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Therapeutic Exercise andTechniques-II

Soft Tissue Injury, Repair, and Management

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Strain

Overstretching, overexertion, overuse ofsoft tissue. Tends to be less severe than a

sprain. Occurs from slight trauma orunaccustomed repeated trauma of a minordegree.

This term is frequently used to referspecifically to some degree of disruption ofthe musculotendinous unit.

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Sprain

Severe stress, stretch, or tear of softtissues, such as joint capsule, ligament,tendon, or muscle.

This term is frequently used to referspecifically to injury of a ligament and isgraded as

1. first- (mild),2. second- (moderate),

3. third- (severe) degree sprain.

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Dislocation

Displacement of a part, usually the bonypartners in a joint resulting in loss of theanatomical relationship and leading to softtissue damage, inflammation, pain, andmuscle spasm.

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Subluxation: An incomplete or partialdislocation of the bony partners in a joint

that often involves secondary trauma tosurrounding soft tissue.

Muscle/tendon rupture or tear: If arupture or tear is partial, pain isexperienced in the region of the breachwhen the muscle is stretched or when itcontracts against resistance. If a rupture or

tear is complete, the muscle does not pullagainst the injury, so stretching orcontraction of the muscle does not causepain.

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Tendinous lesions/tendinopathy:Tenosynovitis is inflammation of the synovialmembrane covering a tendon. Tendinitis is

inflammation of a tendon; there may beresulting scarring or calcium deposits.Tenovaginitis is inflammation with thickening of

a tendon sheath.Tendinosis is degeneration ofthe tendon due to repetitive microtrauma.

Synovitis: Inflammation of a synovial

membrane; an excess of normal synovial fluidin a joint or tendon sheath caused by trauma ordisease.

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Hemarthrosis: Bleeding into a joint, usually due to

severe trauma.

Ganglion: Ballooning of the wall of a joint capsule or

tendon sheath. Ganglia may arise after trauma, andthey sometimes occur with rheumatoid arthritis.

Bursitis: Inflammation of a bursa. Contusion: Bruisingfrom a direct blow, resulting in capillary rupture,bleeding, edema, and an inflammatory response.

Overuse syndromes, cumulative trauma disorders,

repetitive strain injury: Repeated, submaximal over-

load and/or frictional wear to a muscle or tendonresulting in inflammation and pain.

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Clinical Conditions Resultingfrom Trauma or Pathology

Dysfunction

Joint dysfunction

Contracture Adhesions

Reflex muscle guarding

Intrinsic muscle spasm Myofascial compartment syndromes

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Severity of Tissue Injury

Grade 1 (first-degree). Mild pain at the time of injury orwithin the first 24 hours. Mild swelling, local tenderness, andpain occur when the tissue is stressed.

Grade 2 (second-degree). Moderate pain that requiresstopping the activity. Stress and palpation of the tissuegreatly increase the pain. When the injury is to ligaments,some of the fibers are torn, resulting in some increased jointmobility.

Grade 3 (third-degree). Near-complete or complete tear oravulsion of the tissue (tendon or ligament) with severe pain.Stress to the tissue is usually painless; palpation may revealthe defect. A torn ligament results in instability of the joint.

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MANAGEMENT DURING

THE ACUTE STAGEProtection Phase

2-4 days

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Impairments

Inflammation, pain, edema, muscle spasm

Impaired movement Joint effusion (if the joint is injured or if

there is arthritis)

Decreased use of associated areas

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PT Management

Educate the patient

Protection of the Injured Tissue

Prevention of Adverse Effects of Immobility

Tissue-specific movement

Control pain, edema, spasm

Maintain soft tissue and joint integrity andmobility.

Reduce joint swelling if symptoms are present.

Maintain integrity and function of associatedareas

Precautions and contra indications

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MANAGEMENT DURINGTHE SUBACUTE STAGEControl Movement Phase

10 to 17 days

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Impairments

Pain when end of available ROM is reached

Decreasing soft tissue edema

Decreasing joint effusion (if joints are involved)

Developing soft tissue, muscle, and/or jointcontractures

Developing muscle weakness from reduced

usage Decreased functional use of the part and

associated areas

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PT Management

Educate the patient

Promote healing of injured tissues.

Restore soft tissue, muscle, and/or jointmobility.

Develop neuromuscular control, muscleendurance, and strength in involved and

related muscles. Maintain integrity and function of

associated areas.

Precautions

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MANAGEMENT DURIN

THE CHRONIC STAGEReturn to Function Phase

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Impairments

Soft tissue and/or joint contractures andadhesions that limit normal ROM or joint play

Decreased muscle performance: weakness,poor endurance, poor neuromuscular control

Decreased functional usage of the involved part

Inability to function normally in an expectedactivity

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PT Management

Educate the patient.

Increase soft tissue, muscle and/or jointmobility.

Improve neuromuscular control, strength,muscle endurance.

Improve cardiovascular endurance. Progress functional activities.

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Signs of Excessive Stress withExercise or Activities

Exercise or activity soreness that does notdecrease after hours and is not resolved after 24hours

Exercise or activity pain that comes on earlier or

is increased over the previous session Progressively increased feelings of stiffness and

decreased ROM over several exercise sessions Swelling, redness, and warmth in the healing

tissue Progressive weakness over several exercise

sessions Decreased functional usage of the involved part