Trying out skates for the first time in over a decade, sticking close to the wall, wobbling along. You come up on someone even slower than you (shocking!) and decide to brave open ice and go around. You start your big move, its going well, you glance away for a moment…toe pick…crap! Your knee is throbbing, your hand is sore where the ice scraped it, and your shoulder is a bit achy. You are on your belly, on the ice, feeling like an idiot.
The next morning, with a bruise as big as a salad plate on your knee, you think the limp will be your biggest problem, until you try to take off your sleep shirt. That achy shoulder from yesterday is not interested in heading up over your head. You have to take your shirt off like a 2 year old – one arm at a time, then over the head. You suck it up and head on about your day but quickly realize that every time you try to reach out in front of yourself, or up over your head your shoulder protests – bitterly. You haven’t thought about your knee all day.
What has happened? You have a first degree strain of your subscapularis muscle (it is in you armpit). Strain not sprain (strain = muscle, sprain = ligament), and only first degree (they go from a few torn fibers at 1st, a small to large gap at 2nd or a complete rupture at 3rd). What now?
As I have previously stated the first major stage is inflammation, you can read about it in its own blog. The rest of the steps are not radically different from deep wound healing. The body sends cells and microscopic nutrients and components to the wound that clean it, keep infection out and rebuild. The difference comes in the result.
Almost no regrowth of muscle is possible. Occasionally muscle cells with extra nuclei can divide to replace damaged tissue on a very small scale. The intact muscle cells can enlarge. The majority of the healing though will be the laying down of scar tissue. Fibrous collagenous tissue with limited blood flow, minimal extensibility, no contractility and little elastic recoil, all contrary to the nature of muscle. A muscle is designed to move, to get longer and shorter and to return to its starting length. And most importantly muscle is expected to generate force through contraction. Scar tissue can not do any of this.
Creating a mobile scar in dermal tissue is a good thing both functionally and esthetically, in muscle a healthy scar is essential. A healthy scar ensures that you are able to continue unrestricted activity and that you will not re-injury yourself. How you treat your body during this healing phase is critical. For the first 24-72 hours you should RICE (Rest, Ice, Compress and Elevate). Light daily life activity is okay, just try to avoid doing more damage. After that, provided you have no resting pain, you need to start moving that muscle, right to its pain barrier, and in all the directions you want to use it for the rest of your life. Do not use weights or resistance at this point, just want move it (you are doing ROM exercise). By educating the emerging tissue as to it responsibilities you encourage the scar to be of sufficient size to fill the space without shortening the muscle, you also encourage all the little collagen fibres to lie down in alignment with the stretch you place on the muscle (meaning you will have a scar of maximum strength) , and your uninjured muscle, your proprioceptors, and your brain are all learning how to deal with their new situation.
Realistically, for a first degree sprain you shouldn’t have any trouble doing this. There is minimal pain and you should be comfortable moving it quite quickly. The scar will be very small and change the way your muscle behaves minimally. You will likely be unaware of the alteration and re-injury is a small risk. The principles though hold all the way up to a full rupture.
With a rupture the time before safe movement is longer and you would need to have the structure repaired before ROM could make a difference. There would also be a need to progress from ROM to resistance exercise in order to gain back the strength that would be lost through the period of inactivity and the loss of contractile fibres. The key is that you want to retrain your body to deal with the new state of affairs. You can not just “rest” it for three weeks, using only 25% of your regular movement, and have your body know how to behave. You will have a very short, poor quality scar. You will be more likely to have tiny little tears occurring all around it as you try to expand your usage of the muscle. Basically, you will be causing small injuries over and over again, creating more and more scarring.
The issue with muscle healing is that you need your muscles to move, that is their job. If you do not ensure that they learn how to move in their post-injury state they will keep trying to move the way they used to, with poor results. Remember, for injuries the intervention of a health professional can speed the healing process and provide guidance on safe ways to rehabilitate. For mild strains a registered massage therapist or a physiotherapist would be your best choices. If you believe your have a more significant injury a visit to your physician is a must. A reputable RMT or physio will assess your injury and let you know if a doctor’s help is needed. A good doctor will send you to a RMT or physio when it is safe.