Healing 101

When we injure ourselves, whether it’s a broken bone, a sprained ankle or a simple skin cut, all of our tissues follow the same stages of healing; inflammation, repair and remodeling. The stages overlap, one stage flowing into another, with elements of different stages happening at the same time. How well the tissue heals depends on many factors including which tissue has been injured, how you manage pain and inflammation and how and when you start to use the tissues again.

 

Stages of Healing:

 

1. Inflammation: 

Inflammation seems to be the new buzzword in medicine and has been linked to all kinds of health issues. And it’s true that inflammation in the intestines from food sensitivities and in the joints from arthritis is destructive and should be managed. This is not the kind of inflammation we are talking about here. What we are referring to here is the inflammation that begins with injury and lasts anywhere from four days to three weeks. Immediately after an injury, the damaged tissue is bleeding and without oxygen. This activates your immune system, causing an inflammatory response in the injured tissue. A clot quickly forms and many different kinds of inflammatory cells are attracted to the injured tissue. Over the next several days, debris is removed and cells that are more anti-inflammatory in nature are attracted to the area. These cells will transform into the blood vessels and tissues of the healed injury. It is during this phase that many of the cells that you will need in the next two phases are attracted to the area, called in by the injury and inflammation.

 

2. Repair:

This phase begins as early as day four and lasts until about day 28. In this phase you begin to make the basic structure of tissue. Basic blood vessels form. You form a matrix, which is sort of like a gel. Into this gel you lay collagen, the fibers that provide structure. The gel gradually firms, trapping the collagen and beginning the healing of the tissue, closing the gap and reconnecting the edges of the injured tissue.

 

3. Remodeling:

Remodeling is the longest phase and can last as long as two years, depending on the tissue. During remodeling, the basic tissue formation that began in the repair phase is refined. The tissues gradually transform further into the tissue they are meant to be. The ratios of cells and vessels normalize. The collagen fibers become the type that normally occurs in that tissue, the fibers line up along the lines of the forces applied to the tissue and the structural strength of the tissue gradually improves.

 

Use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) After an Injury

Non-steroidal anti-inflammatory drugs (NSAIDs), such as acetaminophen, ibuprofen and aspirin (e.g. Tylenol, Advil, etc.), are often used after an injury to manage pain and inflammation. But many studies indicate that the use of NSAIDs in the inflammation phase impairs healing in the repair and remodeling phases. NSAIDs interrupt the inflammation phase by inhibiting certain enzymes. This interruption limits how many and which cells you have for use in the repair and remodeling phases. (Remember that many of the cells you will use during repair and remodeling are attracted to the area during the inflammation phase.) So you might want to minimize the use of or avoid using them altogether during the first one to two weeks after an injury. On the other hand, studies of NSAID use during the repair and remodeling phases indicate that use during these later phases is not detrimental to healing. In fact, NSAID use during repair and remodeling of ligaments and tendons may in fact improve the quality of the tissue and decrease formation of abnormal scars.

Using ice for inflammation and pain does not interrupt the inflammation phase in the way that NSAIDs do. Cold numbs sensation on the skin and constricts the vessels, decreasing the amount of fluid in the area temporarily, thus providing some relief of pain and inflammation.

 

Tension and Forces through the Healing Tissue

Providing the correct tension to the repairing tissue can assist healing and improve the final quality of the repair. How and when to apply tension through the healing tissue will depend on which tissue is involved and which phase of healing it is in. During the inflammation phase, correct movement will help reduce swelling and prevent abnormal scaring and loss of muscle mass. During the repair and remodeling phase, tissue specific tension will assist with proper bone formation and healing of muscle, ligament and tendon. It does this by providing the stimulus for reorientation of the collagen fibers in the proper direction and encouraging thicker, stronger collagen fibrils that can withstand greater forces. Knowing just how to do this properly is complicated, so get some help. Have your doctor and physical therapist guide you through the phases and tell you how and when to use the tissues, so you can recover from your injury strong and well healed.

 

Interested in learning more? Join us for our upcoming Healing 101 lecture on Thursday, September 21st at 6PM. Click here for more details. 

