This is probably the most common question clients ask our Office Assistants. It’s a really tough question for them to answer because there is so much overlap in methodologies and techniques between the different types of musculoskeletal practitioners. Chiropractors, Physiotherapists, Osteopaths, Massage therapists and others are using a lot of the same techniques nowadays. To complicate it further, there are so many new and incredibly effective treatment modalities and technologies available that did not exist even 10 years ago. Without a background in pathology, years of clinical experience and an understanding how the treatments work at a physiological level, it’s really hard for staff to give good answers. One of the things you learn after 15+ years of clinic practice is that no matter how good or how nice we are as practitioners, we still won’t achieve results for our patients if the correct treatments aren’t chosen. The treatment must address the actual source tissue that is causing the pain or dysfunction and a problem will not stay resolved if the root cause of the tissue injury itself isn’t discovered and removed or prevented.

Hopefully this brief guide will help clarify the many treatment types available today and the tissue and injury types that they are most effective for.

Step 1. Diagnosis:

No matter what type of practitioner you see, we all have to diagnose the injury and determine what exact tissue types are damaged or injured and what types of injury they received. The more effective we are at getting specific on the tissue types injured the more specific the treatment will be and the more specific the result will be. General diagnoses leads to general results and nobody is ever satisfied with that. How and when the injury, dysfunction or cause of pain occurred is critical in choosing the best treatment at the time of the exam.

Examples of some common injured tissue types include sprained or torn ligaments, overstretched ligaments and joint capsules, restricted and shrunken ligaments and joint capsules, strained or torn tendons, degenerative tendons, muscle tears, fascia tears, scar tissue adhesions, compressed nerves, torn cartilage, avulsed bone fragments, bone fractures, bone enthesopathy (fibers pulling off their attachments to the bone membrane), herniated discs, degenerative cartilage (arthritis) and blood vessel entrapments.

Specific Diagnosis = Specific Treatment = Specific Results.

Step 2. Choosing Treatment Type:

Acute vs. Chronic

Acute injuries are either new or re-injured chronic injuries. They are generally inflamed, swollen, red and often have a sharper or more intense pain. With acute injuries the bodies inflammatory repair system is very active. In this phase of healing the goal is to allow a healthy amount of inflammation, which is the bodies natural healing process, and control or limit excessive inflammation so that the body doesn’t over-produce scar tissues. Every tissue type responds to inflammation differently. Tissues with more circulation, like muscles, tend to get more inflamed than white tissues with less circulation, such as ligaments. The general treatment protocol and home care advice for acute injuries is to follow the pneumonic RICE for Rest, Ice, Compress and Elevate in order control inflammation, swelling and avoid worsening the injury further. More effective and specific treatments can be used once the practitioner determines the source tissues that are causing the pain.

Chronic injuries are older and have already gone through the body’s acute repair and healing process yet something didn’t heal properly or the injury never quite finished healing. Sometimes the healing process goes wrong and creates a new problem or new pains. Chronic injuries are generally less inflamed and sometimes not inflamed at all. Treatment at this point can often be more aggressive without causing further damage or injury. The general goal is to remove the sources of the chronic pain or dysfunction and re-stimulate healing where the body didn’t finish or where the initial healing went wrong. Many times our role is just finding out if the clients daily activities are keeping the injury sore especially when the initial cause is not obvious.

Treatment Type for Tissue Type or Injury Type

This is the crucial decision that determines how successful and how fast the desired outcome of the therapy is going to be. More often than not one injury actually requires several treatment types because usually more than one tissue is injured. The body is so intertwined as a web of connective tissues that all attach to each other making it very rare that we don’t damage or cause pain in an adjacent or joining tissue. For example its very rare that someone doesn’t also injure muscles or ligaments when they suffer from a bone fracture.

Below is a list of treatment types that have been both clinically and research proven, time and experience confirmed, to have high success rates when used for the right tissue and injury types. It’s impossible to include all therapies within this article, however when performed by a licensed and experienced professional these are some of the most effective therapies available today.

