The School of Natural Therapies
Training School for Massage & Holistic Therapies
ITEC Sports and Remedial Massage
ITEC Level 3
Submitted by: Khaleem Ash
Soft tissue is all the tissue in the body that is not hardened by the processes of ossification or calcification such as bones and teeth. Soft tissue connects, surrounds, or supports internal organs and bones, and includes muscle, tendons, ligaments.
Fascia is a layer of tissue that is fibrous and surrounds structures such as muscles, blood vessels, and nerves. Soft tissue is found in body joints including knees and ankles.
An injury is damage to your body. Disruption of bony, cartilaginous and soft tissue structures (fractures, tears, sprains, strains) and an abnormality or impairment in the operation of a specified bodily organ or system. It is the mechanical derangement in the absence of injury, altered or impaired function of the body framework (somatic) system (skeletal, arthrodial, myofascial structures.)
Either at the microscopic (single cells or a collection of cells) or macroscopic (muscle, tendon, or ligament fibre) level, tissue is damaged. We call them sprains or strains, or other unseemly terms such as tears, ruptures, or degeneration. On the other hand, a deflated tire is ‘dysfunctional.
Many activities can lead to soft-tissue damage of muscles, ligaments, and tendons. The result can be pain, swelling, bruising, and damage. Soft-tissue injuries are classified as the following: Contusions (bruises), Sprains.
Chronic problems of pain, muscle weakness, restricted range of motion, and misalignment of the skeletal system occur when the muscle repeatedly doesn’t relax completely. However, soft tissue injuries can happen acutely if you twist your ankle or pull a tendon in your groin.
Dysfunctional tissue is non pathological and free from injury or inflammation and is generally demonstrated by aches and pains. While the body generally adapts to the demands placed upon it, repeated stress can cause an imbalance, which can then lead to injury.
Possible causes of tissue dysfunction
• Body composition
• Inactivity
• Lifestyle imbalances
• Repetitive occupational movements
• Occupational stress
• Physically demanding hobbies
• Sleeping position
• Poor posture
• Poor exercise technique
• Adhesions
• Synergistic dominance (muscles overcompensating for a weak muscle)
INJURY: –
Injury happens when the soft tissue is subjected to a force that it can’t absorb, due to impact, trauma or exceeding the normal range of movement.
PRIMARY INJURIES – due to initial trauma
• INTRINSIC – caused by forces within the body such as weak muscles, as a result of an underlying imbalance or overuse of the muscle E.g., a strained hamstring during a 100m sprint.
SECONDARY INJURIES– consequence of a primary injury of ten due to compensatory posture e.g. knee pain due to a previous calf strain.
NON-CONSEQUENTIAL INJURY – not sport related but interfere with sporting ability.
MECHANISM OF INJURY – any action resulting in a stress pattern that damages specific tissues.
SKIN INJURIES
STRAINS – a tear in the muscle or tendon due to excessive overload
SPRAINS – injury of a ligament due to overstretching
TENDINOPATHIES – rupture of a tendon causing inflammation or degeneration of a tendon without inflammation
CAPSULAR LIGAMENT/JOINT CAPSULE DAMAGE – trauma causes accumulation of fibrous tissue and adhesions, leading to loss of movement
The most common soft tissues injured are muscles, tendons, and ligaments. These injuries often occur during sports and exercise activities, but sometimes simple everyday activities can cause an injury.
Sprains, Strains and Other Soft-Tissue Injuries
Sprains, strains, and contusions, as well as tendinitis and bursitis, are common soft-tissue injuries. Even with appropriate treatment, these injuries may require a prolonged amount of time to heal.
Cause
Soft-tissue injuries fall into two basic categories: acute injuries and overuse injuries.
Acute injuries are caused by a sudden trauma, such as a fall, twist, or blow to the body. Examples include sprains, strains, and contusions.
Overuse injuries occur gradually over time when an athletic or other activity is repeated so often that areas of the body do not have enough time to heal between occurrences. Tendinitis and bursitis are common soft-tissue overuse injuries.
Common Acute Soft-Tissue Injuries
Acute soft-tissue injuries vary in type and severity. When an acute injury occurs, initial treatment with the RICE protocol is usually very effective. RICE stands for Rest, Ice, Compression, and Elevation.
Rest. Take a break from the activity that caused the injury. If the injury is to your leg, your doctor may also recommend that you use crutches to avoid bearing weight.
