THER3000: stages of healing / conditions

treatment considerations with acute conditions

reduce pain and swelling; minimize but do not remove protective spasms; treat compensating structures; cold hydro (RICE)

massage interventions with acute conditions

relaxation on unaffected tissue proximally, pillow for drainage, ice affected area, lymph drainage with inflammation, PROM

self care in acute conditions

relaxation techniques (RICE), PROM, AFROM (pain free, mid range), muscle setting

general C/I’s with acute conditions

meds: analgesics / anti-inflammatories, muscle relaxants

aggressive / deep techs, hot hydro close to inflammation; circulatory work distal to injury; destabilizing protective spasms

treatment considerations with early subacute conditions

decrease inflammation, pain, spasm; maintain ROM & strength; may treat peripheral to lesion site

massage interventions in early subacute conditions

treat proximal to injury, elevate for drainage, cold/cool hydro / mild contrast, lymph drainage, proximal swedish, referral TrPs, reduce spasm, PROM, stroking / muscle squeezing distal to injury

self care in early subacute

educate about returning to activity, maintain strength w/sub-max isometric contractions, AFROM

general massage C/I’s with early subacute conditions

meds: analgesics / anti-inflammatories, muscle relaxants

aggressive / deep techs, hot hydro close to inflammation (can begin warm/contrast applications); circulatory work distal to injury (can treat periphery, non-circulatory distal may be ok)

treatment considerations with late subacute conditions

decrease edema, TrPs, pain, adhesions

massage interventions in late subacute stage of healing

treat proximal and distal to affected area; break down adhesions (fascia, gentle frictions); stretch; PROM mid-full range, contrast hydro

self care late subacute conditions

stretch, strength

general C/I’s late subacute conditions

painful stretching or techniques, discomfort lasting 4+ hours = too aggressive; getly stress tissue to encourage mobility & proper alignment, avoid retearing; remove barriers to drainage (fascia, scar tissue); X frictions if taking anti-inflammatories

massage interventions with chronic conditions

reduce adhesions & TrPs, restore ROM and strength, contrast / hot hydro

self care chronic conditions

stretch, strength, endurance, CV training

general C/I’s with chronic conditions

often non unless inflammation (heat, frictions)

effects of massage on scar tissue

helps form good quality scar, can free adhesions, desensitizes

assessment findings indicating scar tissue

observations: altered sensation, avascular (no hair, sweat), postural disfunction (adhesions, compensatory); early: edema, red/raised; later: hypo/hyperpigmentation

palpation: thickened / hardened, dec elasticity, cool → ischemia

testing:

• AF/PR/PF → reduced, possible pain

• AR → weak in affected muscles, possibly disuse atrophy

what stage of healing is scar tissue typically addressed

late subacute / chronic

appropriate hydrotherapy with scar tissue

pre-treatment: heat / warm; cold after frictions in lengthened position helps “set” fibers

treatment interventions - scar tissue

periphery-center-periphery

hydro: pre-treatment hot/warm; post-frictions cold

fascial, frictions

self care - scar tissue

early stages: mid-range AF/PF/AAROM; strengthen (early-sub - submax isometrics, progress with healing, can strengthen antagonists to prevent contractures)

later stages: passive stretch + heat

define strain & grades

overstretch/contraction injury to musculotendinous unit

gr I - minor stretch, minimal strength loss, activity continues

gr II - moderate stretch, difficulty continuing activity

gr III - rupture / avulsion, gap, activity ceases

massage interventions strains

acute: relaxation to unaffected tissue, lymph drainage, PRROM mid-range only

subacute: proximal Swedish, TrP release, gentle frictions (late subacute), periphery-center-periphery

chronic: frictions, prolonged stretch, deep techs to reduce adhesions

massage considerations - strains

protect healing tissue, avoid removing protective spasm (acute), avoid distal circulatory work (acute/early sub), treat compensatory structures, progress load as stage advances

self care - strains

acute: pain free AF/PRROM, muscle setting

subacute: submax isometrics, gradual strengthening

chronic: stretching, strengthening, endurance training

contraindications - strains

acute: AR/PRROM for gr II-III, deep / aggressive work, distal circulation, hot hydro near inflammation

frictions CI’d if on anti-inflammatories (late sub - chronic), avoid disrupting hematoma

assessment findings that indicate strains

acute: edema, heat, bruising, protective spasm (gr I-II), palpable gap (II-III), pain with stretch/contraction

subacute: adhesions forming, dec ROM, TrPs

chronic: decreased strength, adhesions, cool tissue, pain with stretch

define contusion

direct blow causing muscle fiber damage and bleeding; skin intact

massage interventions contusions

acute: NO on-site work; lymph drainage proximal

subacute: gentle swedish proximal, PRROM mid-range

chronic: deep work, frictions, stretch

massage considerations contusion

first 24 hours critical - control bleeding; avoid disrupting hematoma; avoid vigorous work for first 10 days (risk of re-bleeding)

self care contusions

acute: cold hydro, pain free ROM

subacute: gradual ROM, light strength

chronic: stretch, strength

C/I’s contusions

on-site work acute, stretching / vigorous work first 10 days, distal circulatory work (acute), frictions with anti-inflammatories

assessment findings indicating contusion

acute: rapid swelling, bruising, heat, protective spasm, dec ROM

subacute: bruising blue/black → yellow/green, adhesions forming

chronic: adhesions, cool tissue, painful stretch, possible myositis ossificans

what is a hematoma

rapidly forming pooling of blood within tissue after trauma; complication of contusion (follows contusion protocols)

what is myositis ossificans

complication of contusion; bone-like tissue forms inside muscle following a contusion (follow contusion protocols)

causes of edema

increased capillary permeability (inflammation, trauma, immune), obstruction, increased capillary pressure (CV conditions, pregnancy, lesions), decreased plasma protein (liver / kidney disease, severe burns)

medications seen with chronic edema

diuretics, benzopyrones

testing with edema

AF / PR → reduced

swelling / girth measurement (acute injury, if swelling is rapid, there may be a hematoma → medical emergency)

pitted edema +ve = chronic pitted edema from pathology

s/s of trigger points

painful passive stretching, weak / painful contraction (esp inner range), SCM → proprioceptive s/s, tearing, nasal discharge, tinnitus; taut band, twitch response, jump sign; dec circulation, dec ROM

assessment findings indicating TrP

AF → decreased, possible pain

PR/PF → decreased

AR → weak / painful

palpation: panniculosis, jump sign, twitch response, palpable band / nodule

differentiation test: muscle strength (esp in shortened position)