The Stages of Sinew Injuries

Aside from being one of the most common types of sport-related injuries, sinew injuries also often plague those performing repetitive tasks like gardening or computer work in their everyday lives. Surrounding the joints in the body are intricate connections of soft tissue called sinews. The connective tissues around the joints are often collectively called jin in Chinese medicine. The ligaments, tendons, cartilage, and muscles encased in the connective tissue are what allow the joint to hold together. As repetitive or otherwise stressful tasks during work, leisure, and sports activities act upon the body, the tissues in the joint are subjected to the brunt of strain.

Sinew injuries are placed in categories based on the severity of the injury. When the sinews are abruptly stretched and create only microscopic tears in the ligaments and tendons, it’s termed a mild sprain or strain. This is usually the case when there is only minor swelling and mostly painless function of the joint remains. With timely and correct treatment, these microscopic tears generally have a relatively quick healing time and a return of normal functioning after a week. When a complete tear occurs and creates joint instability, it’s termed a severe sprain. In cases where the joint is unable to be used and has dark black-and-blue swelling, there’s most likely a severe injury. If the joints in the lower limb are unable to support the weight of the body, this too is an indication of severe injury. These injuries may require radiology services like an X-ray or MRI.

In Chinese sports medicine, there are three unique stages that sinew injuries pass thorough when healing, each having different appropriate concepts of treatment.

STAGE I - ACUTE SINEW INJURY

The time-frame for this stage begins as soon as the injury occurs and continues for one to seven days post-injury. The injury during stage one will generally be characterized by redness, swelling, and pain at the affected area. The affected area may also be warm or hot to the touch , which is a sign of inflammation. The force of the injury often disrupts the normal movement of blood, vital energy (qi), and other bodily fluids. As qi and fluids stagnant, it results in swelling and possible heat. The black-and blue appearance is caused as blood leaked from injured blood vessels accumulate in the soft tissue. In cases of minor trauma, the redness, pain, and swelling will usually start to subside between one and three days. Severe trauma sinew injuries generally take around seven days for the symptoms to start to subside.

There are four basic principles of sinew injury treatment during the acute stage. First, reduce swelling, reduce redness, reduce inflammatory heat, and stimulate circulation to the affect area, thereby restoring normal circulation. In Chinese medicine, qi, blood, and fluid not flowing freely equals pain. So, restoration of freely flowing blood and qi is essential to healing, reducing pain, and regaining joint mobility. Thirdly, further improve circulation with exercise and movement that isn’t abnormally stressful, thereby also helping to prevent re-injury and reduce swelling and pain. Lastly, only during stage two of a sinew injury (after initial inflammation and swelling has subsided) are warming therapies appropriate. Local application of wet or dry heat, such as from a hot compress, soak, or heating pad, should be avoided. These heat sources only create more swelling and pain during stage one.

Treatment

1. During the acute stage of a sinew injury, Sinew Herbal Ice is by far the most useful herbal formula. Sinew Herbal Ice alone can produce amazing results for sinew injuries. In cases of a severe sprain, you can apply Sinew Herbal Ice while you’re waiting to see a health care professional and it will immediately go to work to reduce inflammation and swelling. These actions are the direct result of the unique formulation of cooling herbs that help to break-up stagnated fluids and cool and reduce inflammation. In other words, Sinew Herbal Ice is the initial phase in restoring the free flow of qi and blood. Western medicine commonly uses ice to reduce inflammation. The problem with using ice as opposed to Sinew Herbal Ice is that ice can constrict blood vessels and congeal stagnant qi, blood, and bodily fluids. While Sinew Herbal Ice is ideal, Acute Sinew Liniment may be substituted.

2. A gentle massage below and above the injury will help stagnant fluids that are trapped in soft tissues to get moving again and be reabsorbed by the blood stream.

3. Martial art experts and Chinese warriors have used Acute Sinew Liniment for hundreds of years in the treatment of sinew injuries. This liniment has “blood regulating” herbs, meaning that they work to dispel stagnant blockages of blood and qi and stop the fluids from congealing. Some refer to this action as breaking the blood or cracking stagnation. You will either apply it on the surface of sinew injury using a basic massage technique or make a poultice by soaking several gauze pads in the Acute Sinew Liniment and taping or wrapping it to the injured area.

4. It’s very important to start simple movement and exercises as soon as possible after the injury. This is vital to prevent muscle atrophy, quickly restore normal range of motion, stimulate circulation, and get rid of any remaining swelling. Keep in mind that at this stage the exercises should be simple and not cause any aggravation to the injured area.

STAGE II - POST ACUTE SINEW INJURY

As stage one comes to a close after seven days, stage two begins. It may last for three weeks. Much of the swelling, pain, and inflammation has subsided. By this time, tendons have repeatedly contracted trying to immobilize and protect the injured area. This often causes stiffness and spasms. During stage one, most of the stiffness and spasms were masked by swelling and inflammation, but as that disappears in this stage, the stiffness and spasms will become more apparent. However, proper treatment during the acute stage will help minimize these actions.

