Condition Spotlight: Soft Tissue Injuries

So your scan results say that you have injured a soft tissue structure and you’re wondering what this means.

In this blog, we are going to take a deep dive into all things soft tissue – what it is, how it can be injured, how we treat it and how you can prevent it.

So, let’s get into it.

What is soft tissue?

The body contains various forms of tissue, called hard tissue and soft tissue. Hard tissue are the tissues that have hardened through processes like calcification and ossification, forming bones and teeth.

Soft tissue is essentially all other kinds of tissue and is present throughout the body and has several functions. These functions include connecting and supporting structures within the body; surrounding and protecting vital organs; and allows your body to move.

There are several different types of soft tissue.

The different types of soft tissue

Muscles

Skeletal muscles are able to contract and relax and contain contractile proteins called actin and myosin. They are anchored to bones via tendons.

There are 3 types of muscle

  • Skeletal muscle – this type of muscle is one you can control in order to produce movement. This is the type that we will focus on in this blog.
  • Smooth muscle – this works involuntarily, meaning that you have no conscious control over it. It is found in organs such as the stomach and intestines.
  • Cardiac muscle – this also works involuntarily and is found exclusively within the heart to pump blood around the body.

Tendons

Tendons join muscle to bone, such as the achilles tendon.

Ligaments

Ligaments join bone to bone, such as in the ankle or knee joints.

Fatty tissue

This helps to cushion the bone and protect vital organs, as well as provide energy

Blood vessels

These include the arteries, veins and capillaries and they are responsible for carrying blood around the body.

Nerves

Nerves control the functions and movements throughout the entire body.

What are common soft tissue injuries?

The most common soft tissue structures that are injured are muscles, tendons and ligaments.

These can be injured in both physical activity and activities of daily living.

Some of the most common injuries that occur to these soft tissues include sprains, strains, contusions (bruising), tears, tendinitis and bursitis.

Symptoms of a soft tissue injury can include pain, bruising, swelling, reduced movement, weakness, muscle spasms and cramps, joint instability and an inability to put pressure through the affected structure/s.

The severity of these symptoms will depend on the severity of the injury.

Soft tissue injuries can be categorised as:

  • Acute

Sudden, unexpected or uncontrolled trauma to the area in injuries such as a sprain, strain or contusion.

  • Overuse

Overuse injuries are gradual injuries over time due to excessive pressure placed on the structure, such as tendinitis or bursitis. Repetitive trauma including friction, pulling and twisting forces can lead to a soft tissue injury.

Sprains

Sprains involve the stretching or partial or complete tear of a ligament, when the joint has been forced to move beyond its normal range of motion.

Common joints that can be sprained include the wrist and the ankle.

Sprains are an acute injury, meaning that they occur with a sudden onset during a traumatic event such as falling off a bike or slipping off a gutter.

Typical symptoms of a sprain include bruising, swelling, instability of the joint, and pain.

The severity of these symptoms will depend on the severity of the sprain. Sprains are common in change of direction sports such as football, netball and hockey.

Strains

Strains involve injury to a tendon which connects a muscle to a bone, or within a muscle itself.

Typical symptoms of a strain include pain, muscle spasms/cramping, weakness of the structure, swelling and inflammation.

These usually occur as an acute injury during rapid starts and movements. They are common in sports that require short sharp movements and increases in speed when running such as various disciplines within athletics, swimming, football, basketball and so on.

The mechanism of injury involves the muscle or tendon stretching or contracting too quickly, meaning that the fibres cannot withstand the load placed upon it.

Grading of sprains and strains

Sprains and strains can be graded in terms of the severity of the injury.

Grade 1

Mild injury

Involves stretching and slight damage of the soft tissue, which may include micro tears. There is mild tenderness and minimal swelling in the area and the person can usually place weight through the structures relatively well.

Grade 2

Moderate injury

Moderate sprains and strains involve a partial tear of the soft tissue. Moderate pain, tenderness and swelling is experienced. You may not be able to apply load to the injured area without pain.

Grade 3

Severe injury

This involves a full or complete tear of the soft tissue structure. Severe soft tissue injuries tend to mean you will have significant pain and swelling present and you will not be able to load through these structures without significant pain. A loss of motion and instability will also occur. The recovery time for grade 3 severe sprains or strains is considerably longer and may require surgery.

