Physiotherapy is essential for managing chest contusions once serious underlying injuries have been ruled out. The goals are to reduce pain and inflammation, restore full range of motion, improve breathing mechanics, and return to normal activity. Advanced techniques often include

Manual Therapy

• Soft Tissue Mobilization: Gentle massage, effleurage, and kneading techniques to reduce muscle spasm, improve circulation, and promote healing in the bruised area. This helps to release tension in the intercostal muscles and other muscles of the chest wall.

Myofascial Release (MFR)

Application of sustained, gentle pressure to release restrictions in the fascia (the connective tissue surrounding muscles and organs) of the chest wall, diaphragm, and associated neck/shoulder structures. This can alleviate tightness and improve tissue mobility.

• Joint Mobilization: If there is associated stiffness or pain in the thoracic spine or rib articulations due to guarding, gentle mobilization techniques may be used to restore normal joint play and reduce referred pain.

Instrument-Assisted Soft Tissue Mobilization (IASTM)

Utilizes specialized tools (e.g., Graston, 0ASTYM) to detect and treat soft tissue dysfunction. The tools glide over the skin, identifying areas of scar tissue, adhesions, or fascial restrictions. By breaking down these restrictions, IASTM can improve blood flow, reduce pain, and enhance tissue remodeling. It’s used carefully over a healing contusion, avoiding direct pressure on fresh bruising.

Dry Needling

Involves inserting fine needles into myofascial trigger points (hyperirritable spots in muscles) within the chest wall muscles (e.g., pectorals, intercostals, serratus anterior, scalenes) or associated muscles that may be guarding. This can help release muscle tension, reduce pain, and improve range of motion. It must be performed with extreme caution in the chest area to avoid pneumothorax.

Kinesiology Taping

 Application of elastic therapeutic tape over the injured area. It can be used to:

• Reduce Pain: By lifting the skin and decompressing underlying tissues, which can reduce pressure on pain receptors.
• Reduce Swelling/Bruising: By creating convolutions that promote lymphatic drainage.
• Provide Support: Without restricting movement.
• Improve Muscle Function: By facilitating or inhibiting muscle activity.

Breathing Exercises and Diaphragmatic Training

• Crucial for chest injuries. Pain often leads to shallow breathing, which can cause lung atelectasis (partial lung collapse) and reduce oxygenation.
• Diaphragmatic Breathing (Belly Breathing): To encourage deeper, more efficient breathing and reduce reliance on accessory breathing muscles.
• Segmental Breathing: Exercises to expand specific parts of the lungs and chest wall.
• Incentive Spirometry: May be used to encourage deep breaths and prevent complications.
• Coughing and Huffing Techniques: Taught to clear airways effectively with less pain.

Therapeutic Exercise

• Gradual Range of Motion (ROM) Exercises: Gentle, pain-free movements of the trunk, shoulders, and arms to prevent stiffness and restore mobility as pain allows.
• Gentle Stretching: For muscles of the chest, back, and shoulders that may have tightened due to guarding.
• Progressive Strengthening: Once pain subsides, strengthening exercises for the core, back, and shoulder girdle muscles to improve stability and prevent recurrence.
• Postural Re-education: Correcting poor posture that may put undue stress on the chest wall.

Cryotherapy and Thermotherapy

• Ice Packs: Applied in the acute phase (first 24-48 hours) to reduce swelling, pain, and muscle spasm.
• Heat Packs: Can be used in the subacute phase to improve circulation and relax muscles.