17/01/2023

Happy New Year all! It’s a bit late in the year for that greeting, but there’s no definitive rules on it, is there? Anyways, I hope all your new years resolutions are going to plan. I started good and steady, trailed off for a few days when feeling a bit run down, and have managed to get going again. I believe it’s all about getting back on the proverbially horse. 

For the month of January I thought a few blogs about acute injury would be valuable for you, dear reader. Let’s start today with how to recognise the signs of an acute injury. There are 4 things to consider:

1. Pain
2. Loss of function
3. Inflammation symptoms
4. The History

Before we go through these one by one, it’s important to point out that with an acute injury an individual will have at least one of these indicators, and quite likely 2 or 3 of them. 

Pain:

The study and understanding of pain is an absolutely enormous topic. Unfortunately, for the purposes of today’s bog we will keep it superficial, and start with the internationally recognised definition:

“An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage”

I’ve highlighted 2 parts of the definition not because they are more important (all aspects of the definition are critical), but rather to simplify pain in the context of acute injury. “An unpleasant sensory” experience can mean very different things to people and is often verbalised with different terms as a result. We regularly hear people saying something like “it’s not a pain but it’s sore/tight/discomfort/achy/tense/stiff etc.” If a person finds any of those sensations unpleasant then it would fall under the pain umbrella, and we would consider potential tissue damage. 

The second part highlighted is “actual or potential tissue damage”. We can experience pain, where there is no tissue damage, and that is not to say the pain is not real or very unpleasant. For example, if you started your New Year’s resolution to get more active with a 2 hour hike on the 3rd of January having done no exercise for 6 weeks, the next day it’s very likely your thigh muscles would feel quite sore or achy. While there is no damage to these muscles, they hurt because the exertion was higher than what they were accustomed and they are letting you know it! Similarly, if you banged your elbow on a hard surface it is likely going to be painful for a short while, but provided there’s no bruising, inflammation signs, the pain goes and you can move your elbow normally, there is a very low chance of tissue damage.

The key point is that pain or any other unpleasant sensory experience is often the first and a very good indicator that something is wrong, but it does not alway mean an acute injury. That is why we should take into account the next few sections. 

Loss of Function:

To lose the function of something means that it does not work like we have normally experienced. For example, if somebody was to trip and land on their wrist, and then they could not grip a cup for a period of time, we would consider there to be potential injury. However, we would still need corroborating evidence from the other areas, as it is possible to experience fear to use the affected area due to pain or a number of other factors. 

Inflammations Symptoms:

The 4 key signs of acute injury related inflammation are pain, swelling, redness and heat. Swelling can sometimes be difficult to detect unless the affected area is close to the skin and has low muscle mass. It is easy to spot if the outside of the ankle or front of the knee is swollen, but more difficult if the injury occurs to the buttocks or thigh. Comparing one side to the other is helpful if you are looking out for swelling. 

For redness I would also include any signs of bruising. In my experience, redness can often be subtle and go un-noticed, so I would recommend checking agains the opposite side. 

Heat in the area that’s been injured is often not readily felt and even if the hand is placed on the area it may be missed unless compared to the opposite side. 

The reason we get swelling, redness and heat is because the body is sending in cells to start the repair process and there is simply more activity in that area. These signs are the most definitive of an acute injury. 

The History:

“How did the problem start?” This is one of the main questions we would ask you if coming to see  us in the clinic. If there was an obvious trauma such as a fall, twist, direct blow we can be more certain there is an acute injury with tissue damage. However, it is not uncommon for the start of the symptoms to be from something innocuous. For example, a long distance runner may have a sudden onset of pain with a normal run they do. This could be to do with underlying problem that has reached tipping point and resulted in acute tissue injury, but we need to look for the other symptoms more closely and understand whether there had been a change or increase in demands leading up to it. Similarly, somebody doing a lot of gardening work that they are not accustomed to could develop symptoms suddenly in their shoulder, neck or back for example. This may be an acute injury or it could be the accumulation of the demand of the activity. Again, we would need to screen the symptoms and the person carefully. 

In summary, sometimes an acute injury can be very clear and obvious, and on other occasions it can be less certain. If you do experience any of the above symptoms, we will talk in our next blog about how to manage the early stages of acute injury. We would also recommend an assessment with a Chartered Physiotherapist to ensure you receive the correct recovery plan and return to normal as soon as possible. 

Till the next blog, stay active and stay well!

Lonan Hughes

Chartered Physiotherapist