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SOF T T IS SU E I NJ U R IE S

A INS , C ON T U SIONS
TE ARS, SPR
NS, B LISTERS
NS , LA CE RA TIO
SKIN ABRASIO
E
INFLAMMATORY RESPONS
Soft tissue injuries are injuries to any type of body tissue other than bone and teeth.

They include: tears, such as ligament sprains and muscular strains. However, you also need to
know about simple injuries like a skin abrasion or a blister.

These injuries all stimulate the same inflammatory response form the body, which can result in
further damage if not controlled through the application of RICER (Rest, Ice, Compression,
Elevation, Referral). The RICER treatment of a soft tissue injury aims to decrease inflammation,
allowing enough inflammation to repair the injured tissue, but not so much as to cause further soft
tissue damage.

In addition to this, you should know how to treat skin injuries (abrasions, contusions, blisters etc).
The essential goal of such treatment is to stop blood loss.

The management of soft tissue injuries has been given its own page in order to fully address the
management of these injuries.
2011 Question 29 (a) (i) Outline types of soft tissue injuries. 3 Marks
Strain
Tears, sprains and contusions are three types of soft tissue injuries. Tears can happed to any soft tissue, but
the two (2) most common are strains and sprains.
A strain is a tear that occurs in a muscle. Often it is referred to as a pulled muscle or a commentator might
say the athlete has done his hamstring in reference to a tear or strain. Strains (muscle tear) are normally
caused by internal forces, poor technique or overtraining. Strains are often classified by a grading system with
three (3) levels:

Grade 1 tear/strain is a small tear to the muscle.


Grade 2 tear/strain is a much larger tear around 50% or more torn.
Grade 3 tear/strain refers to a complete tear, so that surgery is needed to join the muscle back together.
An example of a strain is a pulled hamstring
Sprain
A sprain is a tear that occurs to a ligament (joining bone to bone around joints). Sprains are often caused by an
external force being transferred through the body often to the other side of a joint. They are always caused by a
joint being bent in a direction it is not meant to move. Just like a strain, a sprain has three (3) levels of
classification, that are exactly the same as above only applied to a ligament.

So a third degree tear is a ligament that has been torn in half and needs surgery to repair. An example of a
sprain is a rolled ankle in netball or an ACL rupture in the knee.
Contusion
A contusion is when capillaries are ruptured causing internal bleeding. It is normally referred to as a bruise. A
bruise is normally caused by external force upon the soft tissue that results in the capillaries bursting.
Contusions are also caused through internal forces being imbalanced resulting in capillaries bursting.

Skin abrasions, lacerations and blisters are three (3) other soft tissue injuries, but all occur at the skin level and
result from external forces.

Skin Abrasions
A skin abrasion is a scraping or wearing away of the skin and is usually not very deep. Usually an abrasion is
referred to as a graze. These are common injuries in any sport, especially those where the athlete may
frequently fall or be tackled. and example of an abrasion is a grazed knee from a slide tackle in soccer.
The treatment for skin abrasions is normally to clean the wound, washing it with a disinfectant and then covering
it with a non-stick dressing. In the case of a more serious abrasion the management of blood loss will become
the priority, though this is very rare for an abrasion.
Laceration
A laceration is a deep cut or tear to the skin of resulting from contact with a sharp device. So a cut from a
kitchen knife is a laceration, but also a cut from an ice-hockey skate, bob-sled or a tear from a stud in rugby.
Lacerations often result after a head clash or contact with other sport specific equipment. An example is an ice-
hockey player who gets hit with a stick cutting his skin open.
The treatment for a skin laceration is to manage bleeding. Applying pressure to the area. Depending on the
severity of the laceration, medication attention and stitches or surgery may be needed. For self-managed
lacerations, cleaning the wound and applying a non-stick dressing with pressure to control bleeding is usual. If
bleeding does not stop quickly, ice can be used, and medical treatment is needed.

Blister
A blister is caused by friction or burning that leads to a build up of serum in the skin. Athletes often get blisters
on their feet due to friction from their shoes. Most often blisters are caused by equipment such as a tennis
racquet or soccer boot.
The treatment for a blister, is to cover it with padding, often in the form of a Band-Aid and remove the object
causing the friction/burning. Do not pop the blister, but allow it to heal.
Inflammatory Response
The inflammatory response is the bodies natural reaction to injury and infection. The inflammatory
response involves vasodilation (widening of blood vessels) allowing more blood to the area and
more fluid to exit the vessels into the surrounding tissue. This increases the white blood cells
(leucocytes) entering the area to clean up debris and fight infection (if the injury is open).

The inflammatory response has three phases:

Phase 1 Acute Inflammation


During the acute inflammatory stage, inflammation is fast and painful. The inflammatory response
during this phase involves the vasodilation of blood vessels, and the transfer of fluid into the
surrounding tissue. The inflammatory response causes secondary (additional) damage to the area.
The athlete loses function as inflammation (swelling) is large. New blood vessels begin to be
developed in this phase and the area is swollen, red and painful. The acute inflammatory phase
lasts 48-72 hrs (2-3 days) and it is during this time that RICER is most important.
Phase 2 Repair Inflammation

During the repair phase of the inflammatory response, the body begins to fix the damaged or injured site. The
white blood cells (leukocytes) clean up the debris from the injury and new body tissue begins to be formed.
Often this phase of the inflammatory response produces scar tissue in the repair of the injury, which needs to be
minimised for proper healing to occur as scar tissue is weaker than normal tissue. This phase extends from 3
days to up to 6 weeks.

Phase 3 Remodelling Inflammation


The remodelling phase of the inflammatory response continues to rebuild the injured area. More scar tissue is
produced during this phase of the inflammatory response, but also new functional body tissue is developed and
strengthened. This tissue can replace scar tissue if proper treatment is sought from health professionals. During
this phase of the inflammatory response the balance of exercise and rest is important as too much exercise will
cause further injury, but not enough exercise will result in too much weak scar tissue. This phase of the
inflammatory response can last many months. An athlete will not be back to full health until this phase is
completed (though they often have already returned to play).
It is important to remember that while the inflammatory response is necessary for repair of the injury, too much
inflammation causes further damage. There are five signs/symptoms of inflammation: redness, swelling, pain,
heat, and loss of function.
The management of soft tissue injuries focuses on controlling the inflammatory response and minimising pain.
The immediate management of soft tissue injuries is known as RICER (Rest, Ice, Compressions, Elevation,
Referral) and is applied for at least the first 48hrs.

Rest
the first thing to do when managing soft tissue injuries is to stop playing the sport or doing the exercise and then rest
the area injured. Rest means the area where the soft tissue injury occurred remains still. If this is an ankle then the
joint should not be moved. Rest is better if the athlete does not engage in any physical activity as this allows the body
to focus on healing the injured area.
Rest helps to prevent further damage to the injured area, which helps ensure the inflammatory response is not
stimulated again.
Ice
When managing soft tissue injuries ice should be applied as soon as possible. Ice is often in the form of an ice pack,
or a bag of ice, but can include other forms of cryotherapy. Ice should be applied over the first 48hrs. There are many
methods to icing a soft tissue injury eg 20 min on 20 min off or 1 hr on 1 hr off. Generally as long as ice is consistently
applied to the area with short breaks benefits will occur.
The appllcation of ice to manage soