Soft Tissue Injury, Healing and what hot or cold treatment will do

What to remember when treating your soft tissue injury

  1. What happens following a soft tissue injury
  2. Desirable effects of treating them with cooling or heating
  3. Likely physical effects from cold/heat application

To understand when best to apply hot or cold therapy following an injury, we must apply it to the stages of healing. These phases are broad and overlapping stages where the events of each stimulate the next phase of the healing process. The phases are as follows….

  1. Bleeding – Initial tissue injury leads to bleeding, resulting in an initial increase in pressure and decrease in oxygen availability to the injury site. This can cause hypoxic damage to the tissue and surrounding tissues.
  2. Inflammation – An instant response following trauma and causes a vascular response (vasodilation) leading to oedema (swelling). A cellular response also occurs, removing dead cells and debris at the injury site and this initiates the beginning of the healing process, proliferation!
  3. Proliferation – Lays down replacement collagen or scar tissue and will begin after a day or two following the initial injury and will peak around 2-3 weeks following injury. The amount of scar tissue deposited depends on the vascularity of the tissue.
  4. Remodelling – This phase is often overlooked but is crucial to the heeling of the tissue. At this stage the collagen fibres are orientated and reorganised. Scar tissue has to be modelled and manipulated to avoid weak tissue fibres (A weak spot in the tissue) due to random orientation. It is easier to manipulate and orientate a maturing scar and therefore create a more robust arrangement and structure. This can take up to 18 months to complete!!

Desirable Effect of Hot or Cold Treatment – Circulation, Muscle Function and Pain

Cold on circulation – Cold diminishes circulatory demand and supply by vasoconstriction and decreased metabolism. There is often reflex vasodilation which can lead to complexities of an increased blood flow due to cooling time and vigorous cooling techniques. If cooling is too aggressive blood vessels will open to reduce the effect of cooling on the tissue so treatment must be applied gradually.

Cold on muscle – Muscle contractility behaves paradoxically when subjected to cold. This occurs before the muscle has cooled and can lead to muscle spasm. Therefore, decreasing muscle tension can be achieved by rapid and significant cooling with -15 decrees temperature changes of the tissue and at least 10 minutes of application.

Cold on Pain – Cold has an analgesic and anaesthetic effect, decreasing both pain and feeling.

Heat on Circulation – Heat causes vasodilation and increased metabolic rate, both are not desirable in acute phases of injury (inflammation). However, it does benefit tissue during the healing phases by removing waste metabolites and cytokines.

Heat on Muscle – Vasodilation relaxes smooth muscle and increases blood flow. This causes an increase in metabolic processes within tissue, increasing extensibility and decreasing viscosity, therefore making muscle more elastic and less prone to injury. The decrease in tension observed can result from the clearance of metabolites.

Heat on Pain – Heat can…

  1. Alter the input stimulus
  2. Alter metabolic activity of neural receptors sensitive to pain
  3. Alter transmission of pain relevant neural firing at the spinal chord
  4. Cause counter irritation effect in pain gate where pain signals may be blocked from reaching the brain due to additional input acting as a gate and preventing pain signals passing up the spinal chord.

Soft Tissue Injury Management

The feeling of heat in the inflammation phase is caused by increased blood flow. We need to decrease the blood flow by stimulating vasoconstriction, stem local blood flow to decrease exudate and the inflammatory response to minimise swelling and relieve pain. This returns normal function more rapidly.

How to know if you have inflammation and should treat with cold. Do you have…

  1. Heat
  2. Pain
  3. Redness
  4. Swelling
  5. Loss of function – relatively easy to determine

If it feels HOT, apply COLD and avoid HEAT and FRICTION. This prevents further pain and tissue bleeding.

POLICE your acute injury (Protect, Optimal Loading, Ice, Compression, Elevation) – BLOG POST COMING SOON!

  • Lowers metabolism of injured tissue, decreasing the need for oxygen and inhibiting a secondary hypoxic injury to surrounding tissue
  • Decrease total injury leading to decreased swelling and pain
  • Decreased pressure leading to decrease oedema (swelling)
  • Relieves pain via counter irritation (Pain Gate)
  • Increased blood viscosity – thicker blood = less bleeding
  • Decreased pain via decreased peripheral pain conduction velocity – Pain signals reaching brain more slowly
  • Relaxes muscles in spasm

In The Proliferation Phase

  • Ongoing cryotherapy (cold treatment) to control repair tissue that is laid down.
  • Introduce heat prior to exercise to increase extensibility
  • Use cold post-exercise to minimise swelling and inflammatory response

REMODELLING – The Key to Staying Injury Free

  • Prevents scar formation by orientating tissue fibres.
  • Forms a more robust tissue arrangement at the injury site
  • Use HEAT to help manipulate tissue along with hands on TREATMENT, LOADING and STRETCHING

Failure to remodel can lead to scar formation which will continue to contract and shorten for 18  months post-injury. This can then lead to impaired movement and can become painful. It will also result in incorrect correction during exercise (maladaptive behaviours), making the problem worse as you compensate for incorrect movement, this can result in recurring injuries.


HOT OR COLD, treat it right!


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