Treatment - Soft tissue

Question 1

Aetiology of soft tissue injury

Answer 1

> Overuse - tissue = unable to repair
(symptoms may be due to lack of muscle strength/endurance)
Misuse - abnormal stress (improper form/equipment)
Abuse- overload
Disuse - deconditioned tissue

• Intrinsic factors (inside body) e.g age/genetics/co-ordination
• Extrinsic factors (outside body) e.g training levels/environment/equipment

Question 2

Cook and Purdum model

Answer 2

Normal tissue + optimal load = strengthened
+
excessive load + individual factors
= reactive tissue and eventually tissue disrepair and degenerative tissue if not adjusted to appropriate modified load

Question 3

Symptoms for soft tissue injury

Answer 3

> Muscle/Ligament

• Pain = sudden onset
• disability
• swelling
• aggs = stress on tissue via contraction/RoM

> Tendon

• Tear = similar to muscle/ligament
• Disorder = gradual onset
• aggs = loading tendon
• eases = deloading tendon (may be sore after period of rest post loading)

Question 4

Assessing for soft tissue injury

Answer 4

• AROM vs. PROM (contractile vs inert)
  > Muscle/tendon
• muscle length
• muscle strength (full RoM + isometric)
• Palpate for tenderness (locate lesion/trigger point)
  > Ligament
• accessory tests - end feel/pain/apprehension

Question 5

Treating soft tissue injury

Answer 5

> POLICE = better + faster healing than PRICE

> Tissue needs certain amount of stress to heal better

Question 6

Specific soft tissue mobilisations (SSTMs)

Answer 6

> Aiming to alter regeneration + remodelling phases (where collagen cross links form)

• providing pain relief via pain gate theory to allow function
• Collagen remodelling
• affect visco-elastic properties

> Types

• physiological
• accessory
• combined
• deep transverse frictions

Question 7

Physiological SSTM

Answer 7

> Stretching of tissue

• self directed or by therapist
• Hold for ~ 1 min to engage change (possible oscillation to get further RoM)

Question 8

Accessory SSTM

Answer 8

> Direct pressure
- pressure on tight/painful area
Bowing
- pressure on middle in sideways direction
- good for tendons + scar tissue
Transverse mobilisations
- compressive + transverse forces to superior surface

Question 9

Combined SSTM

Answer 9

> Both physiological + accessory SSTMs

- ie stretch with manual therapy

Question 10

Deep transverse frictions

Answer 10

>  force perpendicular to fibre orientation
> thought to possibly 
- break down adhesions
- increase blood supply
- re-orientate fibres 
- activate cells 
- may also cause further inflammation 
*Pressure = nothing vs stress of actual loading

Question 11

Contra-indications/Precautions

Answer 11

> Open wound
> Clotting disorders
> DVT 
> Skin infections
> Acute inflammation
> Growth plates
> skin disorders
> Possible cancer
> foreign body/implant
> rheumatoid arthritis/spondyloarthritis (cause dysregulated response)
> Bursitis 
> Neural tissue

Question 12

Creep

Answer 12

> Time dependent changes tissue deformation due to external load applied
e.g repeated stretching will lead to long term increase of RoM
increases soft tissue mobility long term

Question 13

Hysteresis

Answer 13

> Amount of time an increase of RoM is maintained post loading
e.g having stretched to increase RoM - how long that RoM will stay increased before returning to normal

> creating this will create heate, reduce stiffness and restore normal response to loading

Question 14

Stress - strain curve

Answer 14

> Amount of load to tissue vs amount of deformation