Ice. Use cold packs for 20 minutes at a time, several times a day. Do not apply ice directly to the skin.
Compression. To prevent additional swelling and blood loss, wear an elastic compression bandage.
Elevation. To reduce swelling, elevate the injury higher than your heart while resting.
Sprains
A sprain is a stretch and/or tear of a ligament, a strong band of connective tissue that connects the end of one bone with another. Ligaments stabilize and support the body’s joints. For example, ligaments in the knee connect your thighbone (femur) with your shinbone (tibia), enabling you to walk.
The areas of the body that are most vulnerable to sprains are the ankles, knees, and wrists. A sprained ankle can occur when your foot turns inward, placing extreme tension on the ligaments of your outer ankle. A sprained knee can result from a sudden twist, and a wrist sprain can occur if you fall onto an outstretched hand.
Sprains are classified by severity:
Grade 1 sprain (mild): Slight stretching and some damage to the fibers of the ligament.
Grade 2 sprain (moderate): Partial tearing of the ligament. There is abnormal looseness (laxity) in the joint when it is moved in certain ways.
Grade 3 sprain (severe): Complete tear of the ligament. This may cause significant instability.
While the intensity varies, pain, bruising, swelling, and inflammation are common to all three categories of sprains. Treatment for sprains begins with the RICE protocol and physical therapy. Moderate sprains often require a period of bracing (for example, a CAM walking boot can be worn to help support and immobilize a sprained ankle). The most severe sprains may require surgery to repair torn ligaments.
Strains
A strain is an injury to a muscle and/or tendon. Tendons are fibrous cords of tissue that attach muscles to bone. Strains often occur in the back or leg (typically, the hamstring).
Similar to a sprain, a strain may be a simple stretch of your muscle or tendon, or it may involve a partial or complete tear of the muscle and tendon. Symptoms of a strain may include pain, muscle spasm, muscle weakness, swelling, inflammation, and cramping.
Soccer, football, hockey, boxing, wrestling and other contact sports put athletes at risk for hamstring strains, as do sports that feature quick starts, such as hurdling, long jumping, and running races. Gymnastics, tennis, rowing, golf and other sports that require extensive gripping have a high incidence of hand sprains.
The recommended treatment for a strain is the same as for a sprain: rest, ice, compression and elevation. This should be followed by simple exercises to relieve pain and restore mobility. Surgery may be required for a more severe tear.
Contusions (Bruises)
Contusions occur when a direct blow (or repeated blows) by a blunt object strikes part of the body, crushing underlying muscle fibers and connective tissue without breaking the skin. A contusion can result from falling or jamming the body against a hard surface. Discoloration of the skin is caused by blood pooling around the injury.
Most contusions are mild and respond well to the RICE protocol. If symptoms persist, medical care should be sought to prevent permanent damage to the soft tissues.
Common Overuse Soft-Tissue Injuries
Tendinitis
Tendinitis is an inflammation or irritation of a tendon or the covering of a tendon (called a sheath). It is caused by a series of small stresses that repeatedly aggravate the tendon. Symptoms typically include swelling and pain that worsens with activity.
Tendinitis may be treated by rest to eliminate stress, anti-inflammatory medication, steroid injections, splinting, and exercises to correct muscle imbalance and improve flexibility. Persistent inflammation may cause significant damage to the tendon, which may require surgery.
Bursitis
Bursae, are small, jelly-like sacs that are located throughout the body, including around the shoulder, elbow, hip, knee, and heel. They contain a small amount of fluid, and are positioned between bones and soft tissues, acting as cushions to help reduce friction.
Bursitis is inflammation of a bursa. Repeated small stresses and overuse can cause the bursa to swell. Many people experience bursitis in association with tendinitis.
Bursitis can usually be relieved with changes in activity and anti-inflammatory medications, such as ibuprofen. If swelling and pain do not respond to these measures, your doctor may recommend removing fluid from the bursa and injecting a corticosteroid medication. The steroid medication is an anti-inflammatory drug that is stronger than the medication that can be taken by mouth. Corticosteroid injections usually help relieve pain and swelling.
Trauma is the most common cause of soft-tissue and other musculoskeletal injuries.
Trauma includes, direct force, as occurs in falls or motor vehicle accidents or during some sports, such as football, repeated wear and tear, as occurs during daily activities or results from vibration or jerking movements
Overuse, as may occur when athletes over train
How severe an injury is depending partly on how strong the force is.
