1. Soft tissue injuries Tears, Sprains, contusions
Skin abrasions, lacerations, blisters
Inflammatory response

2. TEARS SPRAINS CONTUSIONS
Soft tissue injuries are injuries to any type of body tissue other than bone and teeth.
They include:
Tears, such as ligament sprains and muscular strains.
You also need to know about simple injuries like a skin abrasion or a blister.
These injuries all stimulate the same inflammatory response form the body, which can result in further damage if not controlled through the application of RICER (Rest, Ice, Compression, Elevation, Referral).
The RICER treatment of a soft tissue injury aims to decrease inflammation, allowing enough inflammation to repair the injured tissue, but not so much as to cause further soft tissue damage.
In addition to this, you should know how to treat skin injuries to prevent blood loss (abrasions, contusions, blisters etc).
2011 Question 29 (a) (i) Outline types of soft tissue injuries. 3 Marks

3. TEARS SPRAINS CONTUSIONS CONT…
Strain
A strain is a tear that occurs in a muscle - often it is referred to as a “pulled” muscle.
Strains (muscle tear) are normally caused by internal forces, poor technique or overtraining.
Strains are often classified by a grading system with three (3) levels:
Grade 1 - small tear to the muscle.
Grade 2 - much larger tear around 50% or more torn.
Grade 3 - complete tear, so that surgery is needed to join the muscle back together.
An example of a strain is a pulled hamstring

4. TEARS SPRAINS CONTUSIONS CONT…
A sprain is a tear that occurs to a ligament (joining bone to bone around joints).
Sprains are often caused by an external force being transferred through the body often to the other side of a joint.
They are always caused by a joint being bent in a direction it is not meant to move.
A sprain has three (3) levels of classification, that are exactly the same as above only applied to a ligament.
A third degree tear is a ligament that has been torn in half and needs surgery to repair. An example of a sprain is a rolled ankle in netball or an ACL rupture in the knee.

5. TEARS SPRAINS CONTUSIONS CONT…
A contusion is when capillaries are ruptured causing internal bleeding.
Referred to as a bruise and is normally caused by external force.
Contusions are also caused through internal forces being imbalanced resulting in capillaries bursting.

6. SKIN ABRASIONS LACERATION BLISTERS
Skin abrasions, lacerations and blisters are three (3) other soft tissue injuries, but all occur at the skin level and result from external forces.
Skin Abrasions
A skin abrasion is a scraping or wearing away of the skin and is usually not very deep.
Usually an abrasion is referred to as a graze.
These are common injuries in any sport, especially those where the athlete may frequently fall or be tackled.
Example of an abrasion is a grazed knee from a slide tackle in soccer.
The treatment for skin abrasions is:
Clean the wound
Washing it with a disinfectant
Covering it with a non-stick dressing
In the case of a more serious abrasion the management of blood loss will become the priority, though this is very rare for an abrasion.

7. SKIN ABRASIONS LACERATION BLISTERS CONT…
A laceration is a deep cut or tear to the skin of resulting from contact with a sharp device.
Cut from a kitchen knife
Cut from an ice-hockey skate
Tear from a stud in rugby.
Lacerations often result after a head clash or contact with other sport specific equipment
Ice-hockey player who gets hit with a stick cutting his skin open.
Treatment for a skin laceration:
Manage bleeding
Apply pressure to the area
Depending on severity - medication attention, stitches or surgery may be needed
Self-managed lacerations:
Clean the wound
Apply a non-stick dressing with pressure to control bleeding
If bleeding does not stop quickly, ice can be used, and medical treatment is needed.

8. SKIN ABRASIONS LACERATION BLISTERS CONT…
A blister is caused by friction or burning that leads to a build up of serum in the skin.
Athletes often get blisters on their feet due to friction from their shoes.
Most often blisters are caused by equipment such as a tennis racquet or soccer boot.
Treatment for a blister:
Cover it with padding
Remove the object causing the friction/burning
Do not pop the blister, but allow it to heal.

