SOFT_TISSUE_INJURY_powerpoint_presentation
- 2. What is Soft Tissue? • Skin • Ligaments – connects bones at joints • Tendons – attaches muscle to bone • Fascia – dense connective tissue • Skeletal Muscle – usually attached to bone and moves parts of the skeleton • So, tissue that has not hardened into bone and cartilage
- 3. What are the Type of Injuries? • Sprain ligaments are commonly caused by indirect impact, over- stretching (twisting) • Muscle strains – pulling action, over stretching, rupture or direct trauma / overuse. Includes tendons • Contusions (bruise) – direct blow • Intramuscular hematoma is confined to the muscle compartment which fills up with blood. Is more painful and restrictive of ROM • Intermuscular hematoma is when the blood escapes through the fascia and so becomes distributed, thus bruising will be
- 5. Sliding- Filament Theory • Muscle cell ‘fibre’ includes myofibrils which consist of 2 types of protein called thick and thin filaments • Thick filaments are formed with myosin protein, while thin filaments with actin protein. Both form the main contractile elements of muscle and as a unit is called a sacromere • The length of sacromere is determined by the sliding nature of the thick and thin filaments which
- 6. Muscle • Arranged to correlate with the power needed • Grouped in orientation of their fibres – parallel / oblique or pinnate / spiral • The agonist or prime mover (muscle) brings about movement • At the same time the antagonist relaxes
- 7. Soft Tissue Healing from Injury • Repairing damaged tissue • Replaced by granulation tissue, which matures to form scar type tissue • Phases overlap • Bleeding / inflammatory / proliferation / remodelling phases
- 8. Bleeding Phase • Bleeding time to stop will vary with the nature of both the injury and tissue • Short lived 6 – 8 hours (acute stage) • Reduces up to 24hrs • Muscles will bleed longer than other structures i.e. ligaments
- 9. Inflammatory Phase • Essential component of tissue repair • Rapid onset - first few hours • Quickly increases to maximum 2 – 3 days • Gradually resolves over next few weeks • Largely beneficial • Is accompanied by debris removal and repair of damaged tissue • Over response can cause problems
- 10. Proliferation Phase • Generation of the repair material • Production of scar tissue (collagen material), needs to be laid down in an orientated way • Rapid onset 24 – 48 hours • Peaks 2 – 3 weeks / bulk scar tissue • Final products several months • Repair tissue is different. Fibres shorter, inelastic and different elasticity, increases risk of recurrence of rupture
- 11. Remodelling Phase • Greatly overlooked phase • Results in organised / functional scar tissue • Starts as early as 2 weeks • Continues for months to a year • With maturity, the collagen becomes more orientated in line with local stress
- 12. Proliferation / Remodelling Phase –Important in Successful Healing • Collagen fibres need to be orientated to provide tensile strength in the right direction • Using normal stresses via movement, collagen can be laid down this way • If not, collagen fibres are laid in haphazard and thus weakened pattern is caused • With maturity, the collagen becomes even more orientated in line with stress
- 13. What Does This Mean for Treatment ? • Excessive bleeding should be discouraged • Inflammation is normal and essential, though when acute and continues, can cause problems. A question re- NSAID’S use (See next slide) • Early gradual mobilisation (active rest) orientates scar tissue in the line of stress, similar to normal tissue plus early movement helps breaks down adhesions • Unhelpful adhesions / scar tissue will need direct intervention – Sports massage techniques • Remodelling is helped by gradual return to full physical stress - rehabilitation
- 14. NSAID’s as pain relief for STI • As inflammation process is important can NSAIS’s delay overall recovery? • Inhibit COX enzymes and production of inflammatory prostaglandins (these introduce inflammatory cells to the area) • Thus reduces pain, swelling , oedema which can cause anoxia / cell damage • Inhibit COX can alter thromboxane and platelets and so increase bleeding / swelling at site.
- 15. NSAID’s as pain relief for STI • Tendon injuries in those over 40 are usually due to tendonosis in nature rather than inflammation • Research are inconclusive and involves use in animals rather than human trials • Guidance – use NSAID’s for treating chronic inflammation and acute like bursitis and confirmed tendonitis • Use paracetamol for pain relief (though use of single NSAID doses won’t have any effect)
- 16. Overuse Syndrome / Sports • Muscular system develops to the way it is used • Individuals have unique pattern of imbalances • Bundles of muscle fibres react fractionally in a different way, causing small areas to be under slightly greater pressure than surrounding areas • A few fibres are damaged at microscopic level • Causes secondary muscle tension to the surrounding tissue
- 17. • Same as normal tissue response of bleeding / inflammation and formation of scar tissue, yet at a microscopic level • Secondary muscle micro-tension may cause soreness but no real pain and activity continues as inflammatory response is small • Moderate activity is helpful at this stage yet further continuous stress prevents recovery • Adjacent fibres work harder due to micro tissue damage, which is less contractual and stretchy • More micro trauma / scar tissue occurs so less elasticity and the circle continues Overuse Syndrome
- 18. Overuse Syndrome You are full into overuse syndrome • As small parts of muscle deteriorate, imbalance in the muscle and the group occurs • 1 muscle problem then effects different muscle systems. May still be unnoticed ! • Tendon tension increases and may tear (acute) • Biomechanical faults develop, causing more problems elsewhere in the musculoskeletal system
- 19. How to Treat / Stop Overuse Syndrome • Effective and efficient training, includes correct biomechanics. Be prepared to adapt • Have rest days (please), vary training • Use soft tissue massage (STM) techniques to identify and treat problems before any symptoms are recognised • STM to intervene in soft tissue problem i.e. adhesions / scar tissue FIND THE CAUSE
- 20. Soft Tissue Injury Approach • Facilitate / promote normal tissue repair • Immobilization and early mobilization • Enhance sequence of events • Promote normality • Appropriate therapy to influence the process in a positive way • Intervene if needed i.e. adhesions / infection / overuse syndrome