Stages of Healing

After an injury, the body moves through three distinct phases of healing. Our treatment is geared to each specific stage so that as you heal, we maintain your range of motion and mobility and relieve the pain associated with the healing process. The following discussion uses a herniated lumbar disc as an example, however it applies to any injury in the body, from a small cut to a large surgical incision, from a broken arm to head trauma!

Acute Phase

Treatment in the acute phase of injury (first four days) requires the doctor to reduce any swelling (inflammation) that might further push on the spinal cord or its nerves and to reduce your pain. Swelling is reduced with ice and/or soft tissue massage and pain is relieved by temporarily with interferential current (IFC) which is different that electrical stimulation of muscles. The purpose of IFC is to increase the production of pain-relieving substances that naturally occur in the body. This has an analgesic affect. A special table, called a flexion-distraction table is used to help introduce motion into the injured disc. This serves several roles. First, the motion helps increase circulation into and out of the disc. While it may temporally increase inflammation, it also helps carry out inflammatory substances. Second, by stimulating nerves that respond to motion, it also decreases pain, like when you accidentally hit your thumb with a hammer - the first thing you do after you hit your thumb is to compress it with your other hand or shake it. This stimulates nerves that respond to pressure and inhibits the nerves that carry pain signals. You brain thinks about the pressure and not the pain. Flexion distraction also decompresses the injured disc. Think of it as basically stretching the spine to release the pressure on the disc. It is very important to begin gentle motion of injured tissues because the body begins to heal the injury by producing scar tissue. The best way to form healthy scar tissue is to introduce gentle motion that places stress on the tissue. This will allow the scar tissue to form along tension lines and not in a haphazard matrix.

Subacute phase

The subacute phase of injury (4-21 days post injury) is marked by the body's shift from the acute or inflammatory phase of injury to a phase of healing. New blood vessels are formed and the injury continues to repair with the production of scar tissue. At this point, the flexion distraction treatment is increases in intensity to accommodate the increased production of scar tissue. During this pain from tissue injury is felt because the pain from inflammation should end when the acute phase is over. During this period you will be prescribed exercises that can be performed. At times, these exercises may increase inflammation and may be difficult to perform. It is during this period that flexion-distraction may be replaced or used in conjunction with spinal manipulation to further introduce motion into the vertebrae around the injured disc. IFC will be discontinued at this time.

Remodeling phase

The remodeling phase of injury (3 weeks to 2 or more years) is when more aggressive and intense rehabilitation exercises are prescribed to help you regain your full range of motion. It is important to remember that healed scar tissue is only about 80% as strong as the original tissue, predisposing you to recurrent injuries. Flexion distraction will probably be discontinued and by this time you may only be coming in for treatment when you feel your symptoms re-surfacing.