Soft tissue sources & types of injuries, management

2. Soft tissue injuries &
Management Guidelines
Dr. Mustafa Qamar
Assistant professor, SMC

3. Learning Objectives
Identify the different sources and
types of soft tissue injuries.
Identify the management guidelines
of soft tissue injuries

4. Activity Work Sports Trauma
ASTD
(Activity
related soft tissue
disorder)
Repeated
movement/
Sustained
awkward posture
Repeated
movement
pattern/
RTA, MVA
Traumatic injuries
during
sports
= +

5. Soft tissue injuries/lesions

6. Soft tissue injuries

7. Soft tissue injuries/lesions

8. Overview
Soft tissue sporting injuries are
injuries that involve damage to the
ligaments, tendons and muscles.
Soft Tissue injuries

9. Tears, Sprains, Contusion
Tears
Tears (also referred as Strains) are caused by
muscle over stretching, resulting in a partial or
complete tear of the muscle or tendons.
Example
Sprinting in football and the muscle is
overstretched resulting in a tear of the
hamstring

10. Tears, Sprains, Contusion

11. Tears
Signs and symptoms
 Swelling
Bruising
 pain while moving
the muscle

12. Tears
Grading
Grade 1 to Grade 3
Grade 1 minor up to grade 3 complete
muscle tear

14. Sprains
Sprains are caused when the joint is forced beyond normal
range of motion resulting in over stretching and tearing of
the ligament that supports the joint.
Example
Tennis player outstretched to make a shot and rolls on the
ankle tearing the ligament

15. Sprains

16. Sprains
Signs & symptoms
 Swelling- Difficulty in putting weight on the
injured area
 Bruising
 Pain

17. Contusions
Contusions are a direct injury resulting from a blow from
an object to a part of the body, damaging
muscle tissue and internal bleeding occurs.
Example:
Two soccer players competing for the ball and one
players knee collides with the others thigh area
resulting in a contusion (corked thigh)

18. Contusions

19. Contusions
Signs & symptoms
 Pain at the site of the
injury
 Bruising
 Restricted movement

20. Skin Abrasions
Abrasions (grazes) are common sports injuries
that are usually caused by a fall on a hard
surface.
As the athlete falls or slides on the
ground, friction causes layers of skin to rub
off. The wound can contain dirt or gravel,
which should be removed

21. Skin Abrasions
Example
Falling off the bike and the friction of
the skin across the surface of the road
causes the abrasion/graze.

22. Skin Abrasions

23. Skin Abrasions
Symptoms
Bleeding from the abrasion
Skin pain
Skin Tenderness
Complete or
partial loss of skin layers

24. Laceration
A laceration is a tearing or ripping of the skin that result
in a significant blood loss. The repair
of a laceration may require stitching and result in a
permanent scar.
A laceration to the skin creates a significant risk of
infection as dirt and other particles can enter
the blood stream.

25. Laceration
Example.
Two players have a head
clash resulting in a head
laceration with significant
blood loss

26. Laceration

27. Blister
A blister is caused by friction between the skin
and the inside of a shoe or clothing.
Blisters are a common problem for athletes and
can cause significant pain

28. Blister

29. Blister
Example
Athletes who need sport implements to compete
are prone to blisters because of the friction caused by the
sport implement and the hand.
E.g. rowing
Also runners as the feet shift in the shoe causing
friction between the sock and the foot.

30. Treatment of Blister
The proper treatment of the depends on whether
the blister is intact or torn open
 No other treatment needed, If the skin overlying the
blister is protective
The treatment for an open blister includes the
following:-
Clean the area thoroughly with antiseptic soap
Allow the area to dry
Cover with a sterile, non-adhesive dressing

31. Prevention
The key to preventing blisters is to reduce the
friction that causes the blisters and
to prevent clothing (especially socks)
from becoming wet with perspiration.

32. Inflammatory response
The inflammatory response is the body's self
healing process that occurs immediately
following tissue damage. e.g. hamstring tear
Inflammatory Response's main function is to
dispose of dead or dying tissue and to promote
the renewal of new tissue

33. Vessel constricts
Platelets activate
Internal
bleeding
Bleeding stops
Fibrin clot
to vessel
surface

34. Signs & symptoms
Pain- Swelling
 Redness
 Heat
 Loss of function

35. Stages
Inflammatory stage - Begins after the injury,
swelling & pain
Proliferative stage - Dead cells removed and
new cells grown
Remodeling - Swelling gone, regaining of full
motion

37. Stages

38. ChronicPhase
Sub-acuteStage
AcuteStage
Management
Guidelines
CHRONIC
RECURRING PAIN

39. SOFT TISSUE MANAGEMENT
The management of soft tissue injury has eight aims:
To reduce local tissue temperature
To reduce pain
To limit and reduce inflammatory exudates
To reduce metabolic demands of the tissues
To protect the damaged tissue from further injury
To protect the newly-formed fibrin bonds from disruption
To promote collagen fiber growth and realignment
To maintain general levels of cardio-respiratory and
musculoskeletal fitness / activity.
CSP Guidelines (2002)

40. OVERVIEW OF SOFT TISSUE MANAGEMENT
*Persistent swelling and pain will diminish in time and may not be present
after the first few days/weeks during the remodeling phase.

