What you can do to aid bone healing
Nutritionally, making sure you have enough calcium, magnesium, zinc, phosphate, carbohydrates and proteins is going to help the healing process by providing the building blocks needed for bone growth. 
Be sure to avoid re-injury by having patience with your healing process and listening to the advice of your orthopaedic doctor and manual practitioner. 
Making sure that your diabetes and possible other conditions are managed optimally is going to help a lot too. 
Seeing an osteopath is going to help you handle the compensations that happen in your body as a result of using your body differently after the injury. It helps to ease off aches and pains and also increases blood flow and the healing process. Your osteopath and physiotherapist work together to give you a treatment and rehabilitation programme that gets you back to your normal activities as soon as possible. 

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Inflammation
Inflammation occurs directly after the injury and usually lasts up to five days. The signs of inflammation are swelling, heat, redness, pain and loss of function. 

​Treatment in this phase is directed towards relieving pain, preventing further injury, increasing blood flow as well as maintaining muscle tone and pain free range of motion. 

Proliferation (scar tissue formation)
Depending on the tissue that has been injured this phase can last anywhere between 48 hours to over six weeks. In this phase the immune cells that have arrived at the site of the injury during inflammation, start removing the debris and form scar tissue that tentatively connects the different sides of the injured tissue together. At this stage this connective tissue “bridge” is not very strong against tension because the new connective tissue fibres that are created haven’t been told what direction to take. That only happens when the tissue comes under progressive tension. If the tension is too strong, it’ll break the new tissue. Just the right amount of tension, on the other hand, will help to make the tissue stronger. That is why this phase requires a lot of patience from the patient.

Treatment in this phase is directed towards preventing early adhesions, orienting the repairing tissue along the line of tension, relieving pain, maintaining muscle tone and range of motion, reducing swelling, starting exercise to return to normal activity as soon as possible, addressing any possible psychosocial issues and preventing the transition into chronic condition.

You can support the healing with good nutrition including protein, fruits and vegetables and with some supplements. Especially vitamin C, zinc and magnesium are important. 

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Ligament injuries and their healing

Ligament sprains happen when ligaments surrounding a joint are forced beyond their normal range of motion. Because ligaments have relatively little blood supply compared to muscles, they usually take longer to heal. 

Ligament injuries can be put in three different categories depending on the severity of the injury. Mild, grade I, injuries are ones where less than 10% of the ligament fibres are damaged, there’s only mild stretch to one of the ligaments and no instability in the joint. The usual symptoms include mild swelling and very local tenderness over the affected ligament and mild pain at the end range of motion of the affected joint. There’s usually no limping, or perhaps very slight imbalance in gait, some difficulty hopping on the affected leg (if the injury is in the leg). Functionally these injuries recover in about two days to two weeks, structurally the ligaments has healed in approximately 6-30 days. 

Grade II ligament injuries encompass a wide range of partial (11-99% of the fibres) ligament tears and may include several ligaments. There’s usually bruising and mild to moderate swelling around the injured joint, and the joint will feel mildly to moderately unstable with an obvious limp and inability to run or jump. Function is re-established in 14 days to two months but structural healing takes longer, around one to three months. 

In the most severe, grade III ligament injuries there’s usually severe bruising and swelling around the injury site, and oftentimes there’s also the possibility of a fracture as well that needs to be ruled out. This is because in grade III injuries there’s complete tearing of multiple ligaments and sometimes even the joint capsule may be involved. If the injury is in the leg it may be hard or impossible to put weight on that leg. The joint is clearly unstable and it’s nearly impossible to actively move the joint. In these types of injuries the healing times are longer; function is recovered in one to three months but to gain structural soundness takes more than six months. 

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What you can do at home
In the first few days after the injury apply PRICED or METH protocols (see above). Avoid aggravating activities and positions, and take painkillers if needed to ease the pain. For the first day or two the joint can be bandaged for support, but only short term. Be sure to take it easy and avoid reinjuring the tissue which could lead to prolonged healing and even chronic issues.