Treatment during the post acute stage is often seen as more directly aggressive. The wet heat that was inappropriate during the acute stage is now very helpful. Wet heat can be in the form of an herbal soak, hot tub, or hot towel. All of these work to deeply penetrate the muscles, ligaments, and tendons and can help to relax them, thereby reducing stiffness and spasms. If adhesions from congealed blood have formed that prevent tissues from smoothly sliding across each other, then herbal soaks are especially useful. The herbal soak works to soften the congealed blood, and thereby disperse it.

Treatment

1. The Acute Sinew Liniment used during stage one may be continued into the second stage. Again, use simple massage techniques or a poultice for the liniment to dispel any remaining blood stagnation.

2. The Sinew Relaxing Soak, mainly consisting of tou gu cao, may now be used on the sinew to help relax spasms and tightening. Unlike a heating pad that may get to hot, the herbal ingredients in the Acute Sinew Liniment have limited warming and will not overheat the area. You may use the herbal soak by cooking it in a pot of clean water and then immersing the sinew area in the pot of water. While soaks may be used on larger areas of the body by soaking a towel in the soak water and then applying the towel to the injured area, they are most often used for sinews on the hand, ankle, wrist, and foot.

3. The restoration of normal movement and function is such an important area of treatment. We often have a tendency to separate or isolate an injured area, acting as though it isn’t part of the body as a whole, but rather just a separate injured area. The body is interconnected in so many ways. For example, a foot that doesn’t move or function properly can cause various structures in the knees, hips, and back to take up the slack and become stressed themselves. The point is the affected area needs to be retrained to work in harmony with the body as a whole to reduce the risk of injury to other areas, re-injury to injured area, and for full healing to take place. Simple range of motion exercises and strengthening exercise are integral parts of healing and retraining an injured area to function properly, but the movements must be done without applying undo stress to the area. Remember that now is not the time to resume sporting activities or engage in vigorous exercise. This may be tempting as movement is restored and pain subsides. Just keep in mind that the injured area is still weakened and needs to be slowly strengthened by slowly increasing range of motion and intensity of exercise. It may also be helpful to continue massaging with Chinese Massage Oil prior to and after exercise and using the soaks as needed for spasms and breaking up accumulations of stagnant fluids.

STAGE III - CHRONIC SINEW INJURY

Around three to four weeks post-injury, the stage three phase of sinew injury healing begins. While inflammation and swelling have completely subsided, an achy pain and stiffness can remain. If treated promptly and appropriately, minor sinew injuries are usually resolved by now. However, severe tendon and ligament injuries may take substantially longer. Even minor tendon and ligament injuries may take six to eight weeks for complete healing. If appropriate treatment was received during the first two stages, stiffness should be minimal and more rigorous exercises can be started during stage three. Do keep in mind that sinews are very easily re-injured at this point since the subsided symptoms might encourage a return to previous levels of activity. Just because you ran three miles before injury, doesn’t mean that it’s feasible for the injured area to perform at that level just yet. So, continue the treatments from stage two and slowly increase movement and intensity.

For some, especially those that didn’t undergo proper treatment in early stages, residual pain and stiffness may be an issue. It can be daunting to still feel this after resting the sinew injury for three or four weeks. The residual stiffness, residual pain, and risk of re-injury is usually the result of one or more of the following:

1. Residual stiffness and pain means that there is still qi, blood, and other fluids accumulating in the injured tissue. There may even be hard pebble-like nodules in the tissues. This indicates that there are accumulations and possible calcifications, a common occurrence in Achilles tendonitis. Go back to the basics - use the Sinew Relaxing Soak, the Acute Sinew Liniment, and engage in stretching and range of motion exercises.

2. Injured areas are often weak and highly vulnerable to re-injury if overstretched ligaments created joint instability. This is common in areas where there are complex arrangements of ligaments holding bones together, such as in the ankle and wrist. The tiny ligaments are very easily overstretched and sprained, which often results in an unstable joint. As you rotate the unstable joint, you might hear a pop or click as the ligaments and bones slip ever so slightly out and back into alignment. In the above case, the muscle tissue around the joint must be gradually strengthened (strengthening exercises) in order for the joint to regain stability. Sinew Injury Poultice contains herbs that are specifically designed to strengthen the bones and sinews and may be very effective at this point of injury.

3. Cold and dampness might have infiltrated the outer layers of soft tissue around the injury if impaired circulation continued. In this case, the injured area can feel cold to cool to the touch. To check this simply take a finger or thumb and press down into the muscle layer of the injured area. There may also be a sensitivity to cold or dampness, meaning cold weather will cause an ache.

4. Bi syndrome is an obstruction progression from a chronic injury. It often manifests itself as arthritic joint pain. The progression is most often the result of improper or lack of treatment in the early stages of injury. It can also be caused by improperly icing the area. In any event, if bi syndrome is present, Sinew Warming Soak can be used to drive out the cold and restore local circulation. The warming action of Chronic Sinew Liniment is also helpful when the sinew injury is irritated by cold.