Once the inflammation and heat go down and a few days pass, the injury enters the 'sub-acute' stage. The therapist has a few more options for medical treatment during the sub-acute stage of healing. Depending on the severity, gentle work may be and healing to the area. Working in this time period takes great skill and training, but can be largely beneficial in dealing with the speed at which things heal as well as assisting the lymph system in clearing out the cellular waste created by the trauma. Using the sprained ankle again as an example, the therapist could perform gentle circulatory movements over the damaged tissue to encourage blood flow to enter the mobilized area, and deeper techniques over areas adjacent to it. The increased blood flow would also carry out with it any cellular debris that was left from the injury. This method of treatment increases the body's natural healing process, much like opening a tap. Touch to the area can often also decrease pain sensitivity by providing a sensation other than pain. The therapist should also continue the work on the compensating structures to help the client with any resulting pain they might have.
As the chronic stage of healing approaches, where the injury is at the end stage of healing, the therapist's work really begins. This is also the predominate time in which clients come in looking for treatment. In this stage, deeper work can be done to soften scar tissue, re-align muscle fibers, regain mobility, and manage whatever pain is present. In the case of the ankle sprain we were using, the therapist could begin deeper work with the goal of restoring full functional movement and breaking down any scar tissue that is impeding blood flow. They might also work on strengthening the area so that the injury does not re-occur.
At all stages, Orthopedic Massage Therapy is a relevant treatment, if done correctly. However, proper identification of the stage and early treatment are the keys to success.
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