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Lecture 2: Principles of Treating Soft Tissue
Transcript of Lecture 2: Principles of Treating Soft Tissue
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
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
Displacement of the bony partners in a joint.
Muscle/tendon rupture vs. tear
Partial tears = pain
Complete tears = minimal pain
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
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
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
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
Sub acute Stage
Stages of Inflammation/Repair
Acute Stage (inflammatory Reaction)
4-6 days duration (usually)
Signs of inflammation
Swelling, redness, heat, pain, loss of function
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
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
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
PROM. NOT TOO MUCH
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
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
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
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
Progress speed movement
Improve cardiovascular endurance
Progress functional activities
Continue strengthening until muscles are strong enough to respond to the required functional demands
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
Develop support in related regions
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
Soft tissue mobilization techniques
Length/strength balance in muscles
Adapt home, work, sport environments