Soft Tissue Injury, Repair, and Management Chapter 10

Examples of Soft Tissue Lesions: Musculoskeletal Disorders Strain Sprain Dislocation Subluxation Muscle/Tendon Rupture or Tear Tendinopathy, Tendinous Lesions Synovitis Hemarthrosis Ganglion Bursitis Contusion Overuse Syndromes, Cumulative Trauma Disorders, Repetitive Strain Injuries

Clinical Conditions Resulting From Trauma or Pathology Dysfunction Joint Dysfunction Contracture Adhesions Reflex Muscle Guarding Intrinsic Muscle Spasm Muscle Weakness Myofascial Compartment Syndrome Soft Tissue Lesions Figure 10.1 illustrates the self-perpetuating cycle of muscle spasm.

Severity of Tissue Injury Grade 1 (First-Degree) Grade 2 (Second-Degree) Grade 3 (Third-Degree) Soft Tissue Lesions

Irritability of Tissue: Stages of Inflammation and Repair Acute Stage Inflammatory reaction Subacute Stage Repair and healing Chronic Stage Maturation and remodeling Chronic Inflammation Chronic Pain Syndrome Soft Tissue Lesions Table 10.1 outlines the Stages of Tissue Healing: Characteristics, Clinical Signs, and Interventions. Figure 10.2 illustrates pain experienced with ROM when involved tissue is in the acute stage, early subacute stage, and late subacute or chronic stage.

Management During the Acute Stage Tissue Response: Inflammation Cellular Vascular Chemical 4 to 6 days Management During the Acute Stage

Management Guidelines: Protection Phase Patient Education Protection of the Injured Tissue Prevention of Adverse Effects of Immobility Tissue-specific movement Intensity of movement General movement Management During the Acute Stage Box 10.1 contains Management Guidelines: Acute Stage/Protection Phase.

Management Guidelines: Protection Phase (cont'd) Specific Interventions and Dosages Passive range of motion Low-dosage joint mobilization techniques Muscle setting Massage Management During the Acute Stage

Management Guidelines: Protection Phase (cont'd) Interventions for Associated Areas Range of motion Resistance exercise Functional activities Management During the Acute Stage

Management During the Subacute Stage Tissue Response: Proliferation, Repair, and Healing 10 to 17 days (14 to 21 days after onset of injury); but may last up to 6 weeks Synthesis and deposition of collagen Management During the Subacute Stage

Management Guidelines: Controlled Motion Phase Patient Education Management of Pain and Inflammation Initiation of Active Exercises Multiple-angle, submaximal isometric exercises Active range of motion exercises Muscular endurance exercises Protected weight-bearing exercises Management During the Subacute Stage Box 10.2 contains Management Guidelines: Subacute Stage/Controlled Motion Phase.

Management Guidelines: Controlled Motion Phase (cont'd) Initiation and Progression of Stretching Warm the tissues Muscle relaxation techniques Joint mobilization/manipulation Stretching techniques Massage Use of the new range Correction of Contributing Factors Management During the Subacute Stage

Management During the Chronic Stage Tissue Response: Maturation and Remodeling Maturation of tissue Remodeling of tissue Management During the Chronic Stage

Management Guidelines: Return to Function Phase Patient Education Considerations for Progression of Exercises Progression of Stretching Progression of Exercises for Muscle Performance Developing neuromuscular control, strength, and endurance Return to High-Demand Activities Management During the Chronic Stage Box 10.4 contains Management Guidelines: Chronic Stage/Return to Function Phase.

Cumulative Trauma: Chronic Recurring Pain Tissue Response: Chronic Inflammation Inflammatory process is perpetuated Weakening effect Limitation of motion Cumulative Trauma: Chronic Recurring Pain

Etiology of Chronic Inflammation Leading to Prolonged or Recurring Pain Overuse, Cumulative Trauma, Repetitive Strain Trauma Re-Injury of an “Old Scar” Contractures or Poor Mobility Cumulative Trauma: Chronic Recurring Pain

Contributing Factors Imbalance between the length and strength of the muscles Rapid or excessive repeated eccentric demand Muscle weakness Bone malalignment or weak structural support Change in the usual intensity or demands Returning to an activity too soon after an injury Sustained awkward postures or motions Environmental factors Age-related factors Training errors Cumulative Trauma: Chronic Recurring Pain A combination of several contributing factors are frequently seen that cause the symptoms.

Management Guidelines: Chronic Inflammation Chronic Inflammation: Acute Stage Subacute and Chronic Stages of Healing Following Chronic Inflammation Cumulative Trauma: Chronic Recurring Pain Box 10.5 contains Management Guidelines: Chronic Inflammation/Cumulative Trauma Syndromes.

Independent Learning Activities Critical Thinking and Discussion