Soft Tissue Healing and Injuries

Soft Tissue Healing

• Soft tissue healing is a complex process involving various phases
• Key objectives include understanding soft tissue lesions, phases of healing, treatment recommendations, and the PEACE and LOVE acronym for management
• Examples of soft tissue lesions include strains (musculotendinous unit), sprains (joint capsule, ligaments), dislocations (complete displacement), subluxations (partial displacement), tendinopathy, synovitis, hemarthrosis, bursitis, and contusions

Grades of Sprain/Strain

• Grade 1: Stretching or microscopic tears in tissue. Minimal swelling, localized pain, and almost normal range of motion (ROM).
• Grade 2: Partial tear of tissue. Moderate swelling, bruising, and loss of ROM with significant pain.
• Grade 3: Complete tear. Severe pain, swelling, bruising, and loss of ROM.

Healing Times by Grade

• Times vary by tissue type and grade of injury, but general guidelines are provided in a table.

Soft Tissue Repair

• Inflammatory Phase: Assess damage, clear out damaged tissue, lasts 4-6 days to 2 weeks.
• Proliferative Phase: Begin repairs, lasts 4 to 24 days or up to 6 weeks in limited circulation.
• Remodeling Phase: Strengthen and complete repairs, lasts 3 weeks to 2 years depending on tissue type and injury grade.

Stages of Wound Healing

• Presents a visual graphic of the stages of wound healing, including inflammation, proliferation, and remodeling.

Inflammatory Phase (Details)

• Tissue response: Chemical signals (e.g., histamine, bradykinin) trigger vascular changes and edema. Chemotaxis draws immune cells to the area. Clot formation and phagocytosis occur.
• Clinical signs: Swelling, redness, heat, pain, and pain before tissue resistance during movement.

Inflammatory Phase (Management)

• Management considerations: Control stress on the injured tissue (protection). Reduce swelling. Control the inflammatory response, but don't interfere with it. Pain is a guide. The PEACE acronym is a helpful guide (Protection, Elevation, Avoid anti-inflammatories, Compression, Education).

Proliferative Phase (Details)

• Tissue response: Growth of capillary beds, collagen formation (Type III), and granulation tissue development.
• Clinical signs: Pain is synchronous with tissue resistance during movement; decreasing inflammation.

Proliferative Phase (Management)

• Management considerations: Continue controlled stressing of tissues (increase ROM, intensity, frequency). Increase activity as tolerated. Still fragile tissue. Avoid explosive stressing. Pain is the guide. The LOVE acronym is a helpful guide (Load, Optimism, Vascularization, Exercise).

Remodeling Phase (Details)

• Tissue response: Maturation of scar tissue; contracture healing; remodeling of Type III collagen to Type I collagen; collagen aligns with stress.
• Clinical signs: No inflammation; pain at end-range tissue resistance during movement.

Remodeling Phase (Management)

• Management considerations: Progressive stress to tissues (increase volume, load, and intensity); incorporate explosive movements; progressive return to prior level of function; avoid pain, but discomfort is normal when pushing limits. The LOVE acronym is a guide.

Factors Affecting Healing

• Lifestyle factors (diet, activity levels, smoking/alcohol use, stress)
• Comorbidities (age, obesity, diabetes, immunocompromised conditions)

Application (Overview)

• Apply knowledge of phases and healing times to patient cases.
• Identify the healing phase experienced by a patient.
• Predict when a patient transitions to the next phase.
• Provide appropriate patient education.
• Plan appropriate interventions for patients.

Case Studies (Examples)

• Case Studies are presented showing patient details such as age, injury type, injury duration, pain level, activity limitations, and goals to illustrate application of the knowledge to specific situations.