Post-Acute Stage 2 Injuries
If your injury was treated correctly when it first happened, there may be no Stage 2 symptoms and you can quickly return to your normal activities. However, if the injury was severe, or if stasis was not resolved in Stage 1, then Stage 2 treatment is usually necessary to complete the healing process and to prevent the injury becoming a chronic, Stage 3 injury.
The second stage of injury usually begins within a week after the initial injury and can last up to 3 weeks. The swelling and pain are reduced and much or all of the inflammation may be gone. There may be pockets of swelling. There is often stiffness due to spasms in tendons that have reflexively contracted in an attempt to protect the injured area by immobilizing it. In Stage I, these spasms were difficult to see and treat because of the swelling and inflammation. If the injury was treated properly in Stage I, the swelling and stiffness may be minimal at this point.
In Stage 2, treatment can be more direct and aggressive. Herbal soaks and applications of wet heat that were forbidden in Stage 1, can now be used. Wet heat in the form of hot towels, herbal soaks, hot tubs or hydroculator packs (which can be purchased at most pharmacies) penetrates into muscles, tendons, and ligaments, relaxing spasms and stiffness. Herbal soaks in particular can soften and disperse remaining pockets of congealed blood that can cause tissues to adhere to each other, thereby preventing them from sliding smoothly across one another. Unless dispersed, these adhesions can limit range of motion.
Stage 2 Treatments
1. Massage, Acu-Pressure, & Liniments
Pressure on acu-points may be used as in Stage I, but now they can be accompanied by more deep direct massage techniques over the area of injury. Massaging an appropriate liniment into the injured area several times a day can also help to speed healing of damaged tissues.
Extra Strength Trauma Liniment may continue to be used with massage in order to dispel any remaining blood stasis. If there is damage to the ligaments or tendons, then Dragon’s Blood Tendon Lotion, which was too warming for Stage 1, can now be used in Stage 2. If muscles were overstretched, or have tightened up after the injury, use Yoga Stretching Oil combined with gentle movement and stretching exercises. Tiger’s U-I Oil is a warming liniment that activates circulation, and drives cold and damp out of the muscles and joints. I often soak paper towels with the U-I Oil liniment and put a hot water bottle or hydroculator pack over the area in order to aid penetration of this liniment into the tissues.
Acupuncture can be directed more specifically in Stage 2 to address residual pockets of swelling and residual stasis. Acupuncture at this stage can also begin to address constitutional factors that may be connected to the healing process.
Poultices, or Gao, can be very useful for dispersing the residual swelling that we often see in Stage 2 injuries. The stagnant, congealed blood and thickened fluids that are stuck in the layers of soft tissue around the injured area are one of the prime causes of enduring pain that can be present years afterward. Dispersing this stasis is critical to complete healing, and poultices and soaks are the two most effective ways of making sure that congealed blood and fluids are reabsorbed.
If there are pockets of fluid swelling, or if there is a bit of residual heat, Extra Strength Golden Ointment (Qiang Li Jin Huang Gao) is the treatment of choice. If there is still extravasated blood in the tissues, then try using Stage 2 Trauma Ointment. The Stage 2 Trauma Ointment is more warming and has many herbs that strongly disperse blood stasis.
To make a poultice or Gao, coat the injured area with a thick layer of the ointment and then wrap with gauze and an elastic bandage in order to gently compress the herbal material against the skin. Leave the poultice on overnight, or even as long as 48 hours. If you have sensitive skin, I recommend only leaving the poultice on at night and letting the skin breathe during the day.
4. Herbal Soaks
Making an herbal soak consists of cooking herbs in a pot of water and then immersing the injured area in the liquid. Soaks are very useful for wrist, ankle, hand, and foot injuries. Soaks can be used on larger body parts by soaking towels in the herbal liquid and applying the towels to the injured area. In the majority of cases, I recommend the Extra Strength Tendon Relaxing Soak. The herbal ingredients themselves in this soak are only slightly warming in nature, so they don’t overheat the injured area. Extra Strength Tendon Relaxing Soak contains a large amount of Tou Gu Cao, an herb which helps to relax spasms in the sinews.
If there is still discoloration from bruising, The Master Bonesetter’s Tauma Soak (Zheng Gu Die Da Jin Ji) can be used. Master Bonesetter’s Trauma Soak has been a staple of bonesetters for generations because of the all-around ability of this formula to relax spasm, move blood stasis and fluid accumulation, kill pain, and dispel localized heat and inflammation.
5. Movement and Exercise
Restoring movement and normal function is critical at Stage 2. Do simple range of motion exercises in conjunction with exercises that strengthen and re-educate the injured area without re-aggravating it. Injuries often create a break in the connection of the injured area with the rest of the body. There is a sense that the injured part is not integrated with the body as a whole. An injured knee becomes referred to as “my bad knee,” as though it is “other,” or different. The injured area must be re-trained to function in harmony with the rest of the body in order for it to fully heal and reduce the potential for reinjury.
Vigorous exercise or competitive sports activities should not be resumed at this time.
As pain subsides and movement is restored, the impulse to take up activities where you left off before the injury is very strong. Remember, the injured area is still weak and needs to be gradually strengthened. Slowly increase range of motion and intensity while continuing to massage the area with liniments before and after exercise. Use soaks or medicated plasters to release spasms or break up accumulations. It is often useful to stimulate ear acu-points while gradually moving the injured area through range of motion exercises.