Soft tissue & Trauma Obj: I will describe various types of soft tissues in the body Obj: I will explain how tissues respond to trauma Obj: I will describe the types of soft tissue trauma Obj: I will demonstrate proper procedures for treating various soft tissue trauma Obj: I will analyze the indication and contraindication for cold application on a soft tissue injury Obj: I will analyze the indications and contraindications for heat application on soft tissue injuries

Warm up Think of an incident where you either witnessed or experienced a soft tissue injury to the skin, muscle, tendon or ligament. What happened? What did the injury look like? How was the injury treated?

Soft Tissue Soft tissues are the tissues that connect, support, and surround other structures and organs of the body, not being bone. Soft tissues include tendons, ligaments, fascia, skin, fibrous tissues, fat, synovial membranes (connective tissues), muscles, nerves, and blood vessels.

Skin Skin- outer covering of the body

Ligament Ligament- connects bone to bone

Muscle Muscle- tissue that when stimulated contracts and produces movement

Tendons Tendons- tissue that connects muscle to bone

Soft tissue Injury A soft tissue injury is the damage of skin, muscles, ligaments, and tendons throughout the body. Common soft tissues injuries usually occur from a sprain, strain, a blow resulting in a contusion, or overuse of a particular part of the body

5 Signs of Inflammation

5 signs of Inflammation Redness- due to vasodilatation and increase in blood flow Heat- due to vasodilation and increase in blood flow Swelling- due to increase in blood flow to the injured area and possibly from blood that leaks into the injured tissue (bruising) Pain- due to the pressure of fluids or swelling through the nerve endings Loss of function- due to swelling and pain

Contusion Bruise Sudden traumatic blow to body Not penetrate skin Usually injury to blood vessels Superficial, deep, or hemorrhage Hematoma: formation caused by pooling of blood and fluid w/in a tissue space Bone bruise: contusion penetrates to skeletal structures

Contusion

Contusion Symptoms: Treatment: Swelling Point tenderness Redness Ecchymosis- purple discoloration of skin Treatment: PRICE Protection- protect from further injury by preventing them from moving Rest Ice- ice during the first 72 hours to reduce swelling and pain (ice for 15 to 20 minutes every 2 to 3 hours) Compression-use of pressure with bandage or wrap to reduce swelling Elevation- can minimize initial tissue bleeding and swelling

Contusions

Partner Assignment With a partner, create a short movie which shows an incident resulting in a contusion. Include at least five signs and symptoms of a contusion using the body crayons and play dough. Include whether it is superficial, deep, or a hemorrhage Demonstrate knowledge and application of the treatment PRICE. Movie clip should be between 2 to 5 minutes in length. Use movie maker to transition scene and make the final production.

Strains Strain- stretch, tear, or rip in the muscle and/or tendon Severe tension force Excessive muscle contraction Direct blow to the body Common sites: Hamstring Quadriceps Hip flexor Biceps Latissimus dorsi

In what sports is someone more likely to get a strain? Sports and strains? In what sports is someone more likely to get a strain?

Sports and Strains Soccer, football, hockey, boxing, wrestling, and other contact sports put athletes at risk for strains. Sports that feature quick starts (hurdling, long jump, running races, etc.). Gymnastics, tennis, rowing, golf-sports that require extensive gripping-have a high incidence of hand strains. Elbow strains frequently occur in racquet, throwing, and contact sports.

Severity of Strains Grade 1 Grade 2 Grade 3 Some muscle fibers stretched or torn Some tenderness/pain with range of motion Grade 2 Number of muscle fibers torn Active contraction of muscle extremely painful Grade 3 Complete rupture of muscle Significant impairment or total loss of movement Grade 1: movement painful but full range possible Grade 2: usually depression or divot can be felt; some swelling my occur b/c of capillary bleeding; discoloration possible Grade 3: initial intense pain but quickly diminishes b/c complete nerve fiber separation

Strain: Signs & Symptoms Localized swelling Cramping Inflammation Loss of function Pain General weakness Discoloration

Strain- Treatment Treatment Severe Strain could require: Reduce swelling & pain through PRICE Protection- protect from further injury by preventing them from moving Rest Ice- ice during the first 72 hours to reduce swelling and pain (15 to 20 minutes every 2 to 3 hours) Compression-use of pressure with bandage or wrap to reduce swelling Elevation- can minimize initial tissue bleeding and swelling Anti-inflammatory drugs such as ibuprofen Severe Strain could require: Hard cast Surgery

Strains Prevention Regular weight training Proper warm-up Stretching Proper mechanics Proper cool-down/ stretching Proper nutrition & hydration

Partner Assignment With a partner, create a short movie which shows an incident resulting in a strain. Include at least five signs and symptoms of a strain using the body crayons and play dough. Include whether it is a grade 1, grade 2, or grade 3 Demonstrate knowledge and application of the treatment PRICE and the use of anti-inflammatory drugs. Demonstrate knowledge and application of at least 4 prevention techniques. Movie clip should be between 3 to 5 minutes in length. Use movie maker to transition scene and make the final production.

