Healing Injuries: Immobility vs. Stretching

(Originally posted on bcotoronto.com on Aug 23rd, 2012)

Immobility vs StretchingLast week we discussed the physiological effects of heat and cold on the body and how to properly utilize these while healing injuries. This week we are delving into the issue of immobilizing an injury or keeping it moving. This is a much simpler issue but let’s break down the rationale for it now.

Immobilization of a body part or joint is done for one simple reason; to stop movement from causing further damage to the tissues. This is appropriate when something has been partially torn or broken and the two sides of the tear need to be close together for new tissue to knit them back together. Any movement at this point could tear the delicate new fibres and possibly injure the tissue further.

Closely associated with the idea of immobility is Compression and pressure on an injury. This, like cold, is used to limit swelling. While cold slows blood flow and decreases the influx of new fluid from the blood, compression creates a back pressure on the entering fluid thus decreasing it’s flow as well as creating a forward pressure on the lymphatic system which is responsible for draining excess fluid from the tissues of the body. Also compression is very important for keeping all the small tissues in place while healing happens so the two sides of the tear we discussed before.

Too much pressure can cause its own problems though, so care is needed when applying a bandage. Excessive pressure will collapse the small, delicate lymph system that it otherwise would be stimulating and can even cut off the veins in the area, which are much closer to the surface than their arterial cousins. This is dangerous as it creates a backwards pressure in the vascular system which can cause damage to the blood vessels themselves and if left long enough can starve the tissues of much needed nutrients and oxygen.

The other side of this coin is, of course, keeping an injury moving and stretching. Movement of an injury is appropriate for most MINOR injuries because it stimulates blood flow and increases nerve conduction just like heat. Increased blood flow and nervous activity improves recovery and helps to prevent the build-up of scar tissue.

If an injury is inappropriately immobilized or “babied” this will actually make it worse. Injured muscles and ligaments lay down scar tissue to hold the tissue and avoid further injury but instead ends up avoiding function. Movement helps to ensure that the appropriate amount of scar tissue is built and that it is oriented in such a way that the body parts are still of use.

After the need for immobilization has passed (constant pain and swelling are gone), pain-free mobilization and stretching is the key to regaining proper function again. This rehabilitation can take a while but should always be completed to ensure healthy tissues and prevent future injuries to the same tissues due to weakness or instability.

The easiest way to differentiate between when movement or immobility and compression are appropriate is the presence of swelling and the quality of the pain. If there is swelling, then usually there is a tear or break in some structure and the body is trying to compress it on its own. The pain associated with this type of injury is usually achy and constant when the body part is not being used and becomes very sharp and stabbing with any attempt to use the injured tissues. This is when immobilization is called for.

When there is no swelling and the pain is more of an achy or “pulling” sensation only when the body part is being used then gentle stretching and movement is called for.

Come back next week for the last installment of “Healing Injuries” Series. Until then, if you have any questions about this or any other topic, please leave a comment below or e-mail me at drroffey@gmail.com.

Thanks for reading.
Dr. Ben


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