Nutritionally eating more protein (especially in the form of collagen or gelatine, like bone broth)  and making sure you’re getting enough zinc, vitamin C and D, as well as staying well hydrated is going to help give your body all the building blocks and optimal environment to repair the ligament tissue. Anti-inflammatory supplements like omega3 fatty acids (fish oil or algae oil) and curcumin may help to reduce the pain and speed up healing. 

After the initial two days, applying heat will improve blood flow and aid the healing process. At this stage you can go see your osteopath for gentle treatment to improve your range of motion and to reduce stiffness and pain. When you can tolerate it, the osteopath will guide you to gently move the affected site in pain free ranges of motion to avoid stiffness and contracture.

In the remodelling phase of healing your osteopath will give you exercises to improve your proprioception and balance and to start working on building strength around the injured area so that it can regain stability. As the healing progresses, the exercises will get more strenuous and more challenging, and if you’re an active person, more activity specific, to help you gain the level of confidence and strength needed to do the things you love doing. Usually the exercises progress from isometric to eccentric and then to more activity/sport specific movements. The rehabilitation progress for ligaments is going to be slower than for muscles because the tissues have less blood flow and thus take longer to heal. If conservative care doesn’t produce the desired outcomes, your osteopath may refer you for a surgical consultation. 

It is good to remember that ligament sprains heal in three overlapping phases and the duration of the healing process depends on injury’s severity and on the general health, activity, nutrition and age of the individual. Lack of patience in the rehabilitation process and too early return to full activities increases the likelihood of reinjury and the development of chronic pain. Recurring injuries result in increased scar tissue formation and loss of function. So in the long run it pays to have patience in the beginning, that way it’ll take less time and your body will heal better overall. 

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Have you ever wondered what happens in your body after an injury? In this article we’ll talk about tissue healing in general and look at muscle injuries, their healing and what you can do to aid the healing process in more detail. 

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Tissue Healing

Tissues are muscles, ligaments, menisci, discs and fascia. These heal through three main phases: inflammation, proliferation and remodelling. These phases overlap somewhat and can happen simultaneously.

Inflammation
Inflammation occurs directly after the injury and usually lasts up to five days. The signs of inflammation are swelling, heat, redness, pain and loss of function. 

Treatment in this phase is directed towards relieving pain, preventing further injury, increasing blood flow as well as maintaining muscle tone and pain free range of motion. 

Proliferation (scar tissue formation)
Depending on the tissue that has been injured this phase can last anywhere between 48 hours to over six weeks. In this phase the immune cells that have arrived at the site of the injury during inflammation, start removing the debris and form scar tissue that tentatively connects the different sides of the injured tissue together. At this stage this connective tissue “bridge” is not very strong against tension because the new connective tissue fibres that are created haven’t been told what direction to take. That only happens when the tissue comes under progressive tension. If the tension is too strong, it’ll break the new tissue. Just the right amount of tension, on the other hand, will help to make the tissue stronger. That is why this phase requires a lot of patience from the patient.

Treatment in this phase is directed towards preventing early adhesions, orienting the repairing tissue along the line of tension, relieving pain, maintaining muscle tone and range of motion, reducing swelling, starting exercise to return to normal activity as soon as possible, addressing any possible psychosocial issues and preventing the transition into chronic condition.

You can support the healing with good nutrition including protein, fruits and vegetables and with some supplements. Especially vitamin C, zinc and magnesium are important. 

Remodelling 
The final phase of the healing process is the longest and can take anywhere between three months to over a year. In this phase collagen, the fibre that gives the tissue its strength, is remodelled to increase the functional capabilities of the tissue in the direction of stresses put upon it. This could take the form of stretching and moving the body part gently in the pain free range of motion. 

Osteopathic treatment in this phase is directed towards proper alignment for collagen, increasing the elasticity of scar tissue, reducing fibrotic adhesions, relieving muscle spasms, increasing strength and range of motion, normalising joint and muscle activity addressing any possible psychosocial issues and preventing the transition into chronic condition.