Sprain Sprain- stretched or torn ligament (connects bone to bone) Causes: Falling twisting Direct blow Common sites: Ankle Wrist Knee

In what sports is someone more likely to get a sprain? Sports and sprains? In what sports is someone more likely to get a sprain?

Sports and Sprains All sports and exercises, even walking, carry a risk of sprains. The anatomic areas most at risk for a sprain depend on the specific activities involved. For example, basketball, volleyball, soccer, and other jumping sports share a risk for foot, leg, and ankle sprains. Sports such as football, basketball and soccer that involve running with sudden stops, cutting side to side, jumping and pivoting can increase the risk of a knee sprain.

Severity of Sprain First Degree: ligament has been stretched but not torn mild pain some swelling joint instability difficulty jogging or jumping. Second Degree (most common): partial tearing of the ligament significant swelling bruising moderate pain trouble walking Third Degree: ligament is completely torn Severe swelling Severe pain Extreme loss of motion Walking can be very painful

Sprain: Signs and Symptoms Pain Swelling Heat Redness Bruising Stiffness or difficulty moving the joint At the time of injury, you may hear or feel a pop in the joint

Sprain- Treatment Treatment Reduce swelling & pain through PRICE Protection- protect from further injury by preventing them from moving (if ankle sprain, wear a shoe) Rest Ice- ice during the first 72 hours to reduce swelling and pain (15 to 20 minutes every 2 to 3 hours) Compression-use of pressure with bandage or wrap to reduce swelling Elevation- can minimize initial tissue bleeding and swelling Anti-inflammatory drugs such as ibuprofen Surgery may be needed for a tear in ligaments of the knee

Sprain- Prevention Prevention Balance training Strengthen the muscles around the joint Flexibility training of the hips, legs, and ankles Adequate preparation for the activity Taping and bracing the joint

Partner Assignment With a partner, create a short movie which shows an incident resulting in a sprain. Include at least five signs and symptoms of a sprain using the body crayons and play dough. Include whether it is a first degree, second degree, or third degree Demonstrate knowledge and application of the treatment PRICE and the use of anti-inflammatory drugs. Demonstrate knowledge and application of at least 4 prevention techniques. Movie clip should be between 3 to 5 minutes in length. Use movie maker to transition scene and make the final production.

Assignment Quiz: Soft tissue and soft tissue injuries What soft tissue connects bone to bone? What soft tissue connect muscle to bone? What soft tissue makes up the outer covering of the body? What are the five signs of inflammation? What does PRICE stand for? What are three degrees of severity for a contusion? What is the difference between a sprain and a strain? What are two ways to prevent a strain? What are two ways to prevent a sprain? What strain is more severe? Grade 1 or Grade 3?

Soft tissue Overuse injuries Small amounts of body stress accumulate slowly but steadily. The result can be damage and pain. Common soft tissue overuse injuries include: Shin Splints: inflammation of the connective tissue that surrounds the tibia Tendonitis: an inflammation or irritation of a tendon, a thick cord that attaches bone to muscle. Tennis Elbow: a painful condition that occurs when tendons in your elbow are overworked, usually by repetitive motions of the wrist and arm

Small Group Assignment As a team of 3, divide the responsibilities to complete the following tasks: Research the soft tissue overuse injury and type in the information on the appropriate slides: Causes, Symptoms, Treatment, Prevention Create a short movie demonstrating knowledge on that short tissue overuse injury (See Rubric) Present the Causes, Symptoms, Treatment, and Prevention to the class Note: After each group presents, all groups will view each other’s short movie

Tendonitis: Causes Causes The condition is commonly caused by repetition of a particular movement over time.  tendinitis develops in people whose jobs or hobbies involve repetitive movements; aggravating the tendons.

