provide, that it wasn’t broken. But I also just wanted the proof. I begin the task of getting up and at’em while hopping around on one foot. Have you ever tried to scramble eggs while balancing on one leg? Thank goodness I practice yoga. All those Tree Poses came in handy!
1pm: Home from the hospital. No break, but enough pain to warrant crutches.
I email Nick to let him know that I will not be at the clinic for a couple of days. He replies with: “Get well soon and don’t overdo the ice!” Having had no luck with the ice overnight, I take his word for it and forgo any further icing.
I email Jamie to let him know what has happened and that I am booked in for some treatment with him on Monday. He replies with: “Get well soon and try this mirror therapy in the meantime: http://www.youtube.com/watch?v=FM1DKhKehfI&feature=related”
At this point I realize my luck in working where and with whom that I do!
My sister, who helped me to and around the hospital, helps me get settled at home and returns to her schoolwork. I try to resume daily goings on, all with the aid of crutches. This is my first time ever using crutches, and I am quick to realize that they are not the most comfortable aids on the planet. Yet, they allow me mobility, so I swallow my self-pity and shuffle on.
I do a session of gentle passive mobilizations and then some mirror therapy. I am extremely limited in range of motion, but to my surprise, I am able to perform pain free toe curls and a toe tap.
6pm: Big sis returns to help with supper (We ordered Thai. What is normally a 10 minute walk takes us 30 minutes due to my numerous rest breaks. I repeat: crutches are painfully hard to get used to!) We eat, and watch a movie.
9pm: I cry at the frustration and pain of the ankle. I have sprained my ankle many times in the past. In fact, I tore all the ligaments in both ankles during my high school sports days. Still, no injury has ever left me in so much pain, or with such little mobility. This alarms me as I begin to worry about lost work, long-term recovery, and the possibility of having to pull out of a canine agility competition the following weekend.
11pm: I go to bed. I actually sleep.
Saturday, March 24
I have been diligent with passive range of motion, and mirror therapy exercises and today I can put weight in to my toe long enough to relax my leg while using the crutches. Though, best not to get too carried away and still take it easy.
My sister was a great help in allowing me the necessary rest the day before. On this day, my thanks extend to my good friend who picked me up and helped me gather my groceries at the Seaport Farmer’s Market. And to my friend who picked me up at the market, and brought me and my dog to our agility class, so that I could watch the lessons while my instructor practiced the drills with my dog. And, an even further thanks to my parents, for picking me up at class, bringing me a casserole and taking me home to their place for some much needed TLC.
Even though it was a busy day, I was still able to avoid over-exerting myself thanks to the kindness and helpfulness of my loved ones. While we almost never suggest full on “bed rest” for injury recovery, rest is still a crucial part to healing.
Sunday, March 25
A friend picks up me and my dog to take us to the park, where she gets to run around like a maniac while I stand and watch. Yes, STAND! I can now flatten my foot and put enough weight on it to only need one crutch for support.
Monday, March 26
After about 3 sessions of mirror therapy per day, some passive range of motion, and a daily application of MLDs, today I can limp without the aid of a crutch. Though, I still used it for my walk to the clinic, just incase. Better to be safe than sorry, I always say! I get some physiotherapy treatment from Jamie and return home for one last day of rest before returning back to work. Actually, that’s a lie. I rested until 7pm, when I went to the Merritt Awards ceremony. One of the biggest nights for the Nova Scotia theatre community, of which I have been a part since 2000! I left the crutch at home. It’s hard to look glamorous in an animal print dress with a metal crutch as an accessory! I return home by a reasonable hour, with very little consequence of my outing.
Tuesday, March 27
Still limping a bit, but I complete a full pain free day of work!
Wednesday, March 28
Just shy of a week since the injury, I am walking with a full pain free stride. And since I have an agility competition coming up on Sunday, I do a few slow drills in the backyard to see how I will manage. I prove to myself that I will indeed be able to run by Sunday.
Sunday, April 1
I do competition at the agility trial, and we have two excellent runs! I also complete my volunteer duty which required close to 8kms of walking (back and forth at 200yards per trip). Me and the ankle hold up just fine. I was a bit tired and sore on Monday, but nothing a little heat (I have introduced heat at this stage) mirror therapy won’t fix!
I credit my swift recovery to several factors:
#1. I am healthy. Thanks to a good diet my body was already equipped with the right nutrients and energy that it needed for the healing process. Thanks to an active lifestyle, my tissue was strong enough to withstand the injury with little long-term damage.
#2. Early intervention. While I followed my own protocol that “felt” right at the time, there are a few schools of thought around the best approach to addressing an acute injury. Keltie wrote an excellent blog about the use of heat versus ice (http://121wellnessblog.ca/?p=59) and this is generally the accepted approach.
More recent discussion suggests that ice may not be the best, or even a necessary first intervention. In fact, the acronym RICE has changed from meaning Rest, Ice, Compression and Elevation to now referring to Rest, Immobilization, Cold and Elevation.
Now, this raises another conflict in theories: Immobilization. True, we don’t want to force any particular range of motion, and we want to wrap or splint the area to prevent re-injury, but pain free mobilization is key to early intervention.
Even more differing, is an approach brought to my attention in a discussion with Dave, called METH. Along with mobilization, elevation, and traction, it also calls for the use of heat in the early stages of recovery. You can read about it here:
(http://www.t-nation.com/free_online_article/most_recent/radical_methods_of_injury_rehabilitation). I like this authors approach to Mobilization, Elevation and Traction. I still am not convinced on the use of heat.
Perhaps the best approach is no approach? No ice or heat in the early stages? In my experience the ice seemed to worsen my condition. I say “seemed” because, of course, there are so many variables at play that it is difficult to determine which one helped or hindered my progress. That said, Nick’s advice to ease up on the ice was well taken. Our body has a natural inflammatory process for a reason. We need to trust our body. We can help ensure that the negative consequences of unruly inflammation are kept at bay with the use of mobilization, elevation and/or MLDs, and traction.
#3. Mirror therapy. We had learned about this in school as an innovative and successful therapy for people suffering from Phantom Limb Pain, or with stroke victims. But, never had I made the link to applying the principles to an acute injury. Jamie has written about this process here (http://121wellnessblog.ca/?p=117) and I am thankful for the reminder of its application. I have been raving about mirror therapy since the third day of my recovery when it seemed as though I’d barely even hurt myself. I truly credit its use in much of my recovery!