Soft Tissue Injuries Rehabilitation

1. PHYSIOTHERAPY MANAGEMENT IN
GENERAL SOFT TISSUE
INJURIES
Dr. Chhavi Singh
Asst. Prof./Vice – Principal
Nims College of Physiotherapy &
OccupationalTherapy
Nims University

2. Introduction –
Injuries to muscles, ligaments and tendons
Epidemiology - Very common as sports injuries
Common as injuries of RTA, domestic and work-
site accidents
Terminology to Remember-
Ankle sprains - often injure ligaments
Back strains - strain of muscles
Rotator- Cuff tears – tendon or muscle rupture
Deep bruises – haematoma formation

3. Injury classification –
•On Basis of Severity-
1st Degree, Grade 1 or mild injury
2nd Degree, Grade 2 or moderate injury
3rd Degree, Grade 3 or severe injury
•On Basis of Onset –
Acute Injuries and Overuse Injuries
Acute injuries occur suddenly
Overuse injuries occur gradually

4. Clinical Features –
1st Degree, Grade 1 or mild injury
• Microscopic structural damage
• Slight local tenderness
2nd Degree, Grade 2 or moderate injury
• Partial rupture of tissue
•Visible swelling
• Notable tenderness
• Do not affect joint stability

5. 3rd Degree, Grade 3 or severe injury
• Complete rupture of tissue
• Significant swelling
• Significant instability

11. Diagnosis – Clinical Signs and Symptoms
Ligament Injuries –
• Brusing, swelling tenderness
• Pain on movement or loading, pain on palpation
• Instability ± depending on the severity
• MRI scan for confirmation of injury type
Muscle andTendon Injuries-
• Muscles and tendons function together
• Injury may affect the muscle’s - origin, belly ,muscle –
tendon junction, tendon ,tendon-periosteum junction ( A
common injury in sports )

12. Types of Muscle Injuries –
1.Strains
2.Contusions

13. 1.Strains (1st , 2nd or 3rd degree)
• caused by overstretching or eccentric overload
• often at the muscle – tendon junction
• occur as a result of the intrinsic force generated by
the muscle during the change between eccentric and
concentric traction; either in rapid acceleration or
deceleration actions or combinations of acceleration
and deceleration.

14. Clinical features –
1ST degree strains –
•Minimum strength loss and movement restriction
• Pain around the damaged area on active movement or
passive stretch
• In the case of an athlete it can be as distressing as a
more severe injury
2nd and 3rd degree strains –
•More significant functional loss
•Pain will be aggravated by any attempt to contract the
muscle
• Defects may be palpable
•In 3rd degree the muscle may bunch up resembling a
tumor

15. Diagnosis–
1.Strains
•History suggesting acceleration / deceleration
• Sharp pain felt at the moment of injury
• Pain ↓with rest and ↑ or reproduced by attempted
contraction
•Palpable defects on superficial muscles
• Local tenderness and swelling
• Loss of active movement
• Bruising after 24 hrs with spasm

16. 2.Contusions
• Caused by direct blow on a muscle
•The muscle is pressed against the bone
•The muscle tears; heavy bleeding* deep within
muscle → Muscular haematoma * bleeding directly
proportional to muscle blood flow and inversely
proportional to the tension of the muscle at the time of
injury.

17. Clinical features –
2.Contusions
• Depend upon the size and site of haematoma produced
•When superficial – Same as in strains
• Intramuscular heamatoma – Bleeding is within the
fascia covering the muscle –The intramuscular pressure
builds up and counteract further bleeding – Resultant
swelling lasts > 48hrs, accompanied tenderness, pain,
impaired mobility – Swelling tends to increase due to
osmosis.

18. Clinical Features -
Contusion
• Intermuscular heamatoma – Damage includes facia and
adjacent blood vessels – Bleeding occurring between
muscles – No pressure building up as in intramuscular
type – Bruising and swelling appear distally to damage
area within 24- 48 hrs. – Muscle function returns –
Prognosis is better than intramuscular type SoftTissue
Injury

19. Tendon Injuries
Acute injuries to tendons –
classified according to 1st ,2nd and 3rd degree
• are common in sports; superficial tendons are
susceptible to penetrating trauma
• caused by rapid acceleration / deceleration
•usually occur in connection with eccentric force
generation
•mid-tendon substance, muscle-tendon junction or
avulsion fractures
•Injured tendons may have had a predisposition to injury
due to overuse or disease

20. Tendon Injuries -
•Tendons are most susceptible to overuse injury
•Tendinitis (tendon inflammation)
•Tenosynovitis (tendon sheath inflammation)
•Tenoperiostitis (tendon attachments’ inflammation)

21. Tendon Injuries
Diagnosis –
• History suggesting acute or overuse types
• Clinical examination to evaluate continuity
• US or MRI scans → precise diagnosis of Soft
Tissue Injuries

22. Treatment Principles -
Common to all acute injuries are internal bleeding and
likely acute inflammation.Therefore:
• prevent bleeding and pain as first aid by following
PRICE principle
P - Protection
R - Rest
I – Ice for cooling
C – Compression
E - Elevation

23. Treatment of Ligament Injuries
• PRICE immediate administration and contd. up to 2
– 3 days
•The doctor’s role: – determine the stability –
exclude possible #; establish diagnosis (type of injury)
– if the joint is stable → • early mobilisation
• supportive taping or orthosis
• rehabilitation – if the joint is unstable → decide
whether open reduction necessary;
• protection and rehabilitation

24. Rehabilitation (aim to:) –
• identify any predisposing cause with a view to remove it
•prevent adhesion formation
•strengthen muscles related to the ligament
re-educate proprioception
•restore full mobility of the ligament and corresponding
joint
•restore patient’s confidence – restore full functional
activity

25. Rehabilitation ( for ankle joint)
PRICE ,Taping /splinting ,Static cycle /Theraband
activity for antagonist groups ,Close-kinematic
exercises; wobble board activity while seated
,Gradual increase of loading Wobble board ,switch on
to functional activity,WEEKS 1 2 3 4 5 6 11 12

26. Treatment of Acute Muscle Injury –
• Immediately start PRICE; be strict on P, R and E up to
36 hrs
• No massaging the hurt muscle within 48 -72 hrs.
• Close observation for possible compartment
syndrome – Decreasing swelling and rapid recovery of
function may be expected in intermuscular bleeding –
Persistent or increasing swelling with poor function
suggest intramuscular bleeding
• It is important that the accurate diagnosis is made
within 48 – 72 hrs. premature exercising – ↑bleeding in
intramuscular haematoma situation – ↑bleeding and
scar tissue formation complicating the injury and
delaying recovery

27. After initial acute treatment:
1. Gr 1 and 2 strains, intermuscular haematomas and
minor intramuscular haematomas are treated with
2. • Elastic support bandage • Local application of
heat, contrast treatment with heat and cold
3. • Exercises are started after 2-5 days rest;
progression as follows: – Static without load → with
load →free dynamic → PRE →stretches
→Proprioceptive training → functional / sport
specific training 1. Gr 3 strains and severe
intramuscular haematomas demand surgical
intervention or conservative treatment over a
prolonged period

28. •PRICE as in all other injuries administered initially.
• A wide range of approaches to management
based on tendon damaged, age, the degree of
disability and handicap etc.Theoretically all severed
tendons need to be sutured to restore continuity
and allowed to heal.
• Early (within 2 weeks) mobilisation favours
functional recovery.

29. THANK YOU