First Aid After an Acute Injury
Pain, swelling and muscle contraction are the typical symptoms of a soft tissue accident (bruises, strains, sprains and tears). To ensure a straightforward recovery, all three must be controlled effectively, immediately after the injury.
However, it is important to understand that pain, swelling and muscle contraction happen for a reason – they are a natural part of the body’s response to the injury, and the important thing is to keep them under control. The aim of first aid and further rehabilitation after an injury is, therefore, to control these reactions rather than to fight them, which can cause just as many problems as ignoring them.
Pain, Swelling and Muscle Contraction
The first step in treating a dance injury is to prevent further injury or damage. Frustrating as it may be, this means that you should stop dancing immediately and start treating the injury. Resting is essential to healing, so do not exercise through the pain: this will only make the situation worse, and increase your recovery time.
Pain and muscle contraction are protective mechanisms that the body immediately activates in case of an injury. They are designed to remove additional risk or danger to the injured area by impeding movement. Acute pain will make you stop your current physical activity and also force you to reduce impact on the injured area. Similarly, muscle contraction reduces the range of movement in related joints.
Pain and muscle contraction must both be addressed immediately after an accident to secure a full recovery. While people take painkillers as a matter of course after an injury, addressing muscle contraction is often not a priority, but this oversight can cause many problems further down the line in the rehabilitation process. Muscle dysfunction of the affected areas can easily arise after trauma, forcing the body to establish compensatory movement patterns that have an effect on the whole body. This can severely interfere with recovery after an injury.
It is essential to be aware of this, and to take care of your muscles directly after an injury. Trigger point therapy – applying localized pressure on a cramped muscle with your thumb and fingers – or self-myofascial release with a facial roller are simple but effective ways to address muscle contraction after trauma.
Soft tissue swelling is evidence of the body’s inflammatory response as it attempts to repair damaged body tissue. The process is necessary and should not be hindered as it allows new cells to be distributed to the injured area, promoting healing. However, excessive inflammation can occur for different reasons and needs to be controlled accordingly.
The Body’s Inflammatory Response
The inflammatory response is the body’s natural way of dealing with all kinds of tissue damage. Its main functions are to defend the body against harmful substances (like bacteria or viruses), to dispose of damaged tissue, and to promote the renewal of normal tissue.
When tissue cells become injured, they release certain chemicals – called chemokines – that initiate the inflammatory response. Chemokines widen the blood capillaries and boost their permeability, leading to increased local blood flow and tissue swelling, and allowing the body’s natural defense cells (leukocytes) to enter into the injured site. Chemokines actually act as chemical messengers that attract these cells.
Two types of leukocyte play an important role in the inflammatory response: macrophages and neutrophils. Neutrophils are the first to reach the injured site and set to work neutralizing harmful bacteria. Macrophages aid the healing process by engulfing bacteria and dead cells and ingesting them so that the area is clear for new cells to grow.
If the inflammatory response becomes out of control for any reason, it is possible that neutrophils may cause damage to healthy tissue, or delay the healing tissue’s regenerative capabilities, through the release of oxygen-free radicals. It is therefore important to control the inflammation effectively.
Safe Application of Cold and Compression
Applying cold to an injured area is a common recommendation and it is effective in controlling acute pain and excessive swelling or bleeding. However, most people make the mistake of icing an injury too much and for too long. Excessive icing will disturb the body’s natural inflammatory response, increase congestion in the lymphatic system (a vital part of the immune system) and cause muscle dysfunction by affecting neuromuscular function – a series of complications that severely disturb the natural healing process. The use of ice sprays, cool packs or frozen vegetables (as recommended in some guidelines) always carries the risk of overcooling the injured area and thus disrupting natural healing.
A safe way to apply cold and compression at the same time is to soak an elastic compression bandage in ice water and apply it directly to the injured area. The bandage should subsequently be kept wet by applying fresh ice water with a sponge from time to time. When wrapping an injury, apply the bandage snugly using a partial stretch: you should be able to slide at least two fingers under the secured bandage. The best way to apply the compression bandage is to start away from the center of the body and then wrap towards it. Wrap an equal distance above and below the injured area, overlapping by half the width of the bandage. Make sure to wrap slightly looser as you pass the injured body part so that swelling can move out of the area. It is also important to raise the injured area above the height of the heart as frequently as possible to reduce blood flow and help to control the swelling.
Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used to treat pain and control inflammation after an acute injury. They are available on prescription from a doctor but can also be bought over the counter. Examples of NSAIDs include ibuprofen, naproxen, diclofenac (voltaren) and celecoxib.
The reason doctors subscribe NSAIDs is that they are very effective in managing pain after an injury and therefore can contribute to regaining mobility. In fact, getting joints back into motion, and activating injured musculature and soft tissues, are the primary goals after most injuries, as long as immobilization of the injured area is not required.
However, apart from their analgesic (pain-killing) properties, NSAIDs are also anti-inflammatory and this must be taken into account when it comes to tissue healing after trauma. As emphasized above, inflammation is a natural response to trauma and an important part of the healing process. Given that NSAIDs reduce neutrophil and macrophage accumulation in the damaged tissues, taking them for a prolonged period after an injury may actually hinder your recovery!
To alleviate acute pain and control the inflammation process, it may be useful to take an NSAID for a short period. Often, there is excessive inflammation after trauma and there is potential for this to affect surrounding healthy tissues, slowing down the overall recovery process. An NSAID may help to control this excessive inflammation initially, without immediately impeding the healing process.
The level of pain after an accident usually determines whether an NSAID is needed. As soon as the pain can be controlled with a milder analgesic (e.g. paracetamol), a number of supplements can help to control the inflammatory process more sustainably, including Omega-3 fatty acids, Bromelaine (pineapple enzyme), Curcuma and others. Dancers often use NSAIDs as their standard analgesic and they are also likely to use them in case of an accident. They are usually unaware of how NSAIDs can affect the recovery processes of their bodies, and the extremely serious side effects that these types of medication can have in a small number of cases. The use of NSAIDs after trauma (and in general) should therefore be avoided or kept to a minimum, as well as being monitored by a physician.
Promotion of Tissue Healing
Especially in the first few days after an injury, there are certain things that you should avoid so that you do not disturb the body’s healing process. These are summarized in the “Dancer´s No HARM” principle, which stands for:
H – no direct heat to the injured area (including sauna)
A – no alcohol (including vodka)
R – no rehearsing, performing or training
M – no massage
Heat, alcohol and massages are likely to increase swelling and bleeding into the injured soft tissues, resulting in a longer recovery. Although you will be keen to get going again, it’s important to remember that rehearsing or exercising too soon bears a serious risk of causing further damage to the injured part, suffering a re-injury or developing a chronic problem.
Nutrition plays an important and often underestimated role in tissue healing after an injury. For optimal recovery, the body will need adequate amounts of nutrients, including carbohydrates, protein, fat, vitamins and minerals as well as multiple other micronutrients. Dancers who do not meet their nutritional needs are at risk of delayed tissue healing and wound-related complications. Because tissue healing is so dependent on nutrition, a comprehensive nutritional screening is critical and the supplementation of certain vitamins, micronutrients and fatty acids may be advised.
Regaining mobility and equal strength, flexibility and proprioception (awareness and coordination) in both the injured and non-injured parts of the body is essential to the rehabilitation process. Alongside a tailored rehabilitation program, osteopathic treatment (especially deep myofascial release treatment) is often recommended because it physically loosens up the affected soft tissues and treats any muscle dysfunction or dysbalances that have occurred as the result of injury.