9. INFLAMMATORY RESPONSE
Bodies natural reaction to injury and infection.
Involves vasodilation (widening of blood vessels) allowing more blood to the area and more fluid to exit the vessels into the surrounding tissue.
This increases the white blood cells (leucocytes) entering the area to clean up debris and fight infection (if the injury is open).
The inflammatory response has three phases:
Phase 1 – Acute Inflammation
Phase 2 – Repair Inflammation
Phase 3 – Remodelling Inflammation

10. INFLAMMATORY RESPONSE CONT…
Phase 1 – Acute Inflammation
During the acute inflammatory stage, inflammation is fast and painful.
The inflammatory response during this phase involves the vasodilation of blood vessels, and the transfer of fluid into the surrounding tissue.
The inflammatory response causes secondary (additional) damage to the area.
The athlete loses function as inflammation (swelling) is large.
New blood vessels begin to be developed in this phase and the area is swollen, red and painful.
The acute inflammatory phase lasts hrs (2-3 days) and it is during this time that RICER is most important.

11. INFLAMMATORY RESPONSE CONT…
Phase 2 – Repair Inflammation
During the repair phase of the inflammatory response, the body begins to fix the damaged or injured site.
The white blood cells (leukocytes) clean up the debris from the injury and new body tissue begins to form.
Often this phase of the inflammatory response produces scar tissue in the repair of the injury, which needs to be minimised for proper healing to occur as scar tissue is weaker than normal tissue.
This phase extends from 3 days to up to 6 weeks.

12. INFLAMMATORY RESPONSE CONT…
Phase 3 – Remodelling Inflammation
The remodelling phase of the inflammatory response continues to rebuild the injured area.
More scar tissue is produced during this phase of the inflammatory response, but also new functional body tissue is developed and strengthened.
This tissue can replace scar tissue if proper treatment is sought from health professionals.
During this phase of the inflammatory response the balance of exercise and rest is important as too much exercise will cause further injury, but not enough exercise will result in too much weak scar tissue.
This phase of the inflammatory response can last many months. An athlete will not be back to full health until this phase is completed (though they often have already returned to play).
It is important to remember that while the inflammatory response is necessary for repair of the injury, too much inflammation causes further damage. There are five signs/symptoms of inflammation: redness, swelling, pain, heat, and loss of function.

13. MANAGEMENT OF SOFT TISSUE INJURIES
The management of soft tissue injuries focuses on controlling the inflammatory response and minimising pain. The immediate management of soft tissue injuries is known as RICER (Rest, Ice, Compressions, Elevation, Referral) and is applied for at least the first 48hrs.

14. MANAGEMENT OF SOFT TISSUE INJURIES CONT…
Rest
First thing to do when managing soft tissue injuries is to stop playing the sport or doing the exercise
Rest the area injured eg - if this is an ankle then the joint should not be moved.
Rest helps to prevent further damage to the injured area, which helps ensure the inflammatory response is not stimulated again.
Ice
Ice should be applied as soon as possible in the form of an ice pack, or a bag of ice, but can include other forms of cryotherapy.
Ice should be applied over the first 48hrs.
There are many methods to icing a soft tissue injury eg 20 min on 20 min off. Generally as long as ice is consistently applied to the area with short breaks benefits will occur.
Helps reduce the pain, decreases inflammation, and speeds up recovery.
Ice causes vasoconstriction (narrowing of the arteries), reducing inflammation
Then when taken off the vessels dilate (vasodilation) allowing the blood to flow through with a momentary increase in the inflammatory response that allows waste removal and new nutrients to be delivered for repair.

15. MANAGEMENT OF SOFT TISSUE INJURIES CONT…
Compression
Compression helps to reduce or control the inflammatory response and stabilises the joint (if injured).
involves the application of a compression bandage or garment around the injured area.
helps force fluid away from the area reducing the inflammation at the area.
Can also help reduce movement, limiting re-injury, and provide support for the injured area.
Elevation
It is important to get elevation correct.
Elevation of the injured soft tissue must be above the heart.
An injured elbow could be rested on the chest as a person lies down or an ankle needs to be placed on a pillow or 2 while the athlete lies flat.
Elevation above the heart means gravity can assist in the removal of fluid from inflammation.
Gravity helps to move the blood and other fluid back towards the heart reducing or controlling the inflammatory response.

16. MANAGEMENT OF SOFT TISSUE INJURIES CONT…
Referral
Refer the athlete to a health or medical professional.
Allows for proper diagnosis and rehabilitation to be applied if needed.
This will help improve recovery and prevent future injury to the site.
Often GPs will provide an anti inflammatory drug to help reduce pain and improve recovery.
Important to control the inflammatory response because if left to its own devices, the inflammatory response will cause further damage to the area.
Too much inflammation increases the pressure around the injury which damages the nearby cells delaying recovery.