Soft Tissue Healing and Management

Soft Tissue Healing

• Soft tissue healing involves distinct phases: inflammatory, proliferative, and remodeling.
• Various soft tissue lesions include strains (musculotendinous unit), sprains (joint capsule, ligament), dislocations (complete displacement), subluxations (partial displacement), tendinopathies (tendon pathology affected by mechanical load), synovitis (synovial membrane inflammation), hemarthrosis (bleeding into a joint), bursitis (inflammation of bursa), and contusions (bruising from trauma).
• Sprain/strains are graded (1-3) based on tissue damage: Grade 1 involves stretching or microscopic tears, minimal swelling, and mostly normal range of motion (ROM). Grade 2 involves partial tear, moderate swelling, bruising, and significant loss of ROM with pain. Grade 3 involves complete tear, severe pain, swelling, bruising, and loss of ROM.
• Healing times vary by tissue type and grade of injury, as shown in a table.
• The acronym PEACE is a guideline for managing soft tissue injuries during the inflammatory phase. It stands for Protection, Elevation, Avoid anti-inflammatories, Compression, and Education.
• The acronym LOVE is a guideline for managing soft tissue injuries during the proliferative phase. It stands for Load, Optimism, Vascularization, and Exercise.
• The inflammatory phase involves assessing the damage, clearing out damaged tissue, lasting 4-6 days to 2 weeks, and managing inflammation.
• The proliferative phase involves growth of capillary beds, collagen formation, and strengthening. Swelling decreases; movement, pain before tissue resistance, are seen in this phase.
• The remodeling phase involves collagen maturation/contracture, and aligns with stress, with no inflammation and pain at end-range tissue resistance.
• Lifestyle factors, comorbidities, and age affect healing time.

Case Studies

• Case 1: A 16-year-old with a Grade 1 ATFL sprain (36 hours ago) exhibits slight swelling, pain (4/10 worst in 24 hours), pain at end-range dorsiflexion and inversion, and normal ambulation but pain with running/jumping. The patient wants to be ready for tomorrow's state championship.
• Case 2: A 40-year-old with a Grade 2 hamstring strain (2 months ago) has no swelling. Pain is reported with stairs and running(2/10), and slight pain at end-range stretches (2/10). The patient wants to be ready for softball season in a couple of months.
• Case 3: A 23-year-old with a back strain (2 weeks ago) is slowly regaining range of motion, but still experiences pain (4/10) at end-range flexion and rotation; and (4/10) while sitting for longer than 30 minutes. The patient wants to be able to run and be ready to take a flight to Germany within next month.

Application

• Application involves various steps: Identifying the healing phase, predicting when the patient moves to the next phase, educating the patient about their phase of healing, and providing the patient with appropriate interventions.