ACTIVE RELEASE TECHNIQUES (ART)

-Releases shortened, tight, scarred muscles
-Releases peripheral nerve entrapments
-Breaks adhesions and scar tissues in ligaments, fascia, joint capsules and nerves
-Releases trigger points and muscle knots
-Releases compressed arteries and veins

SHOCKWAVE THERAPY

-Regenerates the bone at its attachments (enthesopathy) with tendons, ligaments and joint capsules
-Regenerates tendons
-Regenerates nerves
-Regenerates bone injuries (shin splints, stress fractures, enthesopathy)
-Turns off muscle knots/trigger points
-Blocks pain pathways in neuromas, ganglions and arthritis
-Releases Dupytrens contractures
-Releases scar tissue adhesions
-Increases blood vessel growth in tendons, bone, ligament and joint capsules
-Assists in scar tissue breakdown

SPINAL MOBILIZATIONS/MANIPULATIONS/MANUAL THERAPY

-Breaks scar tissue adhesions in joint capsules, fascia and ligaments
-Removes pressure from compressed nerves and cartilage
-Restores normal joint biomechanics
-Restores lost joint motion
-Temporarily releases reactive muscle spasms and muscle guarding

ULTRASOUND

-Excellent for healing tendons and muscles (acute and chronic)
-Stimulates desired type 1 collagen during acute injury repair
-Assists in the removal of undesired scar tissues
-Increases circulation to speed healing

MICROCURRENT

-Stimulates healthy collagen production
-Reduces swelling, inflammation and pain
-Excellent for ligament sprains
-Mildly assists in bone repair

SPINAL DECOMPRESSION/TRACTION

-Reduces pressure on spinal nerves from disc bulges or herniation
-Reduces size of disc bulges or herniation
-Reduces compression on painful degenerative joints
-Reduces compression on inflamed joints and cartilage
-Stretches out and elongates shortened and scarred joint capsules and ligaments

TRAUMEEL INJECTIONS

-Stimulates healing in chronically injured ligaments, joint capsules, cartilage, muscles, fascia and tendons
-Natural anti-inflammatory
-Reaches hard to get to tissues like inside joints
-Triggers healing responses in low circulation slow healing tissues

GRASTON TECHNIQUE

-Breaks and removes large restrictive scar tissues from muscle tears
-Excellent for thinning and smoothing out painful thickened tendons (i.e. Achilles, Rotator Cuff tendons)
-Restores normal flexibility to shortened ligaments, tendons, fascia and joint capsules
-Releases fascia restrictions and adhesions

ACUPUNCTURE

-Increases circulation
-Restores blocked “Chi” energy (Chinese Medicine) to diseased or damaged tissues
-Reduces and often blocks nerve pain signals
-Reduces muscle spasm
-Stimulates organ functions
-Stimulates endorphin release (natural pain killers)

INTERFERENTIAL CURRENT

-Improves circulation
-Releases endorphins for pain killing
-Reduces muscles spasms
-Stimulates muscle recruitment in weakened or inhibited muscles
-Assists in re-building muscle strength

NEURAL MOBILIZATIONS

-Lengthens shortened and stiffened nerves
-Mobilizes restricted nerves pinched by tight muscles
-Releases adhesions and scar tissues attached to nerves
-Moves compressed nerves away from disc bulges and bone spurs

PRESCRIPTION ORTHOTICS

-Restores Foot, Knee, Hip and Pelvis Alignment
-Reduces fatigue on foot, calf, knee, hip and low back muscles
-Creates joint movement efficiency
-Releases pressure on neuromas, spurs and pain points
-Reduces cartilage wear and tear preventing arthritis

For more details about how these and other treatments work or to inquire if they can help your own pain or injury please visit the services page on our website at www.synergyhealthmanagement.com, or email us your questions at [email protected] or book a pain and injury evaluation at
250-727-3737 Ext 2

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