Macon Physical Therapy - The Wellness Center - Pain After Injury

Pain After Injury

What is the most serious impact of the pain?

Sever pain after injury causes metabolic and hormonal changes that inhibit fibrinolysis substances (that keep your blood circulation flowing) . Inhibition of fibrinolysis may increase thrombolic (blood clot) complications such as deep venous thrombosis and pulmonary embolism (small blood clot inside the artery of your lung that connected also to your heart), which are the leading causes of morbidity after reconstructive orthopedic surgery.

After injury, how pain can be developed?

After injury the pain receptors called “nociceptors” can be activated and send pain signal from the site and surrounding sites of the injured region to special neuropath called A alpha, A delta and C fibers within the peripheral nerves. These pain signals are transmitted from these fibers to the spinal cord and geographically integraded in the dorsal column of the spinal cord, then it goes up through the lateral spinothalamic tracts (spine nerve tracts that responsible to carry the pain signal to the brain) into the lateral thalamus (sensation receptor part of the brain) into the sensory cortex in the brain that can make one feels the pain. Be informed that pain receptors “nociceptors” can be also activated by other means such as chemical, thermal (heat or cold) or mechanical impacts.

After injury the body release chemicals such as bradykinin, serotonin, substance P and histamine, those are stimulators to the pain receptors.

Why the site of injury swells?

The above mentioned after injury released chemicals, they are also vasodilators (make the veins swell). These chemicals increase the volume of the lymphatic and blood circulation at the site of injury, which will be congested with these chemicals and other materials such as hematoma (blood clots), collagen fibers deposit (Jelly material between muscle fibers created for protection and nutrition but if it increases more that its normal rate become like glue between muscle fibers and joint capsule which leads to hardening muscles and joint stiffness) and protein particles , which contribute to heavy traffic that slowing down the body absorption and paralyze the drainage system that responsible for evacuation and clean up. As a result swelling continues, protein particles thickening and the site become hard to touch. When you squeeze your finger it will sink in, medically known edema formation.

Why movement hurts after injury?

As we mentioned earlier, the pain receptors can be activated by three things, chemicals, thermal (heat or cold) and mechanical. A alpha (nerve motor fibers) and A delta (nerve motor and sensory fibers) are responsible for motor (mechanical) activities and fine sensation, which they synapse into the dorsal column of spinal cord. Movement stimulate pain signal from the site of injury and surrounding region into large A alpha, Delta and C fibers, which transmitte pain signal to the dorsal (sensory) column of the spinal cord, into the lateral spino-thalamic tract, into the thalamus and finally into the sensory cortex, when pain signal can be recognized.

After injury, why muscle tighten up?

After injury, the short nerve circuit that used to regulate the muscle tone was disturbed. This short circuit called spinal cord afferent reflex system. Spinal afferent reflex system receive information from the muscle through Gamma fibers that connected to the muscle at deep sensory area called the muscle spindle and another tone information can be also received from the tendon of the muscle at special sensory area called “Golgi tendon organ” all collected information goes out through Gamma fibers that connected from the other side to the dorsal (sensory) horn cell of the spinal cord. After muscle injury that circuit gets interrupted. Proper communication between the injured area and the spinal cord was severed. The spinal cord can no longer receive the tonic information and can no longer carry its regulatory duties and inhibit extra and unwanted tone signal from going back to the muscle. Muscle tone keeps develop and very little can be done to control the extra and unwanted tone development, causing the muscle to stay over toned, swelled and tight.

So what are the therapeutic options?

1. Rest and brace the area until you seek medical assistance.
2. Medicine:

Non-steroidal anti-inflammatory drugs (NSAID) can help decrease irritable chemical production; this should decrease peripheral sensitization and nociceptor transmission. NSAID helps block excessive secretion of dorsal horn excitatory transmitters (the bad chemical that keep the pain such as histamine, serotonin, bradykinin and substance P).
3. Physical Therapy:
Ice packs , are useful during the first three days after injury. Ice packs help reducing swelling and decrease the irritable chemical stimulation to pain receptors.
Passive movement , produces same above effects in addition prevents accumulation of excessive collagen fibers that contribute to undesired adhesions and stiffness.
Ultrasound therapeutic application , assists the body to absorb the irritable Chemicals, encourage synthesize endorphine for pain relief. Ultrasound Application helps removing adhesion, ease mission of mobilization and successful healing process with the least scarring formation.
Electrical stimulation therapy , helps regulating the muscle tone, remove muscle tightness and spasms attacks. Electrical stimulation improve the muscle ionic exchanges (sodium and potassium channels) for promote healing and justification. Electrical stimulation helps modifying the pain signal and close out pain gait that medically called “substantia gelatinosa” located in lamina II in the dorsal horn of the spinal cord. As a result pain signal will find difficulties reaching the sensory cortex in the brain. Pain reduction will be experienced. Electrical stimulation was found to be very beneficial towards healings, whether in the case of internal (inside) muscle fibers or skin, those are wounded or are ulcered.

These are few of many ways that physical therapy can naturally assist in recovery and minimize pain and limitation after injury.

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