Soft Tissue Lesions and Healing

Soft Tissue Lesions

• A strain involves the musculotendinous unit
• A sprain involves the joint capsule and ligaments
• A dislocation means there is complete displacement
• A subluxation involves partial displacement
• Tendinopathy affects tendon pathology and is affected by mechanical load
• Synovitis is inflammation of the synovial membrane
• Hemarthrosis is bleeding into a joint
• Bursitis is the inflammation of a bursa
• A contusion is bruising due to trauma

Grades of Sprain/Strain

• Grade 1 involves stretching or microscopic tears in tissue
• Grade 1 presents with minimal swelling, localized pain and almost normal ROM
• Grade 2 involves a partial tear of tissue
• Grade 2 presents with moderate swelling, bruising, and loss of ROM with significant pain
• Grade 3 involves a complete tear
• Grade 3 presents with severe pain, swelling, bruising and loss of ROM

Healing Times by Grade

• Muscle tissue takes 0-3 days to heal if exercise induced
• Muscle tissue takes 1-4 weeks to heal in Grade 1
• Muscle tissue takes 3-12 weeks to heal in Grade 2
• Muscle tissue takes 1-6 months to heal in Grade 3
• Tendonitis takes 3-7 weeks to heal
• Tendonosis takes 3-6 months to heal
• Grade 1 ligament sprain takes 2-8 weeks to heal
• Grade 2 ligament sprain takes 2-6 months to heal
• Grade 3 ligament sprain takes 6-12 months to heal
• Meniscus/labrum takes 3-12 months to heal
• Fractures take 6-8 weeks to heal

Soft Tissue Repair - Inflammatory Phase

• Involves assessing the damage and clearing out damaged tissue
• Lasts for 4-6 days up to 2 weeks

Soft Tissue Repair - Proliferative Phase

• Involves beginning repairs
• Lasts for 4-24 days, but up to 6 weeks in limited circulation such as tendons

Soft Tissue Repair - Remodeling

• Involves strengthening and completing repairs
• Lasts from 3 weeks to 2 years depending on tissue and grade of damage

Inflammatory Phase - Tissue Response & Characteristics

• Chemical signals such as histamine and bradykinin induce vascular changes and edema
• Chemotaxis draws leukocytes and other immune cells to the area
• Clot formation occurs
• Phagocytosis by leukocytes and macrophages occurs

Inflammatory Phase - Clinical Signs

• Redness, swelling, heat, and pain are present
• Pain occurs before tissue resistance with movement

Inflammatory Phase - Management

• Control stress to the injured tissue, such as with protection
• Reduce swelling
• Control the inflammatory response, but do not interfere with it
• Use pain as a guide

PEACE Acronym

• Protection: avoid activities那that increase pain during the first few days after injury
• Elevation: elevate the injured limb higher than the heart as often as possible
• Avoid anti-inflammatories: taking anti-inflammatory medications and icing can reduce tissue healing
• Compression: use elastic bandage or taping to reduce swelling
• Education: let nature play its role and avoid unnecessary passive treatments and medical investigations, since your body knows best

Proliferative Phase - Tissue Response & Characteristics

• Growth of capillary beds occurs
• Type III collagen formation
• Granulation tissue forms

Proliferative Phase - Clinical Signs

• Pain is synchronous with tissue resistance during movement
• Inflammation signs are decreasing

Proliferative Phase - Management Considerations

• Continue controlled stressing of tissues
• ROM, intensity, and frequency can be progressed
• Target restrictions
• The tissue is still fragile, therefore avoid quick, explosive stressing of tissue
• Use pain as a guide

LOVE Acronym

• Load: pain should guide the gradual return to normal activities, and your should tell you when it's safe to increase load
• Optimism: condition your brain for optimal recovery by being confident and positive
• Vascularisation: choose pain-free cardiovascular activities to increase blood flow to repairing tissues
• Exercise: adopt an active approach to recovery to restore mobility, strength, and proprioception

Remodeling Phase - Tissue Response & Characteristics

• Maturation of scar tissue occurs
• Contracture of scar tissue
• Remodeling of Type III collagen to Type I
• Collagen aligns to stress

Remodeling Phase - Clinical Signs

• No inflammation signs
• Pain during movement occurs at end-range tissue resistance

Remodeling Phase - Management Considerations

• Progressively stress the tissues
• Increase volume, load, and intensity
• Incorporate rapid, quick, power movements
• Progressively return to the prior level of function
• Avoid pain but be aware that discomfort is normal when pushing limits

Factors That Affect Healing - Lifestyle

• Diet
• Activity levels
• Smoking and alcohol
• Stress

Factors That Affect Healing - Comorbidities

• Age
• Obesity
• Diabetes
• Immunocompromised conditions

Overview of soft tissue lesions including strains, sprains, dislocations, and tendinopathy. Lesion grades and their characteristics are explained, along with healing times for each grade. Key differences between sprains and strains are emphasized.