Chapter 10: Soft Tissue Injury, Repair, and Management

Introduction

The effective use of therapeutic exercise in the management of musculoskeletal disorders depends on sound clinical reasoning based on the best evidence available that supports the selection of the treatment interventions. Examination of the involved region and the entire movement system is an important prerequisite to identify the impairments as well as any movement patterns that are limiting or may be preventing full participation in desired activities. It is also important during the examination process to determine whether the tissues involved are in the acute, subacute, or chronic stage of recovery so that the type and intensity of exercises do not interfere with recovery but can most effectively facilitate healing for maximum return of function and prevention of further problems. This chapter and subsequent chapters in this book have been written with the assumption that the reader has a foundation of knowledge and skills in examination, evaluation, and program planning for orthopedically related problems in order to make effective choices of exercises that will meet the goals.

Utilizing the principles presented in this chapter, the reader should be able to design therapeutic exercise programs and choose techniques for intervention that are at an appropriate intensity for the stage of healing of connective tissue disorders. Specific joint, soft tissue, bony, and nerve lesions, as well as common surgical interventions, are presented in the remaining chapters.

Musculoskeletal Disorders and Tissue Response to Injury

Examples of Soft Tissue Lesions

Strain. Overstretching, overexertion, or overuse of soft tissue; tends to be less severe than a sprain, occurs from slight trauma or unaccustomed repeated trauma of a minor degree. This term is frequently used to refer specifically to some degree of disruption of the musculotendinous unit.^4,5

Sprain. Severe stress, stretch, or tear of soft tissues, such as joint capsule, ligament, tendon, or muscle. This term is frequently used to refer specifically to injury of a ligament and is graded as a first (mild), second (moderate), or third (severe) degree sprain.⁵

Dislocation. Displacement of a part, usually the bony partners in a joint, resulting in loss of the anatomical relationship and leading to soft tissue damage, inflammation, pain, and muscle spasm.

Subluxation. An incomplete or partial dislocation of the bony partners in a joint that often involves secondary trauma to surrounding soft tissue.

Muscle/tendon rupture or tear. If a rupture or tear is partial, pain is experienced in the region of the breach when the muscle is stretched or when it contracts against resistance. If a rupture or tear is complete, the muscle does not pull against the injury, so stretching or contraction of the muscle does not cause pain.¹

Tendinopathy/tendinous lesions. Tendinopathy is the general term that refers to tendon injury affected by mechanical loading.^16,19 Tenosynovitis is ...