1. Soft Tissue Injury, Repair, and Management
Chapter 10

2. 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

3. 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.

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

5. 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.

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

7. 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.

8. 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

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

10. 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

11. 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.

12. 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

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

14. 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.

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

16. 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

17. 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.

18. 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.

19. Independent Learning Activities
Critical Thinking and Discussion