PRICED vs METH
Most of us have heard of the (P)RICED protocol to be used in acute injuries, but not many are familiar with the METH protocol. Right after the injury has occurred, the first aid is to do the PRICED protocol.
Protect - take care not to re-injure the damaged tissue
Relative rest - taking it easy, not putting pressure on the injured tissues, this is only for the first 1-2 days (sometimes also substituted with OL for optimal loading)
Ice - indicated if there’s a concern for compartment syndrome, excessive swelling and helps to relieve  the initial pain, only use for 1-2 days after the injury at the most
Elevation - elevate the injured limb to prevent swelling
Doctor - see a musculoskeletal practitioner, such as a Reg Osteopath, for accurate diagnosis and care plan

Later in the healing process it’s better to use the METH protocol.
Movement - when the acute pain has decreased, begin pain free gentle movement
Exercise - progressive rehab programme to get back to previous activities and strengthen the structures
Traction - helps to ease the tension in the tissues and re-establish range of movement
Heat - to increase blood flow and help with healing

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Muscle injuries and their healing

Muscle injuries can be put in three different categories based on the severity. The first and mildest form of injury is a grade l minor muscle strain where some of the muscle fibres get stretched (<10%). Some of the symptoms include mild pain with activity, muscle guarding, mild trigger points (knots) in the muscles and mild local compensatory joint motion restrictions. There’s no bruising or loss of function but slight weakness may be noted with strong muscle contraction. Delayed onset muscle soreness (DOMS) that is common after a hard workout is classified under this category. 
Usually rest is enough to let the tissues heal. Functionally the muscle heals in about 2-7 days, and has re-established its structural strength within 4-14 days. 

In grade II muscle injuries some of the muscle fibres are torn, so there’s a partial tear in the muscle. Common signs of this are moderate to severe pain, guarding the affected site, loss of function, bruising and swelling, decreased mobility, limping and muscle weakness. There is usually significant pain when the muscle is stretched. Sometimes the tear can be even palpable. In these cases it’s recommended to see your doctor and get diagnostic imaging (usually ultrasound) to evaluate the extent of the damage and need for surgery. If the tears are not treated properly, partial tears can progress into full thickness tears with repeated trauma and usage. Functionally partial tears heal in 1-10 weeks, structurally they are sound in a few months. 

In full thickness tears (grade III) there’s severe pain at the time of the injury but very little pain afterwards. Other symptoms include severe bruising and loss of function as well as guarding the affected muscle. Usually tears are visible under the skin. In these cases surgery is most often needed and a return to full function might not happen and there’s often long term issues.. Functional healing time for these types of injuries is usually somewhere between 10 weeks to 6 months but structural strength takes longer, usually over a year. 

For the grade ll and lll, you need to see a healthcare professional to help you take care of your injuries. Osteopaths can help with evaluating the extent of the injury and give advice on how to take care of it including the right exercises and when. Osteopaths help to make sure that everything else is functioning optimally in your body so that it can concentrate on healing the injury and minimise the discomfort from compensations. Osteopathic treatment helps to increase blood flow which helps to promote healing and ease the pain. Osteopaths can also make a referral for ultrasound if a  muscle tear is suspected. 

What you can do at home
In the first few days after the injury apply PRICED or METH protocols (see above). Avoid aggravating activities and rest, and take painkillers if needed to ease the pain. Nutritionally eating more protein and making sure you’re getting enough zinc, magnesium, manganese and calcium, as well as staying well hydrated is going to help give your body all the building blocks and optimal environment to repair the muscle tissue. Be sure to take it easy and avoid reinjuring the tissue which could lead to prolonged healing and even chronic issues. 
Applying heat will improve blood flow and aid the healing process.. At this stage you can go see your osteopath for gentle treatment to improve your range of motion and to reduce stiffness and pain. When you can tolerate it, the osteopath will guide you to gently move  the affected site in pain free ranges of motion to avoid stiffness and contracture.

