As described, symptoms in soft tissues, including muscles, can occur as a result of direct trauma (tears/contusions), strain from sustained or repetitive activities, or as a protective mechanism (guarding/spasm) from injury to joints or other tissues.

Management During the Acute Stage: Protection Phase

Pain and Inflammation Control
Use appropriate modalities and massage to control pain and inflammation. Passive support may be necessary to relieve the muscles from the job of supporting or controlling the injured part.

Cervical Region
Cervical collars provide passive support in the cervical region. The length of time a collar is worn during the day relates to the severity of the injury and the amount of protection required.

PRECAUTION: Collars often place the neck in a forward-head posture. This causes healing in a faulty position, which leads to future postural problems or painful syndromes. Usually, turning the collar around or cutting down the portion under the mandible allows the neck to assume correct alignment.

Lumbar Region
Corsets provide passive support of the lumbar region. As with the cervical region, the length of time that a corset is worn should be related to the amount of protection required. Some patients tend to become dependent on the corset and continue to wear it even after healing, when it no longer serves its intended purpose. After healing, it is better to strengthen the body’s natural corset (deep abdominal muscles) and develop effective spinal mechanics.

Muscle Function
When evaluating muscle function, identify the functional position in which the patient has a decrease in the intensity of symptoms. With a muscle injury, this is often with the muscle in its shortened position. In this position, begin gentle muscle-setting techniques. Dosage is critical; resistance is minimal. Use only enough to generate a setting contraction.

Cervical Region
Patient position and procedure. Supine. Stand at the head of the treatment table, supporting the patient’s head with your hands. Start with the guarding muscle in its shortened position. Ask the patient to hold as you apply gentle resistance (light enough to barely move a feather). Both the contraction and the relaxation should be gradual. There should be no neck movement or jerky resistance.

• If there has been muscle injury, the technique is repeated with the muscle kept in the shortened range for several days before beginning to lengthen it.

• As the muscle heals or if there is no muscle injury, progress the treatment by gradually lengthening the guarding muscle after each contraction and relaxation. Movement is performed only within the patient’s pain-free range; no stretching is performed when there is muscle guarding.

• Reverse muscle action. These exercises are valuable for gentle muscle performance activity when neck motions cause pain and muscle guarding. The neck is not moved, but the muscles are called on to contract and relax. The motions include active scapular elevation, depression, adduction, and rotation. If symptoms are not exacerbated, active shoulder flexion, extension, abduction, adduction, and rotation are used to stimulate the stabilizing function of the cervical musculature.

Lumbar Region
Patient position and procedure. Prone, with arms resting at the side. Have the patient lift the head. This initiates a setting (stabilizing) contraction of the lumbar erector spinae muscles. A stronger contraction of the lumbar extensor muscles occurs if the head and thorax are extended. Alternate hip extension also causes a setting contraction of the lumbar extensor muscles.

• When there is muscle injury, the muscle is kept in this shortened range for several days.

• For progression as the muscle heals or if there is no muscle injury, gradually allow the muscle to elongate after each contraction by putting a pillow under the abdomen and then having the patient extend the thorax on the lumbar spine through a greater range. Elongation is performed only within tolerance during the early healing phase. There should be no increase in symptoms.
Alternate position and procedure. Supine. Have the patient press the head and neck into the bed, causing a setting contraction of the spinal extensors.

Traction
Gentle oscillating traction may reflexively inhibit the pain and help maintain synovial fluid and joint-play motion during the acute stage when the muscles do not allow full ROM. Gentle techniques are most effectively applied using manual traction. Position the part with the injured tissue in a shortened position and use a dosage less than that which causes vertebral separation.

PRECAUTION: Traction techniques may aggravate a muscle or soft tissue injury if the tissue is placed in a lengthened position during the setup or with a high dosage of pull during treatment.

Environmental Adaptation
If there are activities or postures that caused the trauma or are continuing to provoke symptoms, identify the mechanism and modify the activity or environment to eliminate the potential of recurrence of the problem.

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