41. Biomechanical implications Inflammatory Stage
PRICE:
Protect
o Duration
o Mode
o Immobilization
Rest or relative rest
o Avoid stress
o Reduced general activity
(McKenzie & May, 2003).
41

42. Ice
o Duration
o Frequency
o Method
Compression
• Elevation.
o Lowers local BP
o Limit the bleeding
(McKenzie & May, 2003).
42

43. o Increase drainage of inflammatory exudates
o Reduce edema
• Early mobilization needs to occur but very carefully to avoid triggering
further tissue damage.
43
(McKenzie & May, 2003).

44. Recovery Time
 Protection
Precaution
Educate the patient
Cold, compression, elevation,
massage
Immobilize the part (rest, splint,
tape, cast).
Avoid positions of stress to the part.
Control pain, edema, spasm
Appropriate dosage of passive
movements within limit of pain, specific
to structure involved.
Appropriate dosage of intermittent
muscle setting or electrical stimulation.
Maintain soft tissue and joint integrity and mobility
MANAGEMENT GUIDELINES—Acute Stage/Protection Phase

45. May require medical
intervention if swelling is rapid
Provide protection (splint, cast).
Reduce joint swelling
Active-assistive, free, and/or
modified aerobic exercises
Adaptive or assistive devices
Maintain integrity and function of
associated areas.
Signs of too much movement
are increased pain or increased
inflammation.
Precautions
MANAGEMENT GUIDELINES—Acute Stage/Protection Phase

46. • Exercise progression may cause muscle soreness that
can last up to 4 hour
So keep in mind these signs
1. If muscle soreness not resolved after 24 hour.
2. Progressive increase feeling of stiffness and
decreased ROM
3. Swelling, redness and warmth in healing tissues
4. Progressive Weakness
5. Decrease functional usage
46

47. Biomechanical implications Proliferation Stage
◊ Focus on gentle range of motion (ROM) but not so vigorously as to
disrupt the scar.
◊ Overly vigorous mechanical loading during the repair stage of
healing CT
o Restart the inflammatory stage
o Excessive scarring/weaker repaired tissue
(McKenzie & May, 2003)
47

48. MANAGEMENT GUIDELINES—Sub-acute Stage
Educate the patient.
Promote healing of injured tissues
Restore mobility
Teach home exercises
Monitor and modify as patient progresses

49. MANAGEMENT GUIDELINES—Sub-acute Stage
Develop neuromuscular control muscle endurance & strength
Maintain integrity and function of associated areas
Precautions
Multiple-angle isometric exercises
Begin cautiously with mild resistance.
Initiate AROM and weight bearing and stabilization exercises.
Progress resistance later in this stage.
Apply progressive strengthening and stabilizing exercises.
Resume low-intensity functional activities
Eccentric and heavy-resistance exercises should not used in the
early sub-acute stage

50. Biomechanical implications Remodeling
 Regular stress sufficient to provide tension without damage,
collagen undergoes chemical and structural changes that allow
elongation and strengthening of the affected tissue
 Remodeling does not progress to the point of recreating a normal
ligament, tendon
(McKenzie & May, 2000).
50

51. MANAGEMENT GUIDELINES Chronic Stage/Return to Function Phase
Progress aerobic exercises using
Safe activities
Progress exercises
Stretching techniques
specific to tight tissue
Safe progressions of
exercises and stretching.
Continue progressive strengthening
exercises and advanced training
activities.
Precautions: There should be no signs of inflammation

52. Overuse, cumulative trauma, repetitive strain.
o Imbalance between the length and strength of the muscles
o Rapid or excessive repeated eccentric demand
o Muscle weakness
o Bone mal-alignment
52

53. o Change in the usual intensity or demands
o Returning to an activity too soon after an injury
o Sustained awkward postures
53

54. CUMULATIVE TRAUMA— CHRONIC RECURRING PAIN
Educate the patient
Promote healing;
decrease pain and
inflammation.
Interventions During
Chronic Inflammation
Educate the patient
Develop strong,
mobile scar.
Controlled Motion and Return
to Function Phases
Maintain integrity and
mobility of involved tissue.
Develop support in related
regions
Develop a balance in
length and
strength of the
muscles.
 Progress functional
independent
Guidelines

55. 55
•CSP PRICE Guidelines (2002) www.csp.org
•Culav, E.M., Clark, C.H., Merrilees, M.J. (1999). Connective tissues: Matrix
Composition and its relevance to physical therapy. Physical Therapy, 79 , 308-319.
•Frank, C., Hart, D., Shrive, N. (1999). Molecular biology and biomechanics of normal
and healing ligaments- a review. Osteoarthritis and Cartilage, 7, 130-140.
•McKenzie, R. & May, S. (2003). Pain and connective tissue properties. In Writer’s
Ink (Ed.), The lumbar spine: Mechanical Diagnosis & Therapy (45-66). Waikanae,
New Zealand: Spinal Publications.
Kisner C, Colby L. Therapeutic exercise 5th edition.