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What does the proper treatment of soft tissue injury depend on?
- identifying the structure involved
- recognizing the stage of recovery
- determining the functional limitations or disabilities
What is overstretching, overexertion, or overuse of soft tissue to a muscle?
What is severe stress, stretch, or tear of soft tissue, such as a ligament?
What is a subluxation?
incomplete or partial dislocation
What is a displacement of a part?
What is a partial muscle/tendon rupture or tear?
pain where torn when stretched or contracts against resistance
What type of muscle/tendon rupture or tear occurs when the muscle doesnt pull?
What is an inflammation of a synovial membrane covering a tendon?
What is the inflammation of a tendon?
What is an inflammation with thickening of the tendon sheath?
What is the degeneration of a tendon from repetitive microtrauma?
What is synovitis?
inflammation of synovial membrane
What is hemarthrosis?
bleeding into a joint
What is a ganglion?
ballooning of the wall of a joint capsule or tendon sheath
What is a bursitis?
inflammation of a bursa
What is a contusion?
bruising from a direct blow (bleeding, edema, inflammatory response)
What is a repeated, submaximal overload or frictional wear to a muscle or tendon resulting in inflammation and pain?
overuse syndromes, cumulative trauma disorders, repetitive injury
What are some clinical manifestations of trauma?
- jt dysfunction
- reflex muscle guarding
- intrinsic muscle spasm
- muscle weakness
What occurs with a first degree soft tissue injury?
mild pain at time of injury or within 24 hours
What occurs with a second degree soft tissue injury?
moderate pain- must stop activity
What occurs with a third grade soft tissue injury?
super nasty, complete or near complete tear or evulsion
During the acute stage, what types of inflammation and repair occur?
- vasular changes predominate
- clot formation
- phagocytosis, early fibroblastic activity, formation of new capillary beds
- 4-6 ish days
SIGNS- swelling, redness, heat, pain, loss of function, muscle guarding
During the subacute (repair and healing stage), what types of inflammation and repair occur?
- 14-21 ish days after injury (may last up to 6 weeks)
- synthesis and deposition of collagen
- fibroblast until 21st ish day
- wound closure in muscle and skin takes 5-8 days
- wound closure in tendon and ligaments take 3-5 weeks
SIGNS- signs of inflammation gradually decrease, but may still have some pain
How long does it take wounds to close in the muscle and skin?
How long does it take wounds to close int he tendons and ligaments?
During the chronic (maturation and remodeling stage), what types of inflammation and repair occur?
- 6months to 1 year possibly
- after the subacute stage. but before pt has gained full function
- long standing condition with recurring episodes of pain from chronic inflammation or dysfunctions resulting from the healing process
- maturation of connective tissue
- can remodel the new tissue up to 8-10 weeks
- at 14 weeks cannot remodel new tissue
SIGNS- no signs of inflammation
How long can new tissure be remodeled?
cant remodel after 14 weeks
If you continue with excessive stresses and irritants and the inflammatory response continues, what is it called?
repetitive motion people
What are some signs of chronic inflammation/pain?
increased pain, swelling, muscle guarding that lasts more than several hours after activity, increased stiffness after rest, loss of ROM 24 hours after activity, progressive increased stiffness of the tissue
During the protective phase of treatment, what is the LTG?
formation of a strong, mobile scar
initially fibril formation is random
What is the jt/ligament pathology treatment during the acute stage?
- PROM within limit of pain
- gentle passive jt traction or glides within limits of pain
- grade 1 or 2 distractions
- gentle glides massage
- muscle setting
What is the muscle pathology treatment during the acute stage?
- m. setting with m. relaxed/shortened
- ES with m. shortened
- massage transverse to injured fibers
- passive jt-play mvmts (1 or 2)
During the acute stage of treatment, what do you do for a tendinous lesion?
- gentle massage with tendon taut
- PROM and jt-play mvmts (1 or 2)
During the acute treatment stage, what is the precaution?
if increased pain or inflammation, your doing too much mvmt
How do you know if you can move from the protective phase of treatment to the repair and healing stage?
if pt has decreased swelling, pain is no longer constant and pain is not increased by motion in available range
What are some types of exers that can be used during the repair and healing stage of treatment?
- active exers withing pain free range
- multiple angle, submaximal isometric exers (in shortened/relaxed position)- if jt pathology, comfortable position for isometrics
- AROM in pain free ranges (1st isolated, single plane motions)
- protected closed chain exers
- DO NOT use eccentrics if muscle injury
During the subacute phase of treatment, what are some jt/lig treatments?
- passive jt play within limits of pain
- if limited range and decreased jt play with no effusion-stretch capsule (2)
- increased intensity cross-fiber or soft tissue massage
What are some muscle treatments during the subacute healing stage?
- gentle contract-relax or ES
- progress intensity cross fiber massage (shortened)
- 2 and 3 glides
For the tendon and tendon sheath, what treatments would you do during the subacute stage?
- increased intensity cross-fiber massage
- grade 2 and 3 traction or glides
What is another name for the acute treatment stage?
protective phase of treatment
What is another name for the subacute treatment stage?
repair and healing stage
How do you know if your doing too much activity or motion during the subacute treatment stage?
- resting pain
- increased weakness or spasm
What is another name for the chronic stage of treatment?
- return to function phase
- maturation and remodeling stage
What do you need to progress to the chronic stage of treatment?
free jt play within a useful ROM to avoid jt trauma
What are some treatments used for the chronic stage of healing?
- if loss of jt play- use multiangle isometrics to increase strength
- if have jt play- resistive isotonic exers
- mobilize any adhesions
- healing will increase tensile quality of injured tissue will continue for 12-18 months(depends)
- exers from simple to multidirectional, complex
- strengthening-open and closed eccentric and concentric
- controlled stabilization progression
- safe mechanics taught and practiced
- muscular and cardiovascular endurance
- if needed-plyos, agility training and skill development
What are some signs your doing too much during the chronic stage of healing?
- jt swelling
- pain longer than 4 hours or requires meds
- decrease in strength
- fatiguing more easily
no signs of inflammation, discomfort shouldnt last more than a couple hours
What are some causes of chronic recurring pain-chronic inflammation?
- overuse syndrome, cumualtive trauma disorders, repetitive strain injury
- trauma-repetitive injury
- reinjury of old scar
- contractures or poor mobility (modalities and rest, biomechanical counseling-body mechanics)
What should you do for chronic recuring pain-chronic inflammation injuries?
- control inflammation (modalities and rest)
- identify and modify the reason for the chronic irritation and teach pt with biomechanical counseling
- exercise at nonstressful intensities
when pain from chronic inflammation decreases, progress thru exers program with controlled stresses
*if progressive loss of ROM with stretching, stop the stretching