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  2. Soft tissueinjuries • Include damage to muscle, tendons, ligaments, cartilage, skin, blood vessels, organs and nerves. There are many types of soft tissue injury. • Acute soft tissue injuries include sprains, strains, dislocation, torn cartilage, contusions and abrasions. • Prolonged soft tissue injuries may include many of the same types of injury, but their severity necessitates a long rehabilitation.

  3. Identification of muscle injuries TalkObserveTouchActive movementPassive movement Skill test Things to look for – • Swelling • Pain • Tenderness • Possible pain on active movement • Possible pain if the muscle is stretched • Inflamed and swollen tendon • Decreased function, loss of power

  4. Soft Tissue Injuries • Sprains – arise from the stretching or tearing of a ligament • Sprains occur when these ligaments are stretched or torn beyond their normal range of motion, resulting in pain, swelling and the inability to perform normal joint movements. • Healing is a slow process because ligaments have a relatively poor blood supply.

  5. Signs and Symptoms of Sprains • Signs - distressed, collapse, swelling, possible discolouration, and bruising, if rupture of a tendon may see deformity of muscle. • Symptoms – pain on movement

  6. Grading of Ligament and Tendon Damage No damage to structure – normal ligament

  7. Grade 1 • Some pain but no joint instability • Athlete can usually continue activity • Up to 50% fibre disruption • Early part of the linear region (approx 5–6 % of initial length)

  8. Grade 2 • Cause severe pain and some joint instability • 50 –80% fibre disruption • Cannot continue activity • Up to 10% of initial length • Can cause the ligament to lose 50% or more of its integrity (stiffness and support).

  9. Grade 3 • A lot of pain at time of injury, but often less pain after injury • Joint unstable – most of the collagen fibres have ruptured. May not appear unstable but will not tolerate loads. • Instability can lead to early osteoarthritis in joints. • > 80% fibre disruption • > 10% of initial length

  10. Strains • Strains – occur when a muscle or tendon is stretched or torn • Strains cause considerable pain and bleeding, which may cause discolouration around the injury. Any movement in the form of stretching and any pressure on or around the injury will result in sharp pain.

  11. Signs and Symptoms of Strains • Signs – distressed, collapse, swelling, loss of power or unable to bear weight, possible dislocation, deformity (implying possible dislocation) • Symptoms – pain

  12. Strains Grading • There are three levels of strains which also follow the grading system  • 1 - relatively little damage • 2 - moderate damage • 3 - extensive damage

  13. Contusions • Contusions (bruise) caused by a sudden blow to the body • Some are superficial, remaining close to the skin. However, others penetrate deeply, causing the bone to bruise. • Contusions interrupt the blood flow to surrounding tissue. When this occurs, a haematoma (blood tumour) forms as the blood clots in the connective tissue membrane. Internal bleeding into the area may continue for a period of time.

  14. What happens when an injury occurs • Damage to the tissue, such as torn tissue fibres • Bleeding at the injury site from the damaged capillaries (small blood vessels in the soft tissue) • Formation of a blood clot • Swelling of the injured area, due to accumulation of fluid at the injury site (blood and tissue fluid) • Pain at the injury site • Further tissue damage, bleeding and swelling can occur if the injury is not managed correctly in the first instance, for example, playing on may cause further damage and bleeding; the more extensive the capillary damage, the more cells will be damaged.

  15. Inflammationis extremely painful – The pain is caused by: • Tissue damage • Irritation of the bleeding • Tissue swelling • Damage to nerve endings • Release of chemical irritants

  16. INFLAMMATORY RESPONSES When soft tissue is injured, it becomes inflamed but responds by activating a self-healing process. This is referred to as the inflammatory response and may last up to three or four days after the injury occurs, depending on the extent of the damage. The injury will progress through the following phases as part of the healing process.

  17. Phase 1 - The Inflammatory Phase (Acute Inflammatory Response) (0 – 72hrs) • Is characterised by: • pain, redness and swelling around the injured area • loss of function and mobility • damage to cells and surrounding tissues • increased blood flow to the area • leakage of fluid causing swelling (oedema) • the formation of many blood vessels to promote healing.

