Chronic soft tissue injuries

These types of injury are the result of repetitive stress on a tissue. Commonly known as overuse injuries. See our Tendinopathy post for more details.

Signs and symptoms

Different soft tissue injuries have different signs and symptoms but there is usually some level of redness and swelling, as well as pain and reduced range of motion. There may be some bruising.

Joint-stabilising ligament injuries

Ligament injuries range from mild tearing of a few fibres to complete tears, which can lead to joint instability. The common areas affected are the knee and ankle, but it can also happen around the shoulder, elbow and wrist.

Ligament injuries are graded from 1-3:

1. Minor injury with little swelling and tenderness: minor impact on function due to intermittent pain on movement. Grade 1 usually heals in a few weeks, with max strength returning after 6 weeks.
2. Ligaments are stretched but intact: some joint laxity (giving way) may be experienced as well as moderate swelling pain and negative impact on function. Grade 2 requires some reduction in use to offload the tissue during the initial phase. Healing may take anywhere from 6 to 12 weeks depending on the injury.
3. Complete ligament rupture with excessive joint laxity: Often painful but can also be pain-free due to the destruction of sensory fibers in the injury. Marked swelling and bruising. Painful or inability to weight-bear. Grade 3 requires the opinion of an orthopedic specialist to determine if it requires surgery. A return to normal activity can take anywhere from 4 to 12 months

Muscle Strains

Muscle strains are the same as ligament sprains but in a different type of tissue in the body. Strains happen when a muscle is overloaded and fails, causing tearing of the fibres. We grade muscle strains in the same way as ligaments, from one (mild) to three (severe). Symptoms include swelling, bruising, redness, pain at rest and with movement, inability to use the muscle (moderate to severe only), and muscle weakness.

Treatments for muscle strains depend on the severity of the injury. Initially, POLICE protocol (see below) should be followed. An assessment and accurate diagnosis by an osteopath or physiotherapist will help to determine when and how the muscle can safely be loaded again. The initial rehab starts with low impact movements, followed by a gradual increase in tension.  Proprioception and endurance training is recommended only in the advanced rehab stages.

Tendon Injury

Tendons connect muscles to bones and work to transmit forces between the two. The most common tendon pain is from overuse – called tendinopathy. However, acute tendon ruptures also occur.

Tendon ruptures often happen without warning or apparently for no particular reason. The most frequently injured tendons are covered below.  A ‘pop’ or a ‘bang’ followed by weakness and pain, is a common sign that a complete rupture has happened. These commonly happen in the achilles in the ankle and the bicep tendon in the upper arm.

Rotator cuff tendon injuries are categorised based on which of the four rotator cuff tendons is affected and the extent of the injury – small/medium/large/complete tear. Symptoms include severe pain at the time of injury, night pain, pain with overhead movements, pain radiating down the arm, and shoulder muscle weakness.

Full-thickness tears require surgical intervention, however, in most other cases conservative rehab is recommended – such as osteopathy, physiotherapy, or acupuncture and specific exercises and stretches.

Bicep tendon injuries often occur after a strong, sudden contraction of the bicep muscle. Similar to the rotator cuff, symptoms include pain in the front of the shoulder, pain with overhead movements, night pain and ‘pop-eye deformity’ – when the bicep muscle, under contraction, appears to rise lower down the arm.

Surgery is generally offered to younger patients that are athletic or require maximal arm strength – Tradesmen, for example. Conservative management is recommended.

A Quadriceps tendon rupture means you will be unable to straighten the knee without help. Some people can walk after injury, some cannot. Graded as either partial or complete.

Partial ruptures require a short period of immobilisation (possibly in a moon-boot) followed by a gradual return to normal activities with specific strengthening exercises. 3-6 week heal time.

A complete rupture calls for surgery, usually in the 72hrs following injury, to reattach the tendon. Following surgery is a period of immobilisation. Depending on the patient and surgeon, rehab will either be conservative (around 4-6 weeks immobilisation) or aggressive (around 10 days immobilisation with exercises included early on). The aggressive approach has produced better results more quickly but it is not for everyone.

