UNDERSTANDING SOFT TISSUE INJURIES

The soft tissue structures include the muscles, tendons, ligaments, joint capsule, myofascial, and other connective tissues. These structures are often injured during sports participation but even with simple daily activities.

CAUSES OF SOFT TISSUE INJURIES

Trauma is the typical cause of soft-tissue and other musculoskeletal injuries,either due to a direct trauma from a blunt blow or indirect trauma from repeated submaximal loading, resulting in clinical signs and symptoms. Generally, soft-tissue injuries fall into two categories:

• Acute soft tissue injuries are due to sudden trauma, such as a fall, twist, or blow to any part of the body, and it may include sprains, strains, and contusions.
• Overuse soft tissue injuries develop gradually over time when specific areas of the body are constantly subjected to repeated trauma and are not allowed time to heal. These can include tendinitis, bursitis, and tendinopathies.

THE SOFT TISSUE HEALING PROCESS

When soft tissue is injured, it goes through three basic stages of wound healing: inflammation, proliferation, and maturation.

ACUTE: Hemostasis and Inflammatory Phase

Following injury, hemostasis takes place to seal off the bleeding through the formation of a clot via blood vessel constriction. Once hemostasis is achieved, these blood vessels dilate to enhance circulation and allow the flow of oxygen-rich blood, nutrients, white blood cells, antibodies, enzymes, and other beneficial elements to promote good healing and prevent infection. This phase is manifested by the presence of inflammation, characterized by swelling, redness, and warmth at the injured site, and usually lasts up to 72 hours.

SUBACUTE: Proliferative Phase: Regeneration and Repair

In the second stage, the injured site begins to be rebuilt with new tissues. New capillaries or small blood vessels are formed via a process called angiogenesis to bring in a sufficient supply of nutrients and oxygen. Fibroblasts begin to synthesize collagen tissue in random and disorganized orientation.  As the process continues, the number of fibroblasts decreases as more collagen is laid down.  This phase lasts from 48 hours up to 6 weeks.

CHRONIC: Remodeling and Maturation Phase

The remodeling stage involves a process of reorganization, degradation, and re-synthesis of the extracellular matrix or the structural support in an attempt to create a tight, strong scar, recover the normal tissue structure and increase the functional strength of the soft tissues. The granulation tissue is gradually remodeled, forming scar tissue that fills up the gaps formed by the ruptured ends. This phase is also marked by the resolution of the initial inflammation and lasts from 3 weeks to 12 months.

TREATMENT OF SOFT TISSUE INJURIES

The initial 48 – 72 hours post-injury of a soft tissue injury is the acute phase. When acute soft-tissue injuries occur, the initial treatment with the PRICE Protocol is usually very effective and provides immediate relief or reduction in the severity of the signs and symptoms, especially pain and inflammation.

• PROTECTION - An assistive device such as crutches may be advised to avoid weight‑bearing of the injured leg. This can also be accomplished through the use of taping and braces.
• REST - Avoiding the activity that caused the injury protects the injured part from being aggravated while allowing early repair and healing.
• ICE - Use of cold compress for 15 to 20 minutes at a time several times per day for the first 48 through to 72 hours following injury reduces pain and inflammation. Do not apply ice directly to the skin as this can cause an ice burn.
• COMPRESSION - An elastic compression bandage limits further swelling and blood loss, as well as movement to prevent further damage.
• ELEVATION - Elevating the injured limb above the level of your heart while resting can further alleviate the swelling.

Although the PRICE Protocol  would be a wise remedy early in the injury, it is advised to begin gentle movements in the pain-free range of motion as soon as possible. This is to encourage blood and lymph flow to the area, supplying the site with beneficial elements for repair and clearing it of waste products while also preventing the muscles and other tissues from becoming weak and stiff from disuse.

• For more information regarding the importance of movement in injury rehabilitation, check here.

Whenever appropriate, overuse injuries are likewise treated with the PRICE Protocol  to address the acute symptoms or chronic inflammation. However, the two most crucial parts in the management of overuse injuries are the identification of the cause and implementation of corrective treatments. Overuse injuries in the early stages can be treated with:

• REST BREAKS - Never play through the pain. Taking a time off from the sport or activity that’s causing the problem will help your body heal itself and prevent aggravation. You may cut back the training intensity, duration, and frequency, but this requires consultation with a professional for appropriate advice.
• COLD AND HEAT TREATMENTS - Depending on the type of injury or presence of acute inflammation, these modalities can relieve pain and swelling. In overuse injuries, ice is typically advised following exercises to reduce post-training soreness, while heat therapies are applied during rehabilitation.
• PHYSICAL THERAPY - Appropriate rehabilitation protocols provided by a physical therapist can address specific issues, such as weakness and inflexibility.
• ANTI-INFLAMMATORY MEDICATIONS - Anti-inflammatories help relieve pain and control inflammation and allow an early healing process.

Long-term solutions to overuse injuries require corrective strategies of the causative factors, such as training and technique errors.

• Learning the proper training, form, and technique from a professional.
• Observing an appropriate and timely training progression.
• Engagement in cross-training activities.
• Ensuring a balance in flexibility, strength, and cardiovascular training.
• Adopting efficient rest and recovery periods.
• Use of properly fitted and corrective equipment (e.g. use of shoe inserts to correct biomechanical issues)

ADDITIONAL TIPS: Overuse injuries can be prevented with few simple steps to follow:

• Don’t skip on your warm-ups and cooldowns.
• Increase training intensity at a rate of no more than 10 percent a week.
• Allow yourself adequate time to recover.
• Participate in cross-training.

 RECOVAPRO THROUGH THE STAGES OF HEALING AND RECOVERY

Learn how Recovapro can help you through the stages of healing, so you can recover faster and get back to doing what you love sooner!