soft tissue injury

• identifying the structure involved
• reorganizing its stage of recovery
• determining the functional limitations or disabilites

overstretching, overexertion, over use of soft tissue (muscle)

severe stress, stretch or tear of soft tissue (jt capsule, ligament, tendon, muscle)

• 1st degree- mild
• 2nd degree- moderate
• 3rd degree- severe

subluxation

dislocation

partial muscle/tendon rupture or tear

complete muscle/tendon rupture or tear

tenosynovitis

inflammation of tendon

tenovaginitis

degeneration of the tendon from repetitive microtrauma

synovitis

bleeding into a joint

ganglion

inflammation of a bursa

• contusion
• (bleeding, edema, inflammatory response)

repeated, submaximal overload or frictional wear to a muscle or tendon resulting in inflammation and pain

• dysfunction
• joint dysfunction (no natural play)
• contractures
• adhesions (collagen binds to tissues)
• reflex muscle guarding
• intrinsic muscle spasm (local increased contraction of muscle-like a knot)
• muscle weakness

overstretching, mild pain at time of injury or withing the first 24 hours

moderate pain that requires stopping the activity

near complete or complete tear/avulsion..severe pain

• vascular changes are predominate
• clot formation
• phagocytosis, early fibroblastic activity, formation of new capillary beds
• lasts 4-6 days ish
• signs- swelling, redness, heat, pain, loss of function

• lasts approx. 14-21 days ish after injury (may last up to 6 weeks)
• synthesis and deposition of collagen
• fibroblast until 21st day ish
• wound closure in muscle and skin takes 5-8 days ish
• wound closure in tendons and ligaments take 3-5 weeks ish
• signs of inflammation gradually decrease

• after the subacute, but before the pt has gained full function
• long standing condition while recurring episodes of pain from chronic inflammation or dysfunctions resulting from the healing process
• maturation of connective tissue
• can remodel the new tissue up to 8-10 weeks ish
• at 14 weeks cannot remodel the new tissue
• no signs of inflammation

chronic inflammation

signs- increased pain, swelling, muscle guarding that lasts more than several hours after activity, increased feeling of stiffness after rest, loss of ROM 24 hours after activity, and progressive increased stiffness of the tissue

formation of strong, mobile scar

intially, fibril formation is random

• PROM withing limit of pain
• gentle passive joint traction or glide within limits of pain
• grade 1 or 2 distractions
• gentle glides massage
• muscle setting

• PROM
• muscle setting with the muscle relaxed/shortened
• ES with muscle shortened
• massage transverse to injured fibers
• massage
• passive joint play mvmts (1 or 2)

• gentle massage with tendon taut
• PROM and joint-play mvmts (1 or 2)

if increased pain or inflammation, then youre doing too much mvmt

if decreased swelling, pain no longer constant, and pain not increased by motion in available range, can progress program

• active ex., within pain-free range
• multiple angle, submaximal isometrics (in shortened/relaxed position), if jt pathology-comfortable position for isometrics
• AROM in pain free ranges - first isolated, single plane motions
• protected closed chain exers.
• DO NOT use eccentrics if muscle injury

• passive joint play within limits of pain
• if limited range and decreased joint play with no effusion- stretch capsule (2)
• increased intensity cross-fiber or soft tissue massage

• gentle contract-relax or ES
• progress intensity cross-fiber massage (shortened)
• 2 glides

• increased intensity of cross-fiber massage
• grade 2 traction or glides

resting pain, fatigue, increased weakness and spasm

• need free joint play within a usefull ROM (to avoid jt trauma)
• if loss of joint play- use multi-angle isometrics to increase strength
• if have joint play- resistve isotonic exers
• mobilize any adhesions
• healing with increased tensile quality of injured tissue will continue for 12-18 months ish
• exers from simple to multidirectional to complex
• strengthening- open and closed eccentric and concentric
• controlled stabilization progression
• safe mechanics taught and practiced
• muscular and cardiovascular endurance
• if needed, plyometrics, agility training and skill development

no signs of inflammation, discomfort should not last more than a couple hours

• joint swelling
• pain longer than 4hours or requires medication
• decrease in strength
• fatiguing more easily

• overuse syndrome, cumulative trauma disorders, repetitive strain injuries
• trauma-repetitive injury
• reinjury of old scar
• contractures or poor mobility -> modalities and rest, biomechanical counseling

• control the inflammation-modalities and rest
• identify and modify the reason for the chronic irritation and teach the pt with biomechanical counseling
• exercise at nonstressful intensities
• once pain from chronic inflammation decreases, progress through exercise program with controlled stresses

if progressive loss of ROM with stretching stop the stretch