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C h e c k o u t A B M P 's l a t e s t n e w s a n d b l o g p o s t s . Av a i l a b l e a t w w w. a b m p . c o m . 79 Consequences of Poorly Healed Injuries Trigger points can develop from trauma to muscles and also from postinjury pain. For example, someone with fractured ribs on one side, for whom it is excruciating to take a deep breath, might splint the area by contracting the external oblique on the same side as the fracture, and thus a trigger point is created. Unfortunately, even when the fracture is mended, the trigger point remains, and the person may continue to splint the area, ending up with a permanently short and tight muscle, which is not only less elastic and can cause pain, but is also more prone to injury. 1 Fibrotic tissue. In the body's heroic, powerful attempt to heal an injury, acute inflammation helps repair the injured tissue by increasing nutrition through greater blood flow and cleaning up debris through more white blood cells to the area. 2 Next, scar tissue grows, bringing stability but not elasticity. However, scar tissue grows in a disorganized way and needs normal, healthy motion to help the fibers align properly or remodel. If this does not happen, it can lurk in or around injured structures, forming a kind of glue that holds structures such as muscles, ligaments, fascia, nerves, periosteum, and spaces between bones in poor anatomical positions. For example, if a severe ankle sprain did not heal properly, it could result years later in the ankle and foot being turned in or out slightly due to thick, disorganized scar tissue. When my elbow was finally out of its cast, the fascia between the distal insertion of the left biceps and the brachialis muscle's insertion underneath it had become extremely tight, adhered to both muscles, and was effectively gluing the two muscles together. This not only limited stretching of the joint capsule (necessary to prevent adhesive capsulitis), but also limited full elbow extension. Scar tissue that had developed between the ends of the proximal left ulna and radius was compressing the artery at the left elbow, which was causing a protective spasm of the biceps, making elbow extension far more difficult. Painful or restricted movements and postural warps. At the time of injury, pain is helpful because it lets us know that we need to rest the area to prevent us from injuring it further. But many dysfunctional movement patterns can result from high levels of pain during healing. Holding the body in fixed, unchanging positions for long periods of time can happen when there is pain with a movement, or if the area is weak after being immobilized for a long time in a sling, cast, brace, or splint. Reduced strength and alterations in how the joint is moved can predispose one to injury, as muscles, ligaments, and fascia "learn" these new positions, resulting in tense and rigid soft-tissue structures. For example, a hand that was very painful after it was broken may never be used fully again if the person favors it and unconsciously prefers to overwork the other hand. When my elbow cast was removed only five weeks after injury, I had already adopted a kyphotic, slumped-forward position on the injured side, effectively shortening my neck flexor and pectoral muscles while weakening the thoracic and neck extensor muscles. Postural warps caused by patterns of substitution plague many of our clients. Reinjury is more likely, too. Notes 1. S. Aftimos, "Myofascial Pain in Childhood," New Zealand Medical Journal 9 (1989): 440–1. 2. G. Trudel, M. Jabi, and H. K. Uhthoff, "Intraarticular Tissue Proliferation After Immobility: Methods of Assessment and Preliminary Results in Rat Knee Joints," Journal of Rheumatology 25, no. 5 (May 1998): 945–50; "Stop That Cycle of Recurring Injuries: Understanding Your Body's Healing Cycle," Go Physio (2014).