What does treatment of soft tissue injury depend on?
- identifying the structure involved
- reorganizing its stage of recovery
- determining the functional limitations or disabilites
What is a strain?
overstretching, overexertion, over use of soft tissue (muscle)
What is a sprain?
severe stress, stretch or tear of soft tissue (jt capsule, ligament, tendon, muscle)
How are ligaments severity determined?
- 1st degree- mild
- 2nd degree- moderate
- 3rd degree- severe
What is an incomplete or partial dislocation?
What is a displacement of a part?
What occurs when there is pain where a muscle is torn when stretched or contracts against resistance?
partial muscle/tendon rupture or tear
What occurs when a muscle doesnt pull at all?
complete muscle/tendon rupture or tear
What is an inflammation of the synovial membrane covering a tendon?
What is tendinitis?
inflammation of tendon
What is the inflammation with thickening of tendon sheath?
What is tendinosis?
degeneration of the tendon from repetitive microtrauma
What is the inflammation of the synovial membrane?
What is hemarthrosis?
bleeding into a joint
What is the ballooning of the wall of a joint capsule or tendon sheath?
What is bursitis?
inflammation of a bursa
What is bruising from a direct blow called?
- (bleeding, edema, inflammatory response)
What are overuse syndromes, cumulative trauma disorders, repetitive injuries?
repeated, submaximal overload or frictional wear to a muscle or tendon resulting in inflammation and pain
What are some clinical manifestations of trauma?
- joint dysfunction (no natural play)
- adhesions (collagen binds to tissues)
- reflex muscle guarding
- intrinsic muscle spasm (local increased contraction of muscle-like a knot)
- muscle weakness
What is a grade 1 (first degree) tissue injury?
overstretching, mild pain at time of injury or withing the first 24 hours
What is a grade 2 (second degree) tissue injury?
moderate pain that requires stopping the activity
What is a grade 3 (third degree) tissue injury?
near complete or complete tear/avulsion..severe pain
What occurs during the acute inflammation and repair stage?
- 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
What occurs during the subacute (repair and healing) stage of inflammation and repair?
- 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
What occurs during the chronic (maturation and remodeling) stage of inflammation and repair?
- 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
What occurs when excessive stresses and irritants cause the inflammatory response to continue?
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
What is the long term treatment goal during the acute phase (protective phase of treatment)?
formation of strong, mobile scar
intially, fibril formation is random
During the acute phase of treatment, what is the joint and ligament pathology?
- 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
During the acute phase of treatment, what is the muscle pathology?
- muscle setting with the muscle relaxed/shortened
- ES with muscle shortened
- massage transverse to injured fibers
- passive joint play mvmts (1 or 2)
During the acute phase of treatment, what is the tendinous lesion?
- gentle massage with tendon taut
- PROM and joint-play mvmts (1 or 2)
What are the precautions during the acute treatment phase?
if increased pain or inflammation, then youre doing too much mvmt
During the subacute phase of treatment, what are some treatment guidelines?
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
During the subacute phase of treatment, what is the joint and ligament pathology?
- 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
During the subacute phase of treatment, what is the muscle pathology?
- gentle contract-relax or ES
- progress intensity cross-fiber massage (shortened)
- 2 glides
During the subacute phase of treatment, what is the tendon and tendon sheath pathology?
- increased intensity of cross-fiber massage
- grade 2 traction or glides
During the subacute phase of treatment, how do you know if you are doing too much?
resting pain, fatigue, increased weakness and spasm
During the chronic phase of treatment, what are the treatment goals?
- 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
During the chronic phase of treatment, what are some signs youre doing too much?
- joint swelling
- pain longer than 4hours or requires medication
- decrease in strength
- fatiguing more easily
What are some causes for chronic recurring pain/chronic inflammation?
- overuse syndrome, cumulative trauma disorders, repetitive strain injuries
- trauma-repetitive injury
- reinjury of old scar
- contractures or poor mobility -> modalities and rest, biomechanical counseling
What are some treatment considerations for chronic recurring pain/chronic inflammation?
- 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
What are the precautions for chronic recurring pain/chronic inflammation?
if progressive loss of ROM with stretching stop the stretch