Graston techechnique

Soft-Tissue Injuries: Better, Faster Healing

Beyond “hands only”The early Chinese may have been the first to promote health through using “instruments” on the soft tissues of the body. Those first devices were made of buffalo horn and jade.

Interest in instruments to extend the “reach” of chiropractors, massage therapists, and others got a boost in the ’80s when David Graston suffered a debilitating sports injury. Graston’s disappointment with the rehabilitation methods of the day caused him to create several stainless steel instruments with various shapes and angled surfaces. These instruments were designed to augment hands-only approaches to healing.

Chiropractors and massage therapists have always worked their fingers into injured soft tissue to increase blood flow and break up restrictions. But fingers alone cannot detect restrictions at deeper levels, nor can they match the ability of the right instruments to treat the full range of restrictions.

Today, several companies produce hand-held devices used to perform what’s known as instrument-assisted soft-tissue mobilization (IASTM).


What do the instruments look like?

Most instruments are stainless steel. Others are made of aluminum or polymer.


Which parts of the body can develop soft-tissue injuries?

Soft-tissue injuries, such as strains and sprains, often affect the extremities—the legs or arms. Because “soft tissue” refers to anything that isn’t bone, neck and back injuries fall into this category, as well.

How do soft tissues become injured?

Athletes who suffer a traumatic injury will often need soft-tissue-specific rehabilitation to get back full range of pain-free motion. Many soft-tissue injuries, however, are the result of repetitive motion.

People who may suffer from such injuries include:

Assembly-line workers

Golfers and other athletes

People who spend long hours at a computer without regular stretch breaks

Mothers who hold their babies only on one hip

Students who overfill backpacks or who hang heavy backpacks over one shoulder

Sedentary people who allow their muscles to atrophy


Where do soft-tissue injuries originate?

A soft-tissue injury can occur anywhere that ligaments, tendons, muscles, or myofascia are found. Ligaments connect two or more bones and help stabilize the joints. Tendons attach muscles to bones. Ligaments, tendons, and muscles provide a natural brace to protect the bony skeleton from injury. A ligament can be injured, for example, by making a movement that would take a joint outside of its normal range.

What is a “healing cascade”?

When the body is injured, it works to repair itself through a three-phase “healing cascade” process of inflammation, proliferation, and maturation.
In the inflammatory (“acute”) phase, the body releases chemicals that start the healing process. This process continues through the proliferative phase, during which the body migrates materials it needs to create scar tissue at the site of injury.
During the maturation phase of healing, scar tissue forms in the soft-tissue injury site. In this phase, the injury becomes chronic. Scar tissue helps the body form a “patch” at the site of an open wound or internal injury. Scar tissue, however, is much less flexible than normal tissue. It restricts movement, leading to pain when, for example, an athlete with a sprained ankle tries to return to running.

Why is a second healing cascade important?

Most patients with soft-tissue injuries come to a doctor of chiropractic after injuries have become chronic (weeks, months, or even years post-injury). By that point, the body has completed most if not all of the healing tasks of the original healing cascade. A second healing cascade is needed to restart the healing process, bringing to the site, among other things, oxygen and nutrients.

How is a second healing cascade created?

Although healthy soft tissue is longitudinal (laid out all in the same direction) and flexible, the body lays out scar tissue in a haphazard fashion. Scar tissue is fairly rigid. Pain results when movement stresses scar tissue. The doctor of chiropractic presses his instruments into damaged tissue to help release restrictions created by scar tissue and get a chemical healing cascade started. The goal is the normalization of the tissue. “Normalization” probably does not mean that the instruments force the underlying tissue to re-form longitudinally. It refers instead to the release of restrictions. Treatment, which includes stretching out muscles, helps patients build flexibility and strength in the area.

What is a treatment like?

When doctors of chiropractic trained in IASTM use the instruments, they first spread a light gel film over the patient’s skin. Then, they press into and move the instrument around the site to locate restrictions. Treatment breaks down scar tissue and encourages the body to remodel the underlying tissue. During treatment, smaller capillaries in the area are broken. Bruising is a normal response, signifying that a healing cascade is underway.

How does treatment feel?

IASTM can cause minor discomfort. You may wish to arrange a signal that will tell your chiropractor that the degree of pressure has become too uncomfortable. Treatments are typically short—often just three to five minutes.
The level of discomfort typically is reduced with repeated treatments. Chronic soft-tissue injuries are not healed overnight, but your willingness to perform home stretches and exercises as prescribed by your chiropractor will hasten the process.

What side effects can I expect?