Sprains and strains are common sports injuries . For example, they can occur during running, especially when people suddenly change direction, or during strength training—for example, when weightlifters quickly drop or yank the load rather than moving slowly and smoothly.
Sprains are tears in ligaments (tissues that connect one bone to another). Other soft-tissue injuries include tears in muscles (strains) and tears (ruptures) in tendons (tissues that connect muscles to bones).
Most injuries to muscles and the tissues that connect them result from injuries or overuse. The injured part hurts (especially when it is used), is usually swollen, and may be bruised.
Doctors can sometimes diagnose these problems based on symptoms, the circumstances causing the injury, and results of a physical examination, but sometimes x-rays or other imaging tests are needed.
Most injuries heal well and result in few problems, but how long they take to heal varies, depending on many factors, such as the person’s age, the type and severity of the injury, and other disorders present.
Treatment depends on the type and severity of the injury and may include pain relievers, PRICE (protection, rest, ice, compression, and elevation), immobilization of the injured part (for example, with a cast or splint), and sometimes surgery.
Bones, muscles, and the tissues that connect them (ligaments, tendons, and other connective tissue, which are called soft tissues) make up the musculoskeletal system. These structures give the body its form, make it stable, and enable it to move.
Tissues of the musculoskeletal system can be damaged in various ways:
Sprains: Ligaments (which attach bone to bone) can be torn.
Strains: Muscles can be torn.
Tendon rupture: Tendons (which attach muscle to bone) can be torn.
Fractures: Bones can be cracked or broken. Usually, the surrounding tissues are also injured.
Dislocations: The bones in a joint may become completely separated from each other (called dislocation) or only partly out of position (called subluxation).
Sprains, strains, and other musculoskeletal injuries vary greatly in severity and in the treatment needed.
The term soft tissue injury is often used to describe injuries mainly to ligaments, tendons and muscles or to the ‘fascia’, the connective tissue that binds the body. Injuries to these structures may be haematoma formations (bleeding in or around the structure) or may be actual tears.
Fractures
A broken or cracked bone is known as a fracture. Fractures can affect any bone in the body.
Bones can fracture in a number of different ways. A fracture may be a straight break across the bone (transverse fracture), slanting (oblique fracture) or winding (spiral fracture). The break may run along the shaft of the bone (longitudinal fracture), or the bone may be shattered into pieces (comminuted fracture).
Young bone is softer and more able to bend than adult bone, so children’s bones often fracture on one side but bend on the other. This is known as a greenstick fracture.
An avulsion fracture is when a piece of bone detaches from the main bone, usually because of being torn away by the tendon that attaches a muscle to a bone. A fracture in which the bone collapses is called a compression fracture. Compression fractures usually affect the spongy bone found in the spine.
A fracture in which the skin around the bone has not been broken is called a simple or closed fracture. If the ends of the bone break through the skin, or there is a wound that leads to the fractured bone, it is called a compound or open fracture. In a compound fracture the bone is open to infection, so this type of fracture is more serious.
A complicated fracture is one in which there is injury to other nearby structures, such as major blood vessels and nerves. A fracture-dislocation occurs when a joint becomes dislocated and there is also a fracture of one of the bones of the joint.
After a fracture, the broken fragments of bone normally separate from each other. However, sometimes one fragment of bone can be driven into another. This is known as an impacted fracture.
Cartilage damage is a relatively common type of injury. It often involves the knees, although joints such as the hips, ankles and elbows can also be affected.
Cartilage is a tough, flexible tissue found throughout the body. It covers the surface of joints, acting as a shock absorber and allowing bones to slide over one another.
It can become damaged as a result of a sudden injury, such as a sports injury, or gradual wear and tear (osteoarthritis).
Minor cartilage injuries may get better on their own within a few weeks, but more severe cartilage damage may eventually require surgery. Self-care measures are usually recommended as the first treatment for minor joint injuries.
For the first few days:
protect the affected area from further injury by using a support, such as a knee brace
rest the affected joint
elevate the affected limb and apply an ice pack to the joint regularly and take ordinary painkillers, such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen.
Get medical advice if your symptoms are severe or do not improve after a few days. You may need professional treatment, such as physiotherapy, or possibly surgery.
A grading system of 1-3 is used to describe the severity of the injury.
Grade 1: Usually mild and involves up to 10 per cent of the muscle or ligament. Usually, recovery will take a few days.