Tendonitis: Symptoms Symptoms: Pain - if the affected area is moved the pain worsens A feeling that the tendon is crackling or grating as it moves. This sensation is more common on examination. Swelling in the affected area The affected area may be hot and red A lump that develops along the tendon

Tendonitis: Treatment Rest Heat and cold Pain relievers Corticosteroid injections Physical therapy Shock wave therapy or surgery

Tendonitis: Prevention Strengthening exercise around the tendon   Stretching and cooling down  Avoid repetitive movements 

Shin Splint: Causes Shin splints are caused by repetitive stress on the shinbone and the connective tissues that attach your muscles to the bone.

Shin Splint: Symptoms Symptoms: Soreness along the inner part of your lower leg Mild swelling in your lower leg Muscle pain

Shin Splint: Treatment Ice your shin Rest your body Ibprofen Physical therapy

Shin Splint: Prevention Always wear shoes with good support and padding. Warm up before working out, making sure to stretch the muscles in your legs. Stop working out as soon as you feel pain in your shins. Don't run or play on hard surfaces like concrete.

Tennis Elbow: Causes Cause: Tennis elbow is cause by repetitive motion that can strain the muscle and stress the tendon.

Tennis Elbow: Symptoms pain tenderness weakness

Tennis Elbow: Treatment Anti-inflammatory drugs Ice Rest

Tennis Elbow: Prevention Stretch Strengthen Wearing a brace Proper techniques

Soft tissue injury and the Healing Process https://www.youtube.com/watch?v=8J_GWa1XyNk

Stages of Healing Acute - Protection Phase Sub-Acute - Repair Phase Late Stage - Remodeling Phase  Chronic Phase - Ongoing Repair and Remodeling

Acute - Protection Phase Acute Phase: From the initial time of injury and while the pain, bleeding and swelling is at its worst till about two to four days post-injury Your body's aim at this point is to protect your injury from further damage. Treatment: PRICE: Protection, Rest, Ice, Compression, Elevation

Acute - Protection Phase

Sub-Acute - Repair Phase Sub-Acute Phase When the initial acute phase makes a transition to repairing the injured tissues This phase commonly lasts up to six weeks post-injury Body is laying down new soft tissue and reducing the need to protect the injury as the new tissue begins to mature and strengthen.  Treatment Options: Heat, massage, electrical stimulation, protective strapping or bracing, joint mobilization, stretching and strengthening exercises

Sub-Acute - Repair Phase

Late Stage - Remodeling Phase Late Phase: The period between six weeks and three months post-injury At six weeks post-soft tissue injury the healing tissue is reasonably mature but as it is stretched, strengthened and stressed the new tissue often finds that it is not strong enough to cope with the increasing physical demand.  When the body detects that a repaired structure is still weaker that necessary, it will automatically stimulate additional new tissue to help strengthen and support the healing tissue until it meets the demands of normal exercise or physical function.

Late Stage - Remodeling Phase

Chronic Phase - Ongoing Repair and Remodeling Beyond three months Refers mainly to pain that lasts more than 3 months Soft tissue is constantly being injured by daily activities and workouts, only to repair and remodel the tissue to meet specific exercise demands.

Chronic Phase - Ongoing Repair and Remodeling

Ice vs. Heat Treatment

Ice Treatment Ice: Typically ice in the first 72 hours after an injury when the tissue is red, hot, and swollen. Goal of Ice Treatment: Reduce bleeding into the tissues. Prevent or reduce swelling (inflammation). Reduce muscle pain and spasm. Reduce pain by numbing the area and by limiting the effects of swelling Ice 15 to 20 minute every 2 to 3 hours

Heat Treatment Heat: Use heat after 72 hours Heat causes the blood vessels to open wide (dilate). Goal of Heat Treatment: Bring more blood into the area to stimulate healing of damaged tissues soothing effect and helps to relieve pain and spasm eases stiffness by making the tissues more supple. Apply heat using a heating pad or a hot wet towel. Heat for 10 to 20 minutes but no more than 20 minutes

What stage of healing? Ice or Heat? Case Study What stage of healing? Ice or Heat?

What stage of healing? Ice or Heat? Case Study What stage of healing? Ice or Heat?

What stage of healing? Ice or Heat? Case Study What stage of healing? Ice or Heat?

What stage of healing? Ice or Heat? Case Study What stage of healing? Ice or Heat?

What stage of healing? Heat or Ice or neither? Case Study What stage of healing? Heat or Ice or neither?

What stage of healing? Ice or Heat or neither? Case Study What stage of healing? Ice or Heat or neither?

What stage of healing? Ice or Heat? Case Study What stage of healing? Ice or Heat?