People with Achilles injuries often report that the injury felt like someone kicked/stabbed them in the leg, accompanied by a ‘bang’. Other symptoms include swelling in the back of the heel, decreased ability to heel raise or point toes and a palpable gap in the tendon. Achilles injuries are graded 1-4:

• Grade 1: partial ruptures, less than 50% – typically treated with exercises and manual therapy.
• Grade 2: complete rupture with tendinous gap ≤ 3 cm – typically treated with surgery
• Grade 3: complete rupture with tendinous gap 3 to 6 cm – surgery required
• Grade 4: complete rupture with a defect of > 6 cm (neglected ruptures) – surgery required

Rehabilitation

Like the different signs and symptoms, there are also different rehab stages depending on the severity of your injury. Seeking professional guidance after a soft tissue injury will help you to reach your recovery goals faster. Injury specific exercises, massage, joint mobilisation and natural pain relief will speed up recovery and help prevent re-injury.

At-home care

Everyone has heard of RICE: Rest, Ice, Compress, Elevate.

However, I’d like to introduce a new mnemonic, POLICE: Protect, Optimum Loading, Ice, Compression, Elevate.

• P: Protect yourself from further damage by taking an appropriate amount of time off. Have the injury assessed by a professional to find out how long you should rest and when you can return to daily activities.
• O + L: “Optimal Loading” helps to encourage tissue healing, stimulating repair and building strength in the damaged tissue so it can cope with the strains placed on it when you return to your sport/work. Graded loading helps to prevent stiffness, reduce swelling, and reduce pain. Loading an injury is a key element in producing strong tissue that can handle the forces you place on it. This helps prevent future injury.
• I: Ice. Cryotherapy causes the blood vessels in the area to tighten and in doing so reduces swelling, while also reducing inflammation. However, inflammation is part of the natural healing process after a traumatic injury. Icing an injury for long periods of time can cause further tissue damage and prevent optimum healing. We recommend using an ice pack for 10mins at a time, then having a break and coming back to it again in an hour. Remember to wrap your ice pack in a damp towel or cloth to minimise skin irritation.
• C: Compression also helps to reduce swelling and any bleeding at the injury site. A compression bandage (tubigrip) can provide comfort and support to an injury. It should not increase pain or be so tight that the area beneath it turns red/purple.
• E: Elevation increases the return of blood toward your heart, reducing swelling and easing pain by facilitating the removal of inflammation by-products that cause extra nerve sensitivity.

Frequently Asked Questions

What is the best treatment for a soft tissue injury?

This is highly variable and depends on the extent of the injury. What’s important is following the P.O.L.I.C.E protocol directly after the injury, seeking professional advice, and getting an accurate diagnosis. 

How long does it take for a soft tissue injury to heal?

Factors that influence the recovery time include the age of the patient, the patient habits such as smoking, and adherence to the rehab protocol.

Can soft tissue damage be permanent?

Yes. Some ruptures do not qualify for surgical repair and are therefore permanent. However, this is generally only the case when the patient is not in pain or surgeons determine that surgery would non-beneficial or non-successful. Most other soft tissue injuries will heal given the right time and rehab.

Is soft tissue damage painful?

Yes. However, patients often report feeling pain at first followed by a period of no pain when the tissue has fully ruptured.

Is heat good for soft tissue injury?

No. Heat is great for tired or spasmed muscles. Applying heat can also be used as an ice/heat flush if recommended by your health professional. However, acute/new soft tissue injuries should always have ice applied to help reduce inflammation and swelling.

Does massage help soft tissue damage?

Yes. But only after the initial acute phase has passed. Osteopathic treatment can help with repair and healing, reducing swelling, inflammation, pain from compensatory movements and addressing why the injury happened. Your Osteopath will also help to diagnose the injury and guide your rehabilitation. You will get back to your best, pain-free-self faster than if left alone.

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