02/11/10. “Basics” protocols applied to bone and Periosteum,inflammation and chronic inflammation to nerve and immune system. namual therapy again working on intrinsic muscles of the hand and extrinsic muscles of the forearm.
01/11/10. Targets were concussion/trauma and inflammation. Boosted repair of torn/broken tissues and secretions from fascia and periosteum. Manual therapy included work on the flexor and extensor digitorum-NMT and Integrated Neuromuscular Inhibition techniques(INIT) used to reduce sensitivity and increase ROM.
31/10/10. FSM as in previous sessions but now added “skin” and peripheral nerves as tissues to address some of the loss of sensation/feeling. Lots of manual work and focus also on “homework” to cement work done at session and increase strength and ROM. Stabilation at each of the interphalangeal joints and MET techniques used. T-bar used on palmar aponeurosis to encourage blood flow and encourage softening.
30/10/10. Pain and sensitivity levels both down although medial side -surface and tip of of little finger still present as numb. Main symptoms now relate to loss of Range of Motion(ROM) in flexion,abduction and adduction.
Trauma to nerve, ligaments and joint surface were addressed to reduce pain around joints. Manual therapy as in previous session.
28/10/10 & 29/10/10. FSM protocols concentrated on inflammation and congestion on lymphatic to help dissipate inflammatory fluids. Inflammation on all major tissues of bone,periosteum,muscle bellies and fascia. I also added liagaments due to tendernes around most of the metacarpal-phalangeal joints of 2nd – 5th digits. Boosting of repair and secretions to encourage accelarated extra-cellular matrix(ECM) being laid down by the periosteum(for bone repair) and facia for soft tissue repair.
Manual therapy focused on all the intrinsic muscles(ie those distal to the wrist), picking up thenar,hypothenar,palmar and dorsal interossei, with american version NMT, postional releases and muscle energy techniques.
27/10/10. Cast removed,surgeon happy with progress,healing well. Some bruising visible and tender to palpation on dorsal and palmar surface of hand at the carpals. With more of finger accessible,FSM therapy included full concussion protocol with again emphasis on reducing inflammation,boosting ATP production and secretions at the periosteum.
25/10/10. Basic protocols applied to bone and P,inflammation and the immune system. B & P -inflammation and ATP production, support secretions from P.
24/10/10. Session treated inflammation to nerve,bone and periosteum.Increased ATP production to fascia,bone and peri. Boosted secretions in Fascia(F) and Periosteum(P).
23/10/10. 60 minute session, split into treating-a)concussion/trauma to the nervous system, b) inflammation and repair to bone and periosteum. Some sensation returning to extremity.
22/10/10. 60 minute session, treating as a new injury. Whole hand and fingers covered in bandage, with little finger “buddy” wrapped and fixated to the 4th metacarpal. Primary focus was on reducing inflammation to damaged bones and fascia. Up to this point feeling in the finger was just restricted to numbness. Small gel pads were used to attach to the “tip” of the finger(only part accessible) so that we could deliver the FSM therapy.
17/10/10. Whilst playing in the senior league game of the season for Eoghan Rua,(Coleraine),a seemingly inoccuous challenge lead to Barry McGoldrick snapping the bone in the 5th proximal phalange( pinky finger). The level of pain suggested it was more serious(click on image for detailed view of break).
As fractures go it was classified as a closed and multi-fragmentary,involving the bone splitting into multiple pieces requiring surgical intervention. Two days later a few pins were inserted to “fix” and stabilize during a 90 minute operation to piece together the shattered bones.
The natural process of healing a fracture starts when the injured bone and surrounding tissues bleed. The blood coagulates to form a blood clot situated between the broken fragments. Within a few days blood vessels grow into the jelly-like matrix of the blood clot. The new blood vessels bring white blood cells to the area, which gradually remove the non-viable material. The blood vessels also bring fibroblasts in the walls of the vessels and these multiply and produce collagen fibres. In this way the blood clot is replaced by a matrix of collagen. At this stage, some of the fibroblasts begin to lay down bone matrix (calcium hydroxyapatite) in the form of insoluble crystals. This mineralization of the collagen matrix stiffens it and transforms it into bone. Healing bone callus is on average sufficiently mineralized to show up on X-ray within 6 weeks . This initial “woven” bone does not have the strong mechanical properties of mature bone. By a process of remodeling, the woven bone is replaced by mature “lamellar” bone. The whole process can take up to 18 months, but in adults the strength of the healing bone is usually 80% of normal by 3 months after the injury.