Grade 2: These are moderate tears involving 10-90 percent of the structure and will take several weeks to repair.
Grade 3: Tears are severe and indicate complete rupture of that muscle or ligament. This may actually be less painful than a grade 2 as the injured structure is no longer being stressed. This is a more serious injury and will often require surgery or immobilising in a plaster cast.
Probably the most common soft tissue injury is the ‘sprained ankle’. As above, these may be grade 1, 2 or 3 tears of the ligaments about the ankle. Fortunately, most ankle injuries are grade 1 or grade 2. Usually, it is the ligaments on the outer (lateral) side of the ankle that are damaged.
Here is an example of a haematoma in the hamstring muscle group
Immediately after the injury occurs, it’s recommended to follow the P.R.I.C.E. principals to minimise the local tissue damage and reduce inflammation.
P = Protection
Basically, this involves avoiding the risk of further injury. This means not trying to run and continue with the game when you feel a ‘pull’. It can mean reducing the stress through the tissues by using crutches or using a brace or strapping to support and ‘off-load’ the injury.
R = Rest
This means unloading the injured structure. Try to reduce the hours spent on your feet the day after a sprained ankle, even if it is strapped or bandaged. Don’t be too ambitious about getting back to activities too quickly. Accept that things take time to repair properly and will benefit from the relative rest.
I = Ice
The Association of Chartered Physiotherapists in Sports Medicine (ACPSM) recommend crushed ice be applied for at least 10 minutes to reduce pain after an injury. This may also help to avoid excessive swelling from causing further damage to tissues. It is not recommended to keep the ice on for more than 20-30 minutes because this can cause an Ice burn. It can be reapplied every 2 hours, or sooner if more pain relief is required. Protect from skin burns with a damp tea towel as a barrier.
C = Compression
A simple crepe bandage or tub grip can help to limit swelling in the early stages. This should fit snuggly but not restrict blood flow. Physiotherapists will sometimes add more focal compression under a bandage for example tape or felt.
E = Elevation
This is particularly useful to reduce pain and swelling in injuries. For example, injuries involving the lower limb, if you lie on the floor or bed with your foot up high on the wall the swollen area will be higher than your heart and the fluid will drain more effectively. Gentle movement of knee and ankle whilst elevated will make this even more effective.
Soft Tissue Injury
Damage to any biological tissue except for bone
Soft Tissue Dysfunction
Dysfunctional tissue that is non-pathological – eg. Free from disease and inflammation
Soft tissue injury can occur when they’re taken beyond they’re normal ROM, through impact
or trauma.
Soft tissue dysfunction is the most common injury in sport. Soft tissue refers to tissues that connect, support, or surround other structures and organs of the body.
Soft tissue includes muscles, tendons, ligaments, fascia, nerves, fibrous tissues, fat, blood vessels, and synovial membranes.
A soft tissue injury generally involves one or more of the following structures via sprain, strain or direct blows:
Muscle – muscles are made up of fibres that shorten and lengthen to produce movement of a joint. Muscles are attached to bone by tendons.
Tendon – tendons are tough bone of slightly elastic connective tissue that connect muscle to bone.
Ligament – ligaments are strong bands of inelastic connective tissue that connect bone to bone.
The biggest risk factor for soft tissue injury is a previous injury. A player returning from injury or illness should refrain from activity until declared fit to play by a sports medicine professional.
Prevention:
Warming up, stretching and cooling down.
Undertaking training prior to competition to ensure readiness to play.
Including appropriate speed work in training programs so muscles are capable of sustaining high acceleration forces.
Including appropriate stretching and strengthening exercises in weekly training programs.
Gradually increasing the intensity and duration of training.
Maintaining high levels of cardiovascular fitness and muscle endurance to prevent fatigue.
Allowing adequate recovery time between workouts or training sessions.
Avoiding activities that cause pain.
Types of soft tissue injuries:
Acute injury
Injuries that occur from a known or sometimes unknown incident. Signs and symptoms develop rapidly.
Bruise (contusion, cork)
Bruises are caused by a direct force applied to the body such as being kicked or making contact with a player and result in compression and bleeding into the soft tissue (hematoma).
Signs and symptoms: Swelling and/or discolouration.
Sprain
Sprains are caused when the joint is forced beyond its normal range of motion resulting in overstretching and tearing of the ligament that supports the joint.