Redness of the skin, followed by bruising, is common. These side effects show that your practitioner has been working to get at troublesome areas and help start the healing process. You may also be asked to apply ice as part of your at-home treatment.
Doctors of chiropractic are trained to effectively address your musculoskeletal complaints. If you have further questions about soft-tissue injuries, your doctor can help.

Sources from "www.acatoday.org"

Herniated Disc and Sciatica Facts

Introduction

Herniated discs are probably the most common diagnosis for severe back pain and sciatica (leg pain). Discs are large cushions that lie between the individual vertebrae of our spinal columns.

The disc is composed of layers of ligaments (annulus fibrosis) arranged in a criss-crossing matrix that hold in a gel-like substance (nucleus pulposus), giving the disc its "shock-absorbing" ability. Sometimes the gel swells (which is called a disc protrusion or bulge).




A more problematic situation occurs if the gel pushes through its ligamentous wall (which is a disc prolapse or extrusion). Both situations can led to pressure or irritation of the vulnerable spinal nerve roots. This can lead to sciatica - an abnormal sensation felt anywhere from the buttocks to the feet.

For more that 70 years, orthopedists have believed that most lower back pain and sciatica were caused by herniated discs. The "dynasty of the disc" led to the typical medical advice of bed rest and medication. Gordon Waddell, a renowned British orthopedic surgeon, wrote in the journal Spine, "There is remarkably little scientific or clinical evidence to support the value of bed rest for low back pain or even sciatica." Bed rest is now known to cause prolonged pain, muscle weakness, joint stiffness, and depression.

If bed rest failed, surgery was the usual next step. Unfortunately, due to poor patient selection, many unnecessary surgeries were performed. Waddell said, "surgical successes unfortunately only apply to approximately one percent of patients with low back pain." According to Alf Nachemson, M.D., editor of the journal Spine, bulging discs are found and taken as an excuse to do a lot of surgery and percutaneous discectomy. Discs are made to bulge; that is a normal finding."

Edward Carragee, M.D. the Dean of Neurosurgery at Stanford University reported that disc bulges are present even in 20 year olds, BUT by age 30 there are more episodes of back pain in individuals whose spines had no abnormalities when they were 20 than in those with the bulges! He has also written in the journal Spine that the long-term results of surgery vs. conservative care for pinched nerves is no different.

Back and even leg pain can arise from the muscles, joints, or ligamentous structures of the spine. Whatever the cause, evidence is growing showing that rehabilitation not surgery is the treatment of choice for most lower back disorders.

When should I see a doctor?

Anytime a person has pain radiating down their leg they should see a doctor to find out the reason why. This is not something urgent unless there is buckling of one or both legs, incapacitating pain, progressive pain or numbness, loss of bowel or bladder control, or numbness around the genitalia or anus.

Pain Control/First-Aid

Goal: reduce pain, swelling and inflammation

• physical therapy (e.g. ice, electrical muscle stimulation)

• manual therapy (e.g. massage, traction) and manipulation

• anti-inflammatory/pain medication if necessary

What can I do for myself?

An important study from a leading orthopedic center in San Francisco demonstrated that more than 90 percent of patients with disc herniations responded to non-surgical treatment. Most of these patients had already been referred by neurologists for immediate surgery. Their treatment included simple pain control methods in combination with rehabilitation. According to Nachemson, "All the structures in the back fare better with early, controlled motion....if something is injured and you start to slowly move it under controlled conditions, then the structure heals quicker and better."

It is important to spare your spine if you have a pinched nerve. Slumping or bending forward from the waist are key sources of irritation of the disc. Prolonged sitting is another problem. Try not to sit for more than 20 minutes at a time without getting up and limbering your back. Because the disc is mostly water it swells at night when you are recumbent. Thus, the morning time is a critical time to keep your spine from bending forward while you brush your teeth, dry your feet and change.

Besides taking over-the-counter pain relievers of anti-inflammatories iceing your back at home is a key treatment. This can be performed for 20 minute intervals a few times a day.

Ways to increase your activity.

Walking is a safe exercise for pinched nerves due to herniated discs. If bending forward increases your leg symptoms, but bending backwards ONLY hurts in your back you may want to perform press-up and standing back extension exercises a few times a day. 10-12 slow repetitions are generally recommended. It is best to see a qualified health care provider to determine what exercise is best for you.


Rehabilitation

Goal: stabilize back through better flexibility, strength, and endurance

• education about lifting, sitting, etc.

• exercises to increase back and cardiovascular fitness

• encouragement to achieve and maintain a healthy back

Sources from : Clinicalrehabspecialists.com