Managing Soft Tissue Injuries

One of the most prevalent complaints reported by patients in everyday physiotherapy practice are soft tissue injuries. Whether the injury is of acute or chronic onset, resulted from a sedentary life style or forceful excursion during a sport, it still constitutes a financial and psychological burden on patients.

There are many reasons to sustain a soft tissue injury. For example, a failure to properly warm up and cool down, before and after a game in sport might lead to leg injures like ankle sprains and groin strains. Also, a sedentary life style combined with repetitive movements even of small loads, can cause tissue damage when tissues aren’t allowed enough time for the healing process to take place, like the case with carpenters who suffer from pain at the outer side of the elbow which is called tennis elbow. Moreover, a recurrence of an injury could be the result of inappropriate or incomplete treatment of the previous episode of the injury.

There are more to sustaining soft tissue injuries than a tough tackle down during football or getting involved with a domestic task at home. For instance, the presence of low back pain that is chronic and for more than three months, is an indication of poorer control from your brain over how you move and a sign of possible core muscles weakness. This weakness can lead to injuries in your upper and lower limbs because of inability to stabilize your trunk against the different loads sustained by the body during activity. This loss of stability with diminished central control might lead to loss of balance and increase the risk of falls. Also, loss of the normal degree of flexibility of the soft tissues surrounding the joints, stresses the joints in a constant manner beyond the its normal ability to cope with loads which lead to injuries like meniscal tears of the knees or bursitis of the shoulders.

Failure to address all these issues together would lead eventually to failure of treatment and increase the possibility of recurrence. It is evident from research that a proper management of soft tissue injuries is ranging from dealing directly with the injury with different therapeutic modalities, to introducing beneficial modifications to daily activates and training routines. This raises the question of what is considered as a proper management plan for soft tissue injuries?

After sustaining an acute injury during playing, for example like twisting the ankle while falling, if you can bear your weight immediately at the scene and walk for four consecutive steps, there is no need to go to the A&E if the pain is tolerable and the swelling if present, isn’t massive. A PRICE program consists of (protection, rest, ice, compression and elevation) for the first forty-eight hours is a good start to treating the injury and taking pain killers if needed. If the pain and swelling don’t improve, a visit to the GP is a must. In the case of increasing pain, for example at the shoulder when doing over the head activities or the elbow when playing tennis or lifting heavy objects, a visit to your physiotherapist can reveal a lot about why and how the pain is present and what are the best ways to tackle it down.

Therapeutic exercises are proven to have a healing effect on soft tissue injuries. This is done by exposing the damaged soft tissues to controlled stresses. This is then increased regularly to stimulate the natural healing responses of the body. Nevertheless, exercising is like any other drug, if not prescribed properly, would be a cause for more damage. Thus, the need for guidance from an experienced physiotherapy to design and supervise your treatment is a prerequisite for a successful management. These exercises range from applying stretching to the injured muscle to stimulate the growth of new fibres, to strengthening exercises that can increase the strength of the newly formed tissue.

Another strong modality, especially with acute cases is therapeutic ultrasound, which has a dual effect on accelerating tissue healing by increasing its oxygenation and as a pain killer. The proper intensity of the ultrasound is determined by the physiotherapist considering the status of the injury and the desired goal. A good enhancement of the previous proposed steps is the adding of balance and stability exercises to the program to improve the performance and prevent recurrence of the complaint. Reduction in pain and swelling should be treated cautiously as an indication of resolution of the problem, as the pain might subside, but other factors might persist. A thorough reassessment of the whole body to make sure that there is no residual joint or muscle stiffness or a faulty pattern of movement, that might cause the problem to recur within a few months. Also, in addition to all these treatments especially for athletes, is a program of cardiovascular rehabilitation to enhance the whole-body performance and optimize the skills of athletes.

Interestingly, with cases experiencing recurrent incidences of their complaints, like people who complain from pain at the medial side of their knees or repeated strains of their cruciate ligaments. These people will benefit from approaches that consider the whole chain of movement that the knee is part of, as in this example the faulty segment could be the inner aspect of the foot. Failure to incorporate the ankle and foot in the treatment could lead to more recurrence and episodes of disability.

To sum it up, a comprehensive treatment that consists of stretching and strengthening exercises, balance, stability and proper guidance is a must for proper management of soft tissue injuries.