Signs and symptoms: Swelling, loss of power or ability to bear weight, possible discolouration and bruising and/or sudden onset of pain.
Strain
Strains are caused by muscles over-stretching or contracting too quickly, resulting in a partial or complete tear of the muscle and/or tendon fibres.
Signs and symptoms: Swelling, possible discolouration and bruising and/or pain on movement.
Overuse Injury
Overuse injuries occur as a result of repetitive friction, pulling, twisting, or compression that develops over time.
Signs and symptoms: Will develop slowly, inflammation, pain.
Immediate Management
The immediate treatment of any soft tissue injury consists of the RICER protocol – rest, ice, compression, elevation and referral. RICE protocol should be followed for 48–72 hours. The aim is to reduce the bleeding and damage within the joint.
The No HARM protocol should also be applied – no heat, no alcohol, no running or activity, and no massage. This will ensure decreased bleeding and swelling in the injured area.
This regime should be used for all ligament sprains, muscle sprains and muscle bruises. Referral for bumps and bruises which occur in sport or physical activity, other than those which are minor is recommended.
You can expect full recovery from most soft tissue injuries in one to six weeks. The length of time depends on your age, general health and the severity of the injury.
Injury What Extra Information
Contusion Bruise
Intramuscular Haematoma Bleeding within a muscles
compartment
Muscle is enclosed in a
fascial sheath. Bleeding
causes rapid rise in
intramuscular pressure
Intermuscular Haematoma Bleeding between muscle
compartments
Bruising is visible
Muscle Strain Tearing of muscle/tendon
fibres
Overuse Injuries Multiple tiny strains due to
excessive repetitive
movement or prolonged
muscular use
Sprains Joint is forced past the limits
of movement leading to
tears in the ligament and
sometimes capsule
Soft tissues surround and support organs and skeletal system. They include muscles, nerves, tendons, ligaments, joints, cartilage, spinal discs, and fascia. The connective tissues that surround, connect, and support muscles, organs, bones, blood vessels, and nerves.
A Soft tissue injury can include injury to any connective tissue.
Common types of injury include:
Bursitis
Contusions
Sprains
Strains
Stress injuries
Tendonitis
Soft tissue injuries happen when muscles are abnormally tense or tense for extended amounts of time. Muscles work by contracting, tensing up, and then relaxing. They get shorter when they contract and lengthen when they relax. This contracting and relaxing is what causes movement in the part of the body they’re located.
The mechanisms of injury (MOI) can be acute trauma (external force applied to the body) or an overuse injury, which can be from physical activity, such as in sports or industrial settings. Acute trauma is always a sudden onset, but overuse injuries come on during repetitive use. Even though overuse injuries are not from direct force, we still consider this a form of repetitive trauma rather than illness.
Signs and Symptoms of Overuse Soft Tissue Injuries
There are several examples of common overuse injuries. Most of these are irritations related to tendinitis (inflammation of a tendon), bursitis (inflammation of the bursa, fluid-filled cushion pads in the joints), epicondylitis (irritation of the epicondyle, which surrounds the rounded parts of the bones in a joint), muscle strains, or muscle tears. Tennis elbow (lateral epicondylitis) is an example of one of the more well-known overuse injuries.
Overuse injuries can occur all over the body and it’s very hard to pin down one set of signs and symptoms. Here are a few things to look for:
Pain
Limited range of motion
“Popping” or “snapping” feelings
Swelling
Bruising
In some cases, overuse injuries can be treated with RICE or METH depending on your personal preference pending more evidence to clearly pick a winner between these two treatment options. The one thing both treatment regimens agree on is elevation. The biggest difference between the two is cold or heat.
2.1 Describe the process of soft tissue repair
Healing is the way the body replaces damaged tissue with living tissue at the site of injury. Every connective tissue in the body must go through the same processes once it has sustained some damage regardless of severity.
After the initial injury, there will be inflammation, swelling and pain, as the body repairs itself is chronic stage of soft tissue repair.
Around three to six weeks later, the soft tissue repair process will move into the chronic stage. This can last weeks, months or even years, depending on the injury.
It is widely known that there are 4 distinct but overlapping phases, Bleeding, Inflammation, Proliferation & Remodelling
There must be specific rehabilitation and treatment based on the principles of tissue healing.
The bleeding phase occurs immediately following injury and is short lived lasting from about on average 4-6 hours.