Contusions

Contusions, otherwise known colloquially as a ‘corky’, is the result of a direct blow to soft tissue which can cause the pooling of blood/bruising.

It can result in significant pain in the area as well as swelling and is an acute injury.

It is common in impact sports such as football, soccer, rugby and hockey.

Tendinitis

Tendinitis is an umbrella term to describe a range of conditions that can occur within a tendon.

It involves inflammation or irritation of the tendon or its sheath that protects it.

A common tendon that we diagnose with tendinitis in podiatry is the achilles tendon.

Bursitis

Bursae are small, jelly-like sacs that sit between the bone and soft tissue structure to provide cushioning and to reduce friction during movement.

Bursitis in podiatry is common within the forefoot, where there are lots of small structures connecting to one another.

Symptoms of bursitis can include pain and swelling and can be diagnosed on an ultrasound or MRI.

Risk factors for soft tissue injuries

  • Age – the risk of injury increases with age.
  • Weight – increased or excessive weight can place greater stress on the soft tissue structures.
  • Activity – high impact or fast moving activities can increase the risk of soft tissue injuries.
  • Chronically fatigued structures – for example participating in too many activities.

Phases of a soft tissue injury

There are 3 phases in the healing of soft tissue injuries.

  1. Acute – Protection Phase

  • Begins immediately after the injury occurs and generally lasts for 2-4 days.
  • Bleeding, pain and swelling is typically at its worst during this stage.
  • The aim during this phase is to protect the injured structures. Your body initiates its healing mechanisms at this stage.
  1. Sub-Acute – Proliferation/Repair phase

  • The aim of this phase transitions to repairing the injured structure.
  • It usually last for 2-6 weeks depending on the extent of the injury.
  • During this phase, the collagen fibres begin to form into scar tissue and new blood vessels are formed to assist with blood flow.
  • Swelling and bruising may start to subside but you may still experience pain and loss of function.
  • Rehabilitation activities during this phase should be kept at a pain free level so as not to disrupt the new collagen.
  1. Late stage – Remodelling Phase

  • This phase continues until the structure is fully repaired, which may last 6 weeks to 12 months depending on the extent of the injury.
  • The collagen fibres may be sticky at this point, meaning that the body has to remodel them into place in order to increase strength.

How to prevent a soft tissue injury

Whether you’re exercising daily, playing sports, or just living your life, there are a number of things you can do to help you prevent soft tissue damage, including:

Warm up and cool down – this will ensure that the soft tissue structures are prepared for activity and can recover properly.

Drink plenty of water.

Stretching and strengthening programs – these can help you work on areas that are weaker or are at a high risk of injury

Adequate recovery – this is integral in reducing your chances of injury. Allowing your body to recover will ensure that you can safely exercise without being too fatigued.

Seek medical treatment at the first sign of pain – Prevention is always better than cure! If you are experiencing any pain at all, seek medical treatment sooner rather than later to prevent the injury from deteriorating.

Recovery and Treatment of soft tissue injuries

Recovery of a soft tissue injury can depend on a number of factors, all of which must be taken into account when beginning a treatment plan.

These factors can include your age, weight, the severity of the tissue injury, your occupation and previous injuries.

You may need to present to hospital if the pain/bruising/swelling is severe and you are unable to place any pressure through the area. There are essentially 3 stages to treatment:

STAGE 1

This involves the first 24-72 hours after the injury.

This is where the ‘RICE’ principle of rest ice compression and elevation is extremely important to help reduce pain and swelling.

During this time, it is also very important to stick to the ‘No HARM’ principle – no heat, alcohol, running/activity or massage.

STAGE 2

The aim of this stage is to continue to reduce swelling, pain and stiffness within the structure.

This will depend on your level of activity and may incorporate a stretching/strengthening program, taping, massage or dry needling.

STAGE 3

The final stage is aimed at regaining normal function within the structure and return to activity.

This will involve a staged return to your normal activities depending on your pain levels and strength.

How we can help you

So, what can a podiatrist do when it comes to soft tissue injuries?

We are well versed in diagnosing and treating various soft tissue injuries within the lower leg, ankle and foot. We can help treat the affected area, restore mobility, and help you avoid permanent damage.

If you’ve suffered an injury to your lower limb or feet, or you’re experiencing any pain or discomfort, you can book in to see one of our superstar podiatrists today!

Call us on 03 9432 2689 or book online here.

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