1. 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

2. 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?

3. 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.

4. Skin
Skin- outer covering of the body

5. Ligament
Ligament- connects bone to bone

6. Muscle
Muscle- tissue that when stimulated contracts and produces movement

7. Tendons
Tendons- tissue that connects muscle to bone

8. 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

9. 5 Signs of Inflammation

10. 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

11. 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

12. Contusion

13. 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

14. Contusions

15. 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.

16. 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

17. 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?

18. 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.

19. 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

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

21. 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

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

23. 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.

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

25. 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?

26. 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.

27. 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

28. 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

29. 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

30. 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

31. 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.

32. 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?

33. 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

34. 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

35. 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.

36. 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

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

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

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

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

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

42. 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.

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

44. Tennis Elbow: Symptoms
pain
tenderness
weakness

45. Tennis Elbow: Treatment
Anti-inflammatory drugs
Ice
Rest

46. Tennis Elbow: Prevention
Stretch
Strengthen
Wearing a brace
Proper techniques

47. Soft tissue injury and the Healing Process

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

49. 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

50. Acute - Protection Phase

51. 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

52. Sub-Acute - Repair Phase

53. 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.

54. Late Stage - Remodeling Phase

55. 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.

56. Chronic Phase - Ongoing Repair and Remodeling

57. Ice vs. Heat Treatment

58. 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

59. 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

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

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

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

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

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

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

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