Once an injury has been sustained, the damaged blood cells bleed, the site of the injured tissue will consist of dead cells and extravasated blood.
The second inflammatory phase is an essential part of tissue repair. It has a rapid onset post injury, within a few hours, and increases in strength to reach its maximum between 1- and 3-days post injury.
A natural inflammatory reaction occurs involving a blood vessel and cellular response with exuded fluid resulting in bruising and cellular activity. The inflammation is triggered by blood vessels enlarging and becoming more permeable (the ability to allow liquids to pass through it), this is initiated by chemical responses.
Proliferation Phase – Sub Acute
Repair material is generated at this stage where scar tissue is produced. This starts from 2-3 days after the initial incident and reaches its peak at 2-3 weeks. The injured tissue causes the release of chemicals which affect local blood vessels and allows leakage of blood into the area which form the exudate or swelling in the area. This exudate dilutes any of the irritant substances in the damaged area and due to high fibrinogen content, a soluble protein present in blood plasma, which produces fibrin, which starts to build a fibrin clot which bridges the gap in the damaged tissue.
Remodelling Phase
Around 2-3 weeks post injury (depending on the severity) collagen fibres mature, and the remodelling of the tissue occurs. As the collagen matures it aligns with the typical stresses the injury site must endure. There are different types of collagens, but one in particular is removed from the injury site and replaced with a type which has a greater tensile strength. This type of remodelling can happen for months and even years after the initial incident.
5 Cardinal Signs of Inflammation
Pain, Heat, Redness, Swelling, and Loss of Function
In the case of inflammation, there are five cardinal signs that characterize the condition: pain, heat, redness, swelling, and loss of function.
Inflammation is a complex process involving a variety of cell and signalling proteins that protect the body from infection and foreign substances, such as bacteria and viruses. Inflammation helps the body by producing white blood cells and other substances.
Sometimes, the immune system triggers an inflammatory response inappropriately. This is the case with autoimmune diseases. The body compensates by attacking its own healthy tissues, acting as if they are infected or abnormal.1
When the inflammation process starts, chemicals in white blood cells are released into the blood and the affected tissues to protect the body. The chemicals increase blood flow to the infected or injured body areas, causing redness and warmth in those locations.
These chemicals may also cause leaking of fluids into tissues, resulting in swelling. This protective process will also stimulate nerves and tissues, causing pain.
Acute Inflammation
Acute inflammation may include heat (sometimes from fever) or warmth in the affected area. Acute inflammation is a healthy and necessary function that helps the body to attack bacteria and other foreign substances anywhere in the body. Once the body has healed, inflammation subsides.
Examples of conditions that cause acute inflammation include:
Acute bronchitis, which causes inflammation of the airways that carry air to the lungs.
An infected ingrown toenail.
A sore throat related to the flu.
Skin cuts and scratches.
Physical trauma.
Chronic Inflammation
Chronic inflammation, on the other hand, may continue to attack healthy areas if it doesn’t turn off. It can occur anywhere in the body and may trigger any number of chronic diseases, depending on the area of the body affected.
Examples of conditions that cause chronic inflammation include:
Inflammatory arthritis, which covers a group of conditions distinguished by inflammation of joints and tissues (including rheumatoid arthritis, lupus, and psoriatic arthritis).
Cardinal Signs
There are five cardinal signs of inflammation, though it may also cause additional symptoms if severe.
Pain
Inflammation can cause pain in joints and muscles. When inflammation is chronic, a person will experience high levels of pain sensitivity and stiffness. The inflamed areas may be sensitive to touch.
With both acute and chronic inflammation, pain is the result of inflammatory chemicals that stimulate nerve endings, causing the affected areas to feel more sensitive.
Heat
When inflamed areas of the body feel warm, it is because there is more blood flow in those areas. People with arthritic conditions may have inflamed joints that feel warm to the touch. The skin around those joints, however, may not have the same warmth. Whole-body inflammation may cause fevers as a result of the inflammatory response when someone has an illness or infection.
Redness
Inflamed areas of the body may appear red in colour. This is because blood vessels of inflamed areas are filled with more blood than usual.
Swelling
Swelling is common when a part of the body is inflamed. It is the result of fluid accumulating in tissues either throughout the body or in the specific affected area. Swelling can occur without inflammation, especially with injuries.
Loss of Function
Inflammation may cause loss of function, related to both injury and illness. For example, an inflamed joint cannot be moved properly, or it can make it difficult to breathe due to a respiratory infection.
The reason for all these symptoms is the same: Cytokines released into the bloodstream lead to increased vascular permeability to allow migration of immune cells into tissues.
When inflammation is severe, it may cause additional signs and symptoms. This may include fever, a general feeling of sickness, and exhaustion.
2.2 Describe factors that may influence soft tissue repair
The major recovery time factors are:
Recent evidence suggests that the cause of an injury can affect healing time.
Compare running at high speed with overstretching – both can cause apparently similar soft tissue injuries at the same anatomical location, the hamstring for example, but have very different healing times. In this instance the overstretching injury can take much longer to heal.
The location of an injury makes a big difference to the healing time. Chest wall muscles involved in breathing and neck muscles involved in sustaining postural stability and controlling head movements, take longer to heal as they have little time to rest.
Different tissues regenerate at different rates. As a rule of thumb, the greater the blood supply to the tissue the quicker the recovery time. So muscle heals quicker than tendon and tendon heals quicker than ligament. It’s even been said that breaking a bone is preferred to spraining a ligament as ligaments have a very poor blood supply and can take some time to heal.
Grade of injury
Injuries are normally graded from one to three.
Grade 1 involves a tear of only a few tissue fibres with minor swelling and discomfort accompanied with a minimal loss of strength or range of movement.
Grade 2 involves greater damage with a substantial loss of strength and movement. These injuries are often the most painful and as you would expect there is a correlation between the volume of tissue injured and rehabilitation time.
Grade 3 occurs when a tear extends across the entire cross-section and completely ruptures the tissue. This can be a disturbing sight as the muscle bunches up at one end towards the joint. Interestingly the pain from a grade 3 can be less as the muscle cannot contract and put strain on the injury.
Recent studies suggest that oxytocin may be one of the secret ingredients in blood that promotes regeneration of muscle tissue. Dubbed the love hormone by the press due to its effects in modulating social behaviour including bonding between couples, creating trust and stress reduction. Oxytocin has been found to activate a cellular cascade that triggers growth and proliferation of tissue and is produced in lower quantities as we age.
However, until a safe and effective treatment has been developed to reduce the negative impact of aging, we will have to include advancing years as a factor in calculating the recovery time for injuries.
General health and medication
A patient with generally poor health may expect a slower recovery time. Chronic illness will put added strain on the body and often the medication will exacerbate the problem. The use of anticoagulants and immunosuppressants, such as corticosteroids have been shown to inhibit the body’s repair process. The use of NSAIDS such as Ibuprofen have also been linked to slowed recovery times for soft tissue injuries There is a strong correlation between increased healing time and smoking, obesity and alcoholism. The general health of the patient is an important factor in estimating duration of recovery.
First Aid and remedial treatments
Speed of recovery might not be everything. The quality of the repair is also important and will be affected by early decisions in the remedial treatment of the injury.
Muscle healing involves two competitive processes, scar tissue formation and muscle regeneration. Scar tissue makes for a rapid repair but inhibits muscle formation. Immobilising an injury reduces scar tissue, but the new muscle fibres will not be laid down in an orderly fashion, resulting in weaker muscle. A balance needs to be found, the ideal being a short period of immobilisation followed by early mobilisation. However, an exception may be made in cases of severe ankle sprains.
The application of ice, as an analgesic and to reduce inflammation, is the recommended first aid protocol. However, some inflammation is essential and is important for healing and protection from infection. Care is needed as over-icing may inhibit this process. Ice on its own (as opposed to alternating ice and heat) should only be used in the very early stages of an injury. Over-icing may also promote the formation of scar tissue and adhesions reducing the quality of the repair. Ice slows down the healing process and should be used sparingly.
2.3 Explain the importance of the inflammatory process
Inflammation is a vital part of the immune system’s response to injury and infection. It is the body’s way of signalling the immune system to heal and repair damaged tissue, as well as defend itself against foreign invaders, such as viruses and bacteria.
The inflammatory response is a defence mechanism that evolved in higher organisms to protect them from infection and injury. Its purpose is to localize and eliminate the injurious agent and to remove damaged tissue components so that the body can begin to heal.
The overall function of inflammation is to neutralise and destroy any toxic agents at the site of an injury and to restore tissue homeostasis. Wound healing involves cellular activity and the release of biologically active substances, such as growth factors, enzymes, carbohydrates, and proteins (Krasner, 1990).
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