Relieving pain from an injury is one of the most common reasons a person will make an appointment with a massage therapist. For helping speed the healing process of soft tissue injuries, there are few modalities as effective and as safe as massage. However, massage therapists working with new injuries must have a firm understanding of when that injury is in its most acute stage and what approaches are appropriate – because the acceptable healing modes within that acute stage differ greatly from those that are beneficial afterward.
An acute injury is a sudden, sharp, traumatic injury that causes pain. Typically the result of an impact or trauma such as a fall, strain, sprain or collision, the cause of an acute injury is usually obvious. The signs and symptoms of an acute injury are:
- Skin that is warm to the touch
Seasoned athletes and sports medicine doctors are all too familiar with R.I.C.E., the acronym for treating acute injuries. R.I.C.E. stands for:
- Rest – Rest is vital to protect the injured muscle, tendon, ligament or other tissue from further injury. In addition, rest allows hematoma organization to begin.
- Ice – Ice reduces pain and spasm, causes vasoconstriction to help control primary edema (swelling) and lowers metabolic demand in the tissue to decrease hypoxic tissue death. Ice or cold pack application for 15-20 minutes per hour is essential, but should not exceed the time limit to prevent skin damage.
- Compression – Known to delay the healing process, swelling can be limited with compression. Besides limiting edema formation, compression also slows hemorrhage.
- Elevation – Also advised because it limits edema formation and slows hemorrhage, elevation is most effective when the injured area is raised above the level of the heart.
Knowing about R.I.C.E. for acute injury treatment is insufficient; a practitioner must also know when to advise using this four-step approach and what to avoid. Rest, ice, compression and elevation should be applied up to 48 hours after the injury occurs. If the pain or swelling has not decreased after two full days, a visit to a physician is in order.
Because they risk aggravating a fresh injury, there are several methods that are discouraged during this 48 hour window. Adding to the list of acronyms a therapist should know, H.A.R.M. describes four factors that could slow down injury recovery or even make the injury worse. H.A.R.M. stands for:
- Heat – Heat increases hemorrhage at an injury site. Thus, hot baths, hot showers, saunas, hot water bottles, heat packs and warming liniments should be avoided for at least 48 hours after sustaining an injury.
- Alcohol – Besides masking the pain and severity of an injury, alcohol consumption increases edema and hemorrhage at the injury site.
- Running – Running (for a lower extremity injury), or any form of exercise, has the potential to cause further damage to the injured body part within 48 hours of an injury.
- Massage – Because it encourages circulation, massage can increase edema and hemorrhage during the body’s initial response to injury. Experts suggest extending the time frame for avoiding massage to 72 hours following an acute injury.
However, massage therapists can still apply a useful technique for acute injuries less than three days old without causing harm. While rest, ice, compression and elevation are essential and effective, they only support the cardiovascular side of acute injury physiology. R.I.C.E. overlooks the body’s natural edema removal system, the lymphatic system.
According to Pat Archer in Therapeutic Massage in Athletes, “The exudates in damaged tissue are protein-rich edema, and the presence of these proteins increases oncotic interstitial pressure, leading to secondary edema formation. To control secondary edema, the proteins must be removed from the interstitium since they cannot be reabsorbed by the capillaries. The only way to do so is to improve edema uptake through the lymphatic system.”
Thus, adding lymphatic drainage massage to the standard R.I.C.E. protocol will keep swelling to a minimum. By reducing swelling, the person receiving lymphatic drainage massage will have less hematoma organization and fewer repair fibers invading healthy tissues. By limiting these physiological processes, the healing time for an acute injury can be shortened.
In addition, lymphatic drainage works with ice to reduce pain by interrupting the pain-spasm-pain cycle. This can be explained via two mechanisms:
- Gate Control Theory – The light pressure and rhythmic movement of lymphatic drainage massage on the tissue are soothing and provide additional somatic stimulus to close the spinal gate to pain.
- Edema Reduction – Because it reduces edema, lymphatic drainage massage also decreases fluid pressure on the nociceptors to further decrease pain.
Once a painful injury moves past the acute stage, as evidenced by being greater than 72 hours after the traumatic event AND the absence of inflammation and swelling, gentle circulatory massage techniques can help restore range of motion and function to the affected area. Seventy-two hours post-injury massage can reduce the formation of scar tissue, improve tissue healing and ease muscle spasms that can develop as a result of the pain.
While massage therapists are typically called upon to address chronic pain, they also have a lot to offer clients with an acute injury. If the injury has just occurred, R.I.C.E. may be the only viable option. However, carefully adding lymphatic drainage massage to immediate injury care can be of great help. By knowing what to include and what to avoid in freshly injured clients at each stage of recovery, massage therapists can play a key role in their healing process.