SMOOTHING KNOTS

From onset of injury

In the case of soft tissue injuries, from onset of the damage up until 48-72 hours (the acute stage of the injury) you should follow this advice:

1. REST – immobilise the joint where possible and ensure it is non-weight bearing

2. ICE – where possible put an ice pack on the affected area.  A bag of cold peas are suitable as they mould to the shape of the foot, wrapped in a towel, for around 20 minutes bursts, then returned to the fridge and repeated in 20 minutes intervals.  (10 minutes at a time on areas of poor muscle concentration such as ankles or elbows)  This will reduce inflammation and swelling and should be applied four or five times a day where possible.  This will restrict the blood vessels from bleeding but should not be used for extended periods of time as this will have the reverse affect if used for too long.

3. COMPRESSION – affected injury can then be supported by a bandage or strapping to limit movement or, in the case of a shoulder injury, supported by a sling to immobilise the joint.  Taping techniques recommended are the Louisiana wrap strapping which uses a cohesive bandage to apply compression and support or the Open basket weave taping technique

4. ELEVATION – in the case of a limb, elevate the injury to prevent further micro-trauma to the area and drain away the waste products from the swelling.  Use crutches to allow only part weight bearing when movement is required for the first couple of days.  The ligament will require a certain amount of stress to heal correctly but early mobilisation will only prevent healing if applied too quickly

A massage therapist would be unlikely to be able to assist in working an acute injury prior to 48 hours and would recommend this process is followed and a future appointment made prior to treating the injury.

From 3 to 10 day period – the sub-acute phase

Continue with R.I.C.E. but start to mobilise the affected muscle by starting to complete non-weight bearing mobilisation of the joint and surrounding muscle.  The massage therapist can assist with this by providing passive mobilisation of the joint and surrounding tissues and recommending exercises post the massage session.

Active, non-weight bearing exercise at this stage will promote the dispersal of the inflammation and walking aids should be used if the rupture is severe to prevent full weight bearing activity. 

Where possible use alternate hot and cold bathing to reduce inflammation and swelling and then increase blood flow back to the area to aid speedy recovery. 

10 days onward – the post-acute (or active rehab) phase

The time period varies greatly from patient to patient but the joint is mobilised and massage work begins to re-strengthen the muscles surrounding the joint and break down any scar tissue adhesions that may prevent full recovery and mobilisation of the damaged area.  Mobilisation may consist of active, passive and resisted movements with the patient working with the therapist, with the aim to develop a range and quality of movement first, then developing the strength. 

In the case of an athlete who will want to return to previous form, functional rehabilitation is an important element when the injury is 80-90 per cent pre-injury strength.  The massage therapist will actively work with the patient to ensure restoration of the specific skills required for their sport are developed using functional and full weight bearing activities.  It will be important to develop proprioception to enable the athlete to restore their full balance and coordination from the injury and increase strength and endurance and restore full range of movement to the same as before.