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Lecture 2: Principles of Treating Soft Tissue

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Ashley Ambrosio

on 1 October 2015

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Transcript of Lecture 2: Principles of Treating Soft Tissue

Principles of Treating Soft Tissue
Ch. 10
PTA 105A
Matthew Silva, ATC, CSCS, PTA
Principles of Treating Soft Tissue, Bony and Post-surgical Conditions
the structure involved

its stage of recovery
Acute, Subacute, Chronic

functional limitations/disabilities
Identify techniques for intervention and choose those that are of appropriate intensity for the stage of healing or recovery.
Tends to be less sever that a sprain

Severe stress, stretch, or tear of soft tissue

Incomplete/partial dislocation

Displacement of the bony partners in a joint.

Muscle/tendon rupture vs. tear
Partial tears = pain
Complete tears = minimal pain

Tendinous lesions
Tenosynovitis: inflammation of synovial membrane
Tendinitis: inflammation of a tendon
Tenovaginitis: inflammation w/ thickening of tendon sheath
Tendinosis: Degeneration of tendon due to repeated stress

Inflammation of a synovial membrane

Bleeding into a joint.
Caused by severe trauma

Ballooning of a wall of a joint capsule or tendon sheath.
Arise after trauma. With rheumatoid arthritis

Inflammation of a bursa

Bruising from a direct blow=capillary rupture, bleeding, inflammatory response

Overuse Syndrome
Cumulative trauma
Repetitive Stress
Repeated overload/wear to muscle/tendons creating inflammation and pain

Soft Tissue Lesions


Loss of normal function of tissue or region.
adaptive shortening, adhesions, muscle weakness, etc

Joint dysfunction
Loss of normal jt. Play
Causes: trauma, immobilization, disuse, aging

Adaptive shortening of skin, jt. Capsule, fascia, muscle

Abnormal adherence of collagen fibers to surrounding

Intrinsic Muscle Spasm

Reflex Muscle Guarding
Prolonged contraction in response to pain

Muscle weakness

Myofascial compartment Syndrome
Increased pressure in a myofascial compartment.

Clinical Conditions that result from Trauma or Pathology
Grade I – mild pain, mild swelling, local tenderness with tissue stress.

Grade II – moderate pain, ligamentous fibers torn resulting in some joint hyper mobility.

Grade III – Complete, near-complete tear or avulsion of tendon or ligament. Results in joint instability

Severity of Tissue Injury
Acute Stage

Sub acute Stage

Chronic Stage
Stages of Inflammation/Repair
Acute Stage (inflammatory Reaction)
4-6 days duration (usually)
Signs of inflammation
Swelling, redness, heat, pain, loss of function
Muscle guarding

Subacute (repair/healing)
10-17 days, sometimes up to 6 weeks for tendon injuries
signs of inflammation
Pain when tissue is stretched
Muscles test weak

Chronic Stage(Maturation & remodeling)
Can last 6 months to 1 year
No signs of inflammation
Sometimes contractures/adhesions
Stretch pain may be felt at end ranges
Poor endurance, neuromuscular control

State of Chronic Inflammation (overuse)
A state of prolonged inflammation
Increased stiffness after rest
Increased pain, swelling, muscle guarding lasting several hours after activity

Chronic pain syndrome
A state that persists longer than 6 months
Pain cant be linked to a source
Physical, psychological, and emotional

Stages of inflammation/repair
Educate the patient
Recovery time
How to protect the injured body part

Control pain, edema, spasm
Cold, compression, elevation, retrograde massage (after 48hrs)
Avoid positions of stress to area
Gentle Gr I oscillations

Maintain ST and jt. Integrity/mobility

Maintain function of associated areas
AAROM, AROM, Resisted ROM depending on proximity to effected area.
Use assistive devices as needed to protect the part during functional activities.
Acute stage management

Use proper dosage of rest and mvmt.
Too much mvmt= pain/inflammation

No stretching to site of inflamed tissue
No resistance exercise to site of inflamed tissues.
Management Guide-Acute Stage

Pain at end of available ROM
Decreasing edema and jt. Effusion
Developing ST, muscle, jt. Contractures
Muscle weakness from disuse
Decreased function

Patient education
Anticipated healing time/importance of following guidelines
Teach HEP and modify as needed

Promote healing of injured tissue
Monitor tissue response to exercise
Decrease intensity if inflammation occurs

Restore mobility (ST, Jt, muscle)
Progress from PROM-AAROM-AROM
Increase scar/ST mobility/related areas

Develop neuromuscular control/endurance/strength
Multiple angle isometrics
Initiate AROM and protected w/b and stabilization exercises
As healing/ROM improves…progress to isotonic ex. w/emphasis on form

Maintain integrity/function of associated areas

Too much motion/activity = resting pain, fatigue, spasm, weakness
Pain should not last longer than a few hours after a new activity

Sub-Acute Management

ST/Jt. Contractures that limit ROM
Muscle weakness, poor endurance and neuromuscular control
Decreased function in injured part
Loss of normal function in an expected activity

Patient education
Safe progressions of ex. and stretching
Monitor understanding and compliance
Teach ways to avoid re injury
Teach body mechanics/ergonomics

Increase ST/jt./muscle mobility
Jt. Mobilizations, x-friction, stretching

Improve neuromuscular control, strength, endurance. Progression
Submax to max resistance
Concentric, eccentric, w/b, and non w/b ex.
Single plane to multiplane
Simple to complex motions simulating functional activities
Controlled proximal stability
Safe biomechanics
Progress speed movement

Improve cardiovascular endurance

Progress functional activities
Continue strengthening until muscles are strong enough to respond to the required functional demands

No inflammation
No pain lasting longer than couple hrs.
Jt swelling, pain lasting >4hrs, taking meds= doing too much. BACK OFF
Management of Chronic stage
(return to function)

Pain in involved tissue
Only after repetitive activities
When doing repetitive activities & after
Unable to complete activity
Pain is continued and unremitting

Educate the patient
Explain cause of chronic irritation and avoidance of stressing irritated part
Adapt the environment to stop tissue stress

Promote healing/ control pain
Cold, compression, massage

Maintain mobility of involved tissue
Non stressful PROM
Muscle setting

Develop support in related regions
Posture training
Stabilization exercises.
Chronic inflammation Mgmt.
During chronic inflammation

Chronic inflammation Mgmt
return to function phase
Educate the patient
Ergonomics and ways to prevent recurrence

Develop strong mobile scar
Friction massage
Soft tissue mobilization techniques

Length/strength balance in muscles
Stretching/strengthening exercises

Analyze job/activity
Adapt home, work, sport environments
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