How soon can you needle a muscle after a muscle tear?
How soon can you needle a muscle after a muscle tear? This is a question we regularly get during the GEMt courses and a topic always worth refreshing.
Let’s first refresh tissue healing times:
Bleeding phase (6-24 hours)
- Bleeding occurs in the early stages post injury
- Variable length of time depending on the extent of the soft tissue injury and vascularity of injured structures
Inflammatory phase (6 hours-2 weeks, max reaction 1-3 days)
- Various activities to assist healing eg fluid leakage from capillaries, increased blood cells to the area, chemical sensitisation, phagocytosis
- Fibrin deposition for clot formation and scarring
- Associated oedema, pain, redness and swelling
Proliferative phase (from day 4-6 weeks):
- Inflammation starts to settle down
- Collagen starts to get laid down, in a disorganised fashion, weaker and less flexible than normal tissue (type 3)
- Also extracellular matrix deposition
- Blood vessels start to infiltrate the region
- Pain lessens (usually) but tissue does not have the normal capacity as yet
Remodelling phase (from 2-3 weeks onwards, can last months/years)
- Healing progresses, tissue improves structure and strength
- Increased collagen fibre alignment/organisation and strength (type 1)
- Improved tissue capacity
So why is all this relevant? We need to respect normal tissue healing times. Remember they will be influenced by several factors including the individual response to injury.
We need to ensure the treatment supports these phases and does not interfere with normal tissue healing. For instance, we would not be encouraging early active local movement and treatment in the acute bleeding phase but rather use our RICE techniques we are all aware of.
So getting back to the original question, when can we start to needle a muscle after a tear?
Firstly it will depend on the extent of the tear, bleeding and pain response.
We would generally recommend avoiding needling for the first 48 hours. This is when the RICE principles matter most. Then you could consider needling in the proximal/distal regions of the muscle ie not directly into the tear itself, if you feel the patient has increased tone in these regions that might be altering their pain experience or movement patterning.
You could needle early on with a muscle such as rectus femoris due to its length. Be mindful a local twitch response is a muscle contraction and therefore you do not want this occurring too close to the site of trauma. However, needling more proximal/distal in a muscle such as rectus femoris could certainly be performed carefully very early on. You could consider box taping the localised tear region if you do this.
You can also consider needling adjacent muscles. For instance in the case of a rectus femoris tear you could consider TFL, other quads eg vastus lateralis, adductors, gluteals, corresponding lumbar segments (L2-4) etc.
Once you feel sufficient healing has occurred ie inflammatory phase started to settle down, it can be very effective to needle into the healing fibrotic tissue if you feel indicated and we would suggest you wait at least 7-10 days before considering this as a treatment option (note this is not always required and you can often get good remodeling and adaptation through good rehab too).
There are times you might choose to needle an athlete aggressively into fibrotic tissue followed by active rehab/eccentric exercises. There are many potential mechanisms at play here, once of which is simply pain relief and improved mobility of the tissues.
To summarise, consider healing times and the individual’s response to injury when considering incorporating dry needling into treatment post muscle tear.