Recovery protocols for soft tissue injury
So Friday night I finally made it to my daughters football game, she had been playing womens football for the season, but games were always on when i was at work. So I was very excited to be attending on Friday night.
I took down my table to assist with pre-game massage, and then all the girls headed out onto the field. Angel was on the bench to begin, but 15 minutes into the game she headed out onto the field to join the team. 90 seconds later she was on the ground, when I heard one of the other girls scream "its dislocated, get a stetcher!"
So this had happened (picture left) .....dislocation of the patella laterally, due to a medial blunt force to the knee...ie. she was kicked accidentally on the inside of the knee which caused her knee cap to pop out to the outside. So onto a stretcher, an ambulance was called and we were on our way to the hospital to have it put back in.
The body's response to a joint being out of alignment is to protect, so muscles go into major contraction (think about when your back is out?) . The only way to get the patella back in with minimal pain is with sedation.
After sedation in order to relax the surrounding muscles plus X-rays to ensure there were no fractures, the patella was popped back in. The area was re-x-rayed an hour later to ensure everything was in the right position, and from there it was braced.
5 hours later we were headed home, in a restrictive brace and a very tired little girl.
So what happens to the body in an injury such as a dislocation?
First thing first our recovery and protective mechanisms kick in, aka swelling as the body aims to protect the area. The body will send additional fluid to the area of injury to support and protect the muscles, tendons, ligaments and joints. Swelling shouldn't always be viewed as a bad thing, as long as all limbs still maintain efficient circulation its good to let the body do what it does well.
We opted for no ice in the first 12 hours to allow for the body's natural anti-inflammatories to kick in. Pain relief was with some panadol before bed , elevating the leg and rest. To assist initially with swelling I applied some light compression with oedema taping (rock tape), and elevation. Elevation allows the fluid to run back toward the heart, assisting the body to rid excess fluid.
In the morning, post injury we started with icing 3 - 4 times a day for 20 minutes each, avoiding directly applying to the back of the knee. Ice was applied lateral and medial (inside and outside) of knee and also above and below the back of the knee. Swelling when an area is isolated , especially around the knee area is made worse as its a lymphatic ally rich area. Not having motion (extension and contraction) of the joint means there is no release of fluid. Think here of a sponge with water, as we squeeze (contract) it allows the water to release, as we release the squeeze (extension) we take water up. This creates a flow of fluid in and out. So with that not available we need to assist the body to do the same work, this is where Ice can help. As the tissue cools the blood flow slows and the blood vessels constricts, as we take the ice off and the tissue warms to its natural temperature the blood flow speeds up, the blood vessels opens and allow for a flush of blood and water through the area.
We popped in for a visit Saturday morning to see Liz at Kimberley Physiotherapy for some further advice, which she gave some light, non load bearing activations for the the adductors and quad.
With a dislocation the susceptibility to re-injury is great without correct rehabilitation as the ligaments have been overstretched and are not fully supporting the positioning of the knee cap.
This is where the activation comes in , beginning to rebuild the muscle gently.
You will also have damage to the proprioceptors of the fascia in surrounding areas which can limit signals to the brain on what the knee is doing. This is corrected with fascial based work, which is where my skills come in very handy.
First seven days will be immobilisation, icing, elevation, rest, light rehab work and taping. I am also doing ultrasound once a day and putting the TENS machine on around her quad to assist the activation and re-firing of the quads and adductors. I apply Doterra Ice Blue to the area twice a day for pain relief and she has not had to use any panadol since day 1 as a result, so much better on her liver, which will also aide in her ability to deal the inflammation being held in the tissue.
The other consideration is the way her GAIT (walking pattern) is changed, so I am also addressing tightness in the hip and ankles due to not being able to bend the knee. By address these issues early we can alleviate any dysfunctional movement patterns caused by the wearing of the brace.
For this its fascial release of the hips (psoas, illiacus), trochanteric fan of the hip and TFL (tensor fascia lata), trigger point release in the glutes and releasing the ankle retinaculam which is not going through its usual flexion and extension in the GAIT cycle.
Will keep you updated with further treatment as we progress.