In the remodelling phase of healing your osteopath will give you exercises to improve your proprioception and balance and to start working on building back the strength in the injured tissues. As the healing progresses, the exercises will get more strenuous and more challenging, and if you’re an active person, more activity specific, to help you gain the level of confidence and strength needed to do the things you love doing. 

It is good to remember that muscle strains heal in three overlapping phases and the duration of the healing process depends on injury’s severity and on the general health, activity, nutrition and age of the individual. Lack of patience in the rehabilitation process and too early return to full activities increases the likelihood of reinjury and the development of chronic pain. Recurring injuries result in increased scar tissue formation and loss of function. So in the long run it pays to have patience in the beginning, that way it’ll take less time and your body will heal better overall. 

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What if resting is not working?
If you are suffering from Long Covid you probably know you need to rest to recover. You may have been told to just rest and have been resting now for a month or more. Recovery seems slow or has stopped progressing.  Don't worry, there are very good options for you to do next.

The scientific literature shows that severe complications of Covid infections seem to result from an increase in inflammation and altered immunity caused by a cytokine storm. However, Long Covid can occur from even mild cases of infection. Why is your body not recovering?

Post- infection there is a clean up job for your immune cells and your nervous system needs to get back to normal settings. With even 'mild Covid' there may be irritation of many organs in your body, including your brain, your lungs, your heart and your digestive tract. It also appears that the Covid virus is very good at turning down aspects of the immune system response to be able to have an easier time of infecting cells.

People with co-morbidities or who are already run down/tired or sick when they are infected may be likely to have a harder time with a Covid infection.

What can you do?
Nutritional and lifestyle support for viruses has already been described in detail by Reg Osteopath Venla Karki here.

Then you may like to add in one or more in combination of: Osteopathy, Acupuncture, Massage Therapy and Hyperbaric Oxygen Therapy to speed your recovery. 

Osteopathic treatment has been shown to improve the immune response and calm the autonomic nervous system so you start to feel better quickly. Relieving the pressure in the chest area, improving breathing and easing headaches. We utilise structural, cranial, visceral and Biodynamic Osteopathy. More information on our team here

Acupuncture  works by stimulating the nervous system, causing a release of neurochemical messengers. This enhances the body's homeostatic state, reduces sensitivity to pain and helps promote relaxation. More information on our Acupuncturist here

Massage Therapy reduces anxiety and stress, reducing cortisol and assisting improved immune function. More information on our massage therapist here 

Hyperbaric Oxygen Therapy reduces brain fog and fatigue. it works by reducing inflammation, re-activating the immune system and stimulating mitochondria which provide the power supply in all cells. More information on mHbot here 

In our practice we have very experienced practitioners who are ready to listen to you and work to help you feel better. We work as a team to figure out the really tricky cases and are proud of the value we add to improving the quality of people's lives. 

We look forward to helping you on your full and rapid recovery back to health.

​Dr Melanie Young
B.A., BSc.(Clin Sc.) B.Osteo Sc. MONZ
Reg Osteopath
​Director City Osteopaths
Wellington
​New Zealand

Phone 04 4991439 for our front desk team.
Online booking via our website http://www.cityosteopaths.co.nz

References:
1. Osteopathic Response to the Covid -19 Pandemic
Eric Martinez und David ReddingAus der Zeitschrift Journal of Osteopathic Medicine
​2. Hyperbaric Oxygen Therapy for the treatment of Long  Covid
Tim Robbins, NIHR clinical lecturer, A Michael Gonevski, hyperbaric doctor, B Cain Clark, assistant professor, Sudhanshu Baitule, clinical fellow
3. Support for rehabilitation – self-management for COVID-19 related illness World Health Organisation, Denmark, 2020
4. https://www.healthnavigator.org.nz/health-a-z/c/covid-19-long-covid/
5. https://www.bbc.com/news/health-61711913 Long Covid face lottery over treatment
6. https://denisecallaghan.co.uk/blog/osteopathy-to-help-with-long-covid/

​Venla Kärki Reg Osteopath, MONZ
​www.cityosteopaths.co.nz