Soft Tissue Injuries

Soft tissue is the term used to describe tissues in the body that are not hard or calcified such as bones and teeth. Soft tissues are muscles, tendons, ligaments, fascia, blood vessels, nerves, fat, fibrous tissues, lymph, skin, and synovial membranes. Therefore, a soft tissue injury can be an injury to any of the structures mentioned.

Functions of Soft Tissue

Soft tissue is broad term used to encompass different tissue types that have different structures, make up and also functions. To simplify we will list a few of the functions with each type of soft tissue.

Muscles

There are 3 types of muscles in the body: smooth, cardiac and skeletal. Smooth and cardiac muscle are involuntary and contract without our control or active participation. Smooth muscle is found in organs such as our stomach and intestines, while cardiac muscle is found in our heart and blood vessels. The function of these muscles is to move substances such as blood and digestive products in the different organs they are found in.

Skeletal muscle is the type we are most familiar with. This type of muscle attaches to bones and in some cases, to the skin. Skeletal muscles play a major role in our structure, shape, support and movement.

Fibrous Tissue

This type of tissue is one of the most common in the body and is mainly made of collagen. It surrounds and connects different tissues, organs, and structures within the body, and helps with movement. Each subgroup of fibrous tissue has slightly different types and compositions of collagen, depending on its role in the body. Examples of these are: fascia, tendons (attach muscle to bone) and ligaments (attach bone to bone).

Nerve Tissue

Nerve tissue is made up mainly of neurons (or nerve cells), and neuroglial cells.  These tissues make up our nervous system: the Central Nervous System (brain and spinal cord) and Peripheral Nervous System (system outside the brain and spinal cord). The main functions are to send and carry signals between the brain and the different parts of the body. This allows us to control movements and regulate different systems that keep us alive and moving.

Synovial Tissue

Synovial tissue is a thin connective tissue that makes up the membranes that surround certain joints (shoulder, knees, etc.). It also envelops tendons as they pass over bony prominences to prevent a point of friction, and form fluid-filled sacs called bursa. Bursa serve as a cushion between bones, tendons and skin at certain pressure points, especially around joints. Synovial tissue also produces synovial fluid, which is a lubricant that decreases friction between structures it covers.

Skin

Skin is our biggest organ and covers almost all of our body. It is made up of different cells and servers to protect us from elements, insects and different external forces. The skin also plays a role in sensation and regulation of different systems such as temperature.

Fat

Fat tissues are made of fat cells called adipocytes that are found in different parts of the body such as under the skin. It is also found in our abdominal cavity where it is around our organs to protect and cushion them. The main function of fat is to protect and cushion organs, assists in temperature control and store energy for future use.

Blood Vessels

These are tubular structures such as veins, arteries and capillaries that serve to carry blood, nutrients, blood gases, hormones and waste substances between the necessary structures/organs.

Lymph vessels

These are also tubular structures that are similar to blood vessels and work very closely with our vascular system. They carry lymph fluid, waste products, germs and damaged cells. Their main function is in immunity, carrying infection-fighting cells, as well as clearing away remnants of defunct or dead cells and some germs from injury sites to facilitate the healing process.

Soft tissue injuries

As the name suggests, these are injuries that occur in one or more of the soft tissues mentioned above. There are different mechanisms of injuries that can occur so for the purpose of staying relevant, we will discuss soft tissue injuries that are related to physiotherapy and conditions we commonly see at our practice. We have excluded other conditions that are managed by other healthcare professions, as well as some more complex injuries for this reason too. Common injuries we see and treat include:

• Bruises and contusions
• Sprains
• Strains
• Tendon injuries (tendonitis, tendinosis and tendinopathy)
• Bursitis and synovitis
• Fascial injuries (Fascitiis, myofascial pain syndrome)

Causes

• Trauma such as falls and accidents
• Overuse
• Premature return to sport or training from previous injury or illness
• Poor mechanics or training methods used
• Some medical interventions and medicine may increase the risk of injuries
• Poor diet
• Women may be more susceptible to certain injuries at some stages of their monthly cycle

Prevention

• Correct treatment of previous injuries
• Correct training methods, including correct posture, mechanics, warming up before exercising and regular stretching
• Optimal cardiovascular fitness for training level
• Good exercise mechanics
• Appropriate training load according to need and training seasons
• Good recovery
• Appropriate training equipment

Stages of Soft Tissue healing

Soft tissue healing stages are similar to the bone healing stages. They do not always go in a linear fashion, but may overlap and sometimes regress within the process, and it is normal.

Bleeding Phase

This is the first stage immediate from injury when blood vessels have been ruptured. In this stage blood and different proteins and cells are mobilized to the area. Platelets will also be mobilized and a plug may begin to form in this phase.

Goal of treatment: Stop bleeding.

Time frame: Immediately after injury to a few hours

Inflammation Phase

In this phase different immune system cells as well as nutrients and growth factors are mobilized to the area. The debris from the injured tissue and damaged cells are removed. Clotting also begins in this stage.

Goal of treatment:  Decrease pain and inflammation.

Time frame: 6 hours to 1 week

Proliferation/Repair phase

The materials mobilized in the previous phase are synthesized to build new tissue in the injured site. Different kinds of tissue begin to form, including new blood vessels where needed. The wound size or gap starts decreasing but the tissues are still unorganized.

*PS. Certain drugs or treatments such as radiotherapy may delay this part of healing.

Goals of treatment: preventing atrophy (muscle wasting), increasing pain-free range of motion (ROM)

Time frame: 24hours to a few weeks

Remodeling Phase

This is the final stage of healing where the wound tissue becomes organized, meaning that it starts looking more and more like the tissue of its pre-injury state. The scar also starts functioning normally, without any hindrances.

Goal of treatment: stretching to increase ROM and strengthening. It is key to monitor this phase to avoid re-injury.

Time frame: 1 week to 6 months. (In some tissue healing make take more than a year)

When dealing with soft tissue it is important to note that some injuries can become chronic, where a stage of healing has failed, causing the injury to persist. This could be due to the following:

• Poor management
• The body’s failure to heal the wound effectively
• Poor access to necessary materials and nutrients to restore the injury completely
• Repetitive re-injury.

We advise our patients to get the correct treatment, follow the medical advice provided and pay attention to your body when dealing with the different soft injuries. We are always here to guide you throughout this process.