Pregnancy Related Low Back and Pelvic Pain

By: Gema Sanchez, PT

Prevalence of low back and pelvic pain during pregnancy has been estimated to be as high as 90%. It is so common that many obstetricians consider it a normal finding in pregnancy. Many women also consider pain to be an inevitable and normal part of pregnancy and do not seek treatment, despite significant limitations in day to day activities. As many as 80% of pregnant women report that back pain affects daily activities such as walking, rolling over in bed, getting out of a chair and getting out of bed.

Low back and pelvic pain during pregnancy also has significant repercussions post-partum. Risk of return of pain in a subsequent pregnancy has been estimated at 85%. One study found 20% of women with back pain during pregnancy reported residual pain three years later and 10% of women with chronic low back pain link the onset of their pain to pregnancy. This is unfortunate, since several studies have shown that simple interventions for pain during pregnancy such as exercise, education and manual therapy techniques can significantly improve pain and function during pregnancy and prevent persisting and chronic pain post-partum.

Exercise combined with education (in anatomy and physiology, posture, pain, normal pelvic changes, self help management, ADL modifications) has been found to be an effective treatment for pregnancy related lumbar, pelvic, and symphysis pubis pain. In 2014, Van Benten et al reviewed 22 randomized controlled trials on the effectiveness of physical therapy interventions in treating lumbopelvic pain during pregnancy.  They concluded that exercise combined with education had a positive effect on pain, disability and/or sick leave. In one of the reviewed studies, Shim et al provided education and an exercise program to a group of 56 women with pregnancy related lumbar and pelvic pain. After 12 weeks, the women in the intervention group reported an almost three point decrease in pain. Education and exercise were also provided to late pregnancy subjects with symphysis pubis pain and dysfunction in the study by Depledge, et al. They found that after only one week of education and exercise, average pain decreased by 31.8% and disability decreased by 38.6%.

Osteopathic manual techniques, practiced by osteopathic physicians and physical therapists, have also been shown to be effective for pregnancy related back pain. Licciardone et al compared the effect of the addition of 5-7 sessions of osteopathic manual techniques (soft tissue, myofascial release, muscle energy and range of motion mobilization) to usual obstetric care in 146 women with late pregnancy back pain. They found that back pain decreased and back specific functioning deteriorated less in those women who received the manual techniques.

Low back pain, pelvic pain and functional limitations because of pain should not be considered an inevitable or normal part of pregnancy. Intervention during pregnancy can decrease pain, improve function and reduce the risk of persisting and chronic pain. Physical therapy at New Heights Physical Therapy Plus provides safe and effective customized assessments and interventions in all stages of pregnancy and post-partum.

In June, we will be welcoming a new physical therapist, Julie Burtis. Julie specializes in women’s health and will be splitting her time between the West and East clinics. She will be giving a lecture on Postpartum Rehab at New Heights (East Clinic) on June 29th from 6-7PM.

How-To Not Flunk Your Exercise Resolution

Written By: Gema Sanchez, PT

By now, you have heard over and over again that regular exercise is essential for happy, healthy aging. But establishing an exercise program, and sticking to it, can be extremely difficult, especially for those for whom exercise has never been a part of their life. As a physical therapist, I have had many people express the desire to start a regular exercise program, or lament that they were exercising regularly for a while but then stopped and have been unable to get back to it.

So, what to do? It’s all about clearing any blocks you might have to getting to the gym, pool, Yoga studio, rock climbing gym or local track and starting.

Here is my advice:

  1. Make it convenient

Choose a location close to work or home or on your daily route. You will find it much easier to get to the gym if you pass it every day than if you have to go out of your way to get there. Make it difficult to give yourself the excuse that it is inconvenient. Every day as you pass the gym, thinking to yourself, “I’m signed up and paying my dues, I should go in there”, remember it will only take a turn of the steering wheel to get you in the parking lot.  First obstacle: Get into the gym. You can’t work out if you aren’t in there.  Also, remember to look for spontaneous and easy to establish ways to exercise.   Walking in the evening, playing with your kids, riding your bike to do errands, taking the stairs when you have time and parking further away from your destination are all really easy ways to get your exercise in without having to carve time out of your schedule.

  1. Find something you really like

You will not stick with something that doesn’t challenge you or is not fun. Sure, you may force yourself to go for a while, but come the holidays, or your vacation or nice weather;  you’ll fall out of the habit and not really want to go back.  Don’t like aerobics, how about swimming? Don’t like the gym? How about dance, or Yoga, or Pilates? Can’t afford the gym or classes? You can walk, or ride your bike or look for free classes for beginners at Yoga studios. The most important thing is that the activity itself motivates you. If you are going by will power alone, it won’t stick.

