“I tripped and fell and have never been the same since…”
“I was rear-ended, it wasn’t a big collision, but I can’t get rid of this pain…”
“I bent over to pick up the garbage and something happened…”

Such events, called traumas, can result in bodily changes that cause concern even though there is no evidence of damage on medical diagnostic tests. X-rays may show minimal changes to a joint, the results of MRI and CT scans may be negative. Yet our sleep patterns may change, we may feel fatigued, our digestive system may function differently and we may feel generally poorly.

Trauma can be described as an injury or wound, physical or psychic, caused by an extrinsic agent. Psychic trauma refers to a psychological manifestation that follows a traumatic event. Many people suffer emotionally as well as physically from a traumatic injury.

Physiotherapists often deal with the consequences of physical trauma. Physical trauma can occur when you fall on your hip or are struck by a field-hockey stick on the pitch. It can also be the result of an acceleration/deceleration event such as a motor vehicle accident. Although often forceful, such traumatic events do not always create the type of bodily damage that can be detected through conventional methods, even when the victim presents with symptoms. In general, symptoms of physical trauma can include pain, decreased movement, and swelling.

The existence of “undetectable” physical effects of a traumatic injury can be explained partly in terms of transferred energy. If the human body is the target of a substantial amount of kinetic energy transmitted over a very short period of time, an impact occurs that deforms the body tissue at the point of contact, and energy is further dispersed throughout the body into the tissues. In a motor vehicle collision energy is transferred at the moment of impact and this energy can be absorbed by the body.

A traumatic injury affects the body on several levels. The extent of damage caused by a traumatic injury is related to the force and duration of impact. Motor vehicle accident injuries occur very quickly, usually within 50-90 milliseconds. The damage sustained can be extensive because the body does not have enough time to protect itself against the force of the impact.

The extent of the primary injury is directly related to accident factors such as force of impact and position of the body. A broken bone may be a primary injury. Secondary lesions can develop over the next few hours or days, and can include, for example, neck stiffness and headaches. Even after apparent healing, some lesions can persist with varying degrees of tissue damage and associated dysfunction. Dispersal of energy at the impact site can result in lesions also occurring at distant sites; for example braking very suddenly during a car accident can result in the injury being felt further away where the force of the accident is absorbed in the sacro-iliac joint (pelvis).

Traumatic injury can result in multiple lesions and diffuse areas of pain because of the way the body absorbs the energy of an impact. The body contains a fibrous tissue network, called fascia, that is generally located between the skin and the underlying structures of muscle, organs and bone. It connects cells throughout the body. Fascia is composed of two layers, a superficial layer and a deep layer. The energy dispersed following an impact can be absorbed into these layers, resulting in tissue damage, or lesions. Even though such damage is not visible it can cause serious pain and can manifest itself in many unexpected ways.

The effects of trauma can be cumulative, because some of the damage from a previous injury may remain in the fascia. This is called tissue memory. The tissue “remembers” the vicious crosscheck in hockey at age 13, the numerous tackles taken on the rugby field in youth or the car accident of 10 years ago. The force dispersed during those events may be stored in the tissue memory of the fascial network. The impact of an injury may cause adhesions in the fascial membrane, resulting in decreased flexibility. An old traumatic injury can also have an effect on a subsequent injury, by limiting the tissue’s ability to disperse the new force.

There are many additional factors relevant to the body’s reaction to a particular trauma. The effects of trauma are influenced by a person’s individual physical, psychological and emotional disposition at the time of the traumatic event.

Physiotherapists can address the effects of trauma on the body, although there is no set “recipe” for treatment that would apply to every case. Appropriate treatment is determined by a number of factors, but the goal of treatment for trauma-related injuries is generally to return a person to the level of function he or she had before the injury.

Physiotherapists use a variety of methods to identify and treat the effects of traumatic injuries. The primary site of injury is localized, joint range of motion, muscle strength and muscle flexibility are assessed. Physiotherapists are trained to use specific manual therapy techniques (joint and soft tissue mobilization) to enable the body to respond to therapeutic intervention. Specific techniques include myofascial release therapy. Other methods of treatment include breathing exercises, individual exercise regimes and core stabilization. For some people, a calming exercise regime is beneficial and for others, more activity may be appropriate. Treatment of injury and trauma also requires assessment of the individual’s activities of daily living, such as posture at work.

Physiotherapists can provide effective hands-on care that will promote the recovery of a client suffering from a traumatic injury, and a cooperative effort between the physiotherapist and the client will enhance the individual’s full recovery and enjoyment of continuing physical health.

Corinne Skrobot, B.Sc, is a registered physiotherapist currently practicing at Jericho Sports and Orthopaedic Physiotherapy Clinic in Vancouver. Please visit the website www.jerichophysio.com for contact details.