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
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
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)
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
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.
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
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
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
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
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.
Editor's Notes
Keywords:
phases, 4 phases, four phases, circles
Tendinopathy describes two conditions that are likely to occur together: tendon inflammation, known as tendinitis (or tendonitis), and tiny tears in the connective tissue in or around the tendon, known as tendinosis.
an acute or chronic inflammation of the tendon sheath, occurring in the region of the hand, the wrist joint, the forearm (radial and ulnar tenobursitis), the foot
Tendinopathy describes two conditions that are likely to occur together: tendon inflammation, known as tendinitis (or tendonitis), and tiny tears in the connective tissue in or around the tendon, known as tendinosis.
an acute or chronic inflammation of the tendon sheath, occurring in the region of the hand, the wrist joint, the forearm (radial and ulnar tenobursitis), the foot
the laceration will typically be bandaged to protect the
skin and the stitches.
(due to an influx of fluid into the damaged region).- due to an increase in blood flow to the area).-