  1. Get a buddy

Finding a reliable workout partner is hard but worth the effort.  Many people turn to family, friends or neighbors, but sometimes the best workout partners are found right where you work out. Like you, they have summoned the willpower and have the motivation to show up, which is half the battle.  Having a partner helps keep your workout consistent and challenging. You both bring ideas to the workout and when you are having a day when you are less than motivated to go, having someone waiting and counting on you can be just the extra little something you need to motivate you.

  1. Change it up

Many people learn or develop a workout routine and then do the same routine every time they go to the gym. It’s worth it to gradually add to your routine options, learn new machines, try new classes, watch and learn from the people around you. Not only will your workout be well rounded, you will have more fun and never get bored.  I am a regular at the gym in the cool, rainy weather and we rarely do the same workout twice. But come summer, I would far rather go for walks, do gardening or go for hikes. And by the time the rainy weather returns, I am ready and excited to get back to the gym!

  1. Build the habit slowly

It is really important to set realistic, achievable goals at first. Of course the ultimate goal would be to do some kind of exercise at least 3-7x/week.  If you have not been working out regularly, it is REALLY hard to put this in your schedule. You’ll start well for maybe one or two weeks then life will get in the way and next thing you know you haven’t exercised in 2 weeks.  Then it is very discouraging and hard to recommit.  Instead, start with committing to 1-2 days/week. Even if this is all you do for a month or two, it is much better then stopping and starting or doing nothing.  Once it is an easy and normal part of your weekly schedule, try adding more days as you are able.

 

 

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Top 5 Impediments to Healing

Top 5 Impediments to Healing. New Heights Physical Therapy in Vancouver WA and Portland OR.

When we become injured or sick, it is often in our nature to think there is a one-solution fix. We see our primary care physicians or our physical therapists in hopes that they alone will rid us of our ailments. However, this is not always possible and although our healthcare team plays a critical part in our healing process, there are often behaviors we practice outside the clinic that stand in the way of optimal recovery.

Here at New Heights, our PTs have identified a number of barriers that prevent optimal recovery. The top five were:

  • Poor nutrition
  • Inactivity or TOO MUCH activity
  • Poor hydration
  • Stress/Anxiety/Depression
  • Poor attitude

Other barriers include environmental toxins and lack of sleep. All play a part in our body’s ability to repair itself. Processed foods, pushing through pain and not giving our bodies enough time to heal can lead to chronic inflammation which in turn leads to degeneration and loss of function in the affected area. Factors such as chronic stress or anxiety cause our bodies to be in a constant state of tension, inhibiting the healing process.

Because our PTs recognize these and many other barriers, New Heights’ Portland Clinic is hosting wellness classes and lectures that focus on a holistic health approach. Every month, we invite experts from around the Portland-Metro area to come and share what they know. A majority of these offerings are free and open to both patients and the community.

This fall’s highlights:

  • Dr. Tyna Moore, ND, DC, will be leading a lecture about gut health and how the foods we eat can either promote or inhibit reactions such as inflammation
  • Dr. Kathy Alvarez, MD, will be speaking on stress management and the importance of understanding the effects stress has on the body
  • There will also be lectures on osteoporosis, concussion awareness, sports injury prevention, bike fittings and many others

In addition to the monthly lectures, weekly wellness classes have been developed to help relieve stress and promote healing. Our new yoga instructor, Heather Beckett, will be leading Yoga Steps every Monday, for those new to yoga or recovering from an injury. She will also be leading a Dynamic Yoga Flow class on Wednesdays for those ready for a bigger challenge. Furthermore, group acupuncture and CHILL classes provide more opportunity to de-stress, while MELT classes work to rehydrate to your connective tissue, reduce inflammation and increase joint mobility.

Our goal in providing these classes and lectures is to help build an awareness for the intricacies of our bodies and to recognize that in order to reach optimal health we must take care of multiple systems. Our hope is that you will take control of your health by joining us. For more information about our wellness classes and lectures visit our online wellness class schedule or call 971-339-3405.

References: U.S. News & World Report, American Psychological Association