  18. Phase 2 - The Proliferation (Repair and Regenerative) Phase (3 days – 6 weeks) • Is characterised by: • the elimination of debris • the formation of new fibres • production of scar tissue

  19. Phase 3 - The Remodelling and Maturation Phase (6 weeks to months) • Is characterised by: • increased production of scar tissue • replacement tissue that needs to strengthen and develop in the direction that the force is applied. The type of remodelling varies according to the timing and degree of mobilisation of the injury. Excessive exercise too early will cause further damage. Too little exercise will allow large quantities of scar tissue to form, which lacks strength and flexibility.

  20. Immediate treatment of soft tissue injuries aims to: Immediate • reduce swelling • prevent further damage • ease pain. In the long term, treatment aims to: • restore flexibility • regain full function • prevent recurrence • return the player to the field as soon as possible.

  21. Skin Injuries = Risk of infection • Signs & symptoms of infection are: • Redness • Heat • Swelling • Tenderness • Pain • Decreased function

  22. SKIN ABRASIONS, LACERATIONS, BLISTERS AND CALLUSES • Abrasions, lacerations, blisters, bruises and calluses are forms of skin trauma. They are caused by the application of force, such as scraping or friction to the outer layer of skin. They can cause concern and considerable discomfort.

  23. ABRASIONS • Abrasions occur in games like rugby, where a player may execute a tackle on a dry, hard surface. • The injury causes pain and shallow bleeding as a result of the skin being scraped. • The skinned area may be embedded with dirt and foreign materials. • Treatment : gentle cleansing and sterilisation of the wound to prevent infection.

  24. LACERATIONS • A laceration is a wound where the flesh has incurred an irregular tear. • Lacerations can occur to the scalp and mouth, particularly the lips and tongue if the soft tissue has been forced against the teeth. • Pressure may need to be applied to prevent bleeding. • Lacerations longer than one centimetre need to be referred to a doctor.

  25. BLISTERS • Blisters are caused by a collection of fluid below or within the surface layer of the skin giving rise to intense pain. • Types of blisters: • Closed • Open or torn • Blood • Blisters can contain clear liquid or even blood if a blood vessel has been ruptured. • Blisters occur when new equipment is used, equipment is used for a long time repetitively, or the activity requires sudden changes in direction, causing friction (in a shoe). • Treatment: 24 hours rest. • If fluid in blister is still present and causing concern, it may need to be surgically released and dressing applied. Torn blisters should be washed in soap and water and liquid antiseptic applied.

  26. BRUISES • Bruises (contusions) occur when small blood vessels under the skin tear or rupture, most often from a twist, bump, or fall. • Blood leaks into tissues under the skin and causes a black-and-blue colour that often turns purple, red, yellow, and green as the bruise heals.

  27. CALLUSES • Calluses are increased thickness of skin that usually occur over bone protuberances. • Caused by constant pressure from external sources • e.g. a shoe that is too small • Commonly found on hands because of gripping bat etc. • Calluses cause pain because the area underneath loses blood supply and elasticity, resulting in cracks and tears. • Prevention: ensure clothing and equipment fit, using materials to reduce friction e.g. socks

  28. How can early RICER help in the management of a soft tissue injury? • minimize tissue damage • minimize inflammation • prevent further tissue damage • early and efficient removal of blood clot and tissue swelling • minimise scarring of damaged tissue • regain full function before returning to play • enable the doctor or physiotherapist to make an early diagnosis because the swelling will be less • reduce rehabilitation time • minimize the seriousness of the injury • allow rehabilitation to begin sooner • allow early, but complete recovery before return to sport

  29. Remember soft tissue injuries HEAL by forming new soft tissue (approx 6 weeks). • Hard tissue injuries HEAL by laying done new bone tissue – as you would expect this takes longer! (Approx 6-12 weeks – depending if the bone is non weight bearing (upper body) or weight bearing (lower body)