The Life Cycle of a Musculo-Skeletal Injury
What does a musculoskeletal injury actually involve, how quickly do they recover and how can they be prevented?
This is an important question. Many people believe that an injury in day to day life can be easily treated and recovers quickly without problems. They are often surprised by the length of time for recovery that is required in many injuries, when they actually occur
At Glenelg Orthopaedics, we like to use an analogy to explain that no matter how good an injury recovers, the patient is always left with some (hopefully very small) residual symptoms. If a brand new car is involved in an accident and every fragment or aspect which has been damaged is replaced with brand new products, most would agree that the car is still never quite the same. In the human body, injuries do not result in the use of replacement parts but instead requires the existing parts to be repaired as best possible, often with associated scarring. As such, one must expect that there will always be some residual symptoms with either stiffness or some niggling discomfort. That being the case, the aim of any injury treatment is to try and restore normal anatomy, allowing best function , reducing pain and preventing arthritis long term.
Most injuries are presented to an orthopaedic surgeon either involve fractures or breaks of the bone or tears and ruptures of tendons or ligaments. The aim of the treatment is to make sure that there is an acceptable alignment in the case of a fracture, or in the case of tendon tears, either to accept that the tendon or ligament will scar up and function well or otherwise repair it. In all cases, recovery passes through various stages.
Initial Stage
In the initial 6 weeks the bones and soft tissues will settle as the acute inflammation improves. During this time the pain will be most acute during the first 3 weeks, and then improve as the bone and soft tissues are starting to stick together (early stage of healing). In most cases the first 6 weeks are important to let the initial injury settle. The patient needs to protect the healing response by ensuring their health is optimised and the injured limb is not subject to undue force. This is so that any fracture does not move further or, in the case of a torn tendon or ligament, that this structure does not pull away. As such, in the first 6 weeks it is important to take things extremely quietly and just concentrate on general health, working on good nutrition, good hygiene, and coughing and breathing exercises for the general cardiovascular recovery.
Intermediate Stage
During the next 6 weeks, in general the doctor will encourage regaining normal range of motion of the injury, restoring normality for basic function. In an upper limb injury, this means recovering full movement and in a lower limb means encouraging normal walking patterns.
During this stage, the structures that have either been broken or have been torn are still healing and so should not be subject to excessive force. While some exercise is generally permitted, it is not at the extreme level.
Final Recovery Stage
This stage involves that 3 to 6 month period following surgery when we are aiming to restore the patient back to pre-injury levels, slowly increasing strengthening, training and force subjected to the injured area. It is during this phase that most of the improvement occurs and that the patient starts feeling back to normal. In some cases, longer protection is required. One such example is an anterior cruciate ligament reconstruction, where the ligament needs to recover its own blood supply and therefore, in most situations, is protected for a full year. In other cases the structures heal quicker, such as a broken bone in a hand or a torn cartilage in a knee, and the recovery may be quicker so that at the 6 week mark full activities are restored.
It is important to be aware of the slow recovery of orthopaedic injuries. People often ask why it takes so long. “My hernia operation recovered in 3 to 4 weeks and I felt back to normal.” The difference in this scenario is that a hernia operation involves placement of artificial structures into the abdominal wall, and the artificial structures actually take the place of the normal anatomy. In this case, there is no recovery required to the soft tissues around the area. The same effect occurs when a hip, knee or shoulder replacement is undertaken, which surprisingly seems to have a quicker recovery time than tendon repairs or broken bones.
The reason for this is that when artificial structures are used, recovery is quicker than when we are relying on the soft tissue to recover or the bones to heal. We have to follow their natural healing response. An analogy we like is that in the building of a house, you need to wait for the cement slab to set before the progress can continue. In the case of the broken bones or torn ligaments and tendons, the healing response progresses at a set rate. This response is hastened in fit and healthy young patients and slowed as we age. It is also heavily affected by smoking, which also can enhance the level of pain the patient experiences.
Are there other considerations that need to be taken into account?
We know that a patient returning from injury too quickly without going through rehabilitation process is highly susceptible to repeat injuries. A patient who is deconditioned and is struggling with their general fitness is also more prone to injuries. This is because the stresses placed through the rest of the body affect the ability to respond to sudden stimuli, and reflexes are reduced. In all cases following injury it is appropriate to go through a formal rehabilitation program with a physiotherapist or trainer you trust, to improve your fitness before returning back to full level of function.
Remember, in any injury often surgery may be warranted either to return structures to their original position or to realign fractured bones. The earlier this is done, the better the recovery and as such it is vitally important if the injury is not settling within a week or two, to seek advice from your General Practitioner to consider a referral to an orthopaedic surgeon. At Glenelg Orthopaedics we can give a balanced approach to what is best, and we believe that it is important to treat the patient as we would like to be treated ourselves.
At Glenelg Orthopaedics we provide quality orthopaedic care in a balance approach and encourage a holistic assessment involving allied health to give you the best results.
Glenelg Orthopaedics: Providing Quality Orthopaedic Care