This page gives a general overview of soft tissue injuries and their management. For more information about specific injuries, check the common conditions index to see whether we have completed a page for that injury.

Definitions.

A sprain refers to a joint injury in which the ligaments and capsule around the joint are torn to some degree. A strain is a muscle or tendon injury in which fibres are torn. A contusion, also commonly referred to as a "corky" refers to the bleeding within a muscle, often caused by a direct blow to the muscle.

Classification of injury.

Injuries to soft tissues can be classified as acute or overuse (or chronic). An acute injury is one which happens suddenly, often as a result of some specific incident, and which results in immediate signs and syptoms of injury. A common example of an acute injury is an ankle sprain in which the ankle "rolls", maybe as a result of unstable terrain. Acute injuries can be further classified as resulting from either intrinsic or extrinsic forces. A hamstring strain for example, where contraction of the muscle combined with overstretch has an intrinsic mechanism, whereas a "corked thigh" (quadriceps contusion) in a footballer may result from an external force of another players knee and thus have an extrinsic mechanism.

An overuse injury tends to be one which develops over a period of time, sometimes for no blatantly obvious reason, but gets worse with activity and time. A common example of an overuse injury is lateral epicondylitis ("tennis elbow"). Some factors which may contribute to overuse injuries are overtraining, improper technique, or biomechanical abnormalities. An injury may be classified as chronic if it is an old injury which keeps recurring because of incomplete healing.

Mechanism of Injury.

Damage to tissues occurs when forces are placed on them which stress the tissues beyond their breaking point. Most soft tissues have a certain amount of elasticity, but stretching them too far will result in damage to the fibres of the tissue. As mentioned above, these forces may have intrinsic, extrinsic, biomechanical or other origins.

Grades of Injury.

Injuries to muscle or ligament can generally be graded according to the extent of the damage which has occurred. With a grade 1 injury, a small number of fibres may be damaged, resulting in some pain and swelling, but loss of strength, function or stability may be minimal. A grade 2 injury involves more fibres, there may be moderate pain, swelling, and loss of function, strength or stability. A grade 3 injury refers to the complete rupture of the tissue, and may result in considerable instability of a joint or a gap in the muscle fibres. Surgery is often required to repair the tissue.

Response to injury.

Damage to a tissue results in bleeding, swelling, pain and loss of function, known as the inflammatory phase. Inflammation is the body's natural initial response to injury, and helps alert the individual that injury has occurred and that the part should be protected to avoid further damage. Inflammation however causes pain and can inhibit the healing process, so procedures should be carried out to help minimise it as much as possible.

The inflammatory phase lasts from the time of injury to 48-72 hours. The healing process then starts to repair the tissues; the repair phase. This can last for up to six weeks and involves the laying down of new tissue, and removal of the damaged tissue. Following the repair phase, a remodelling and maturation phase occurs which can continue for up to 12 months.

Physiotherapy management of soft tissue injuries.

Physiotherapy facilitates the body's healing process and helps ensure a speedy recovery and return to activity.
Initial management of soft tissue injuries aims at reducing inflammation and further injury. For more information see the first aid section for soft tissue injuries.

Physiotherapy management during the healing stages is focussed on helping to regain normal function while the body does its job. Electrotherapy and manual techniques can help with pain, swelling, and stimulation of healing, while exercise programs tailored to the specific injury will help regain strength and flexibility, and reduce the amount of stiffness, scar tissue and risk of recurrence.

For more information about physiotherapy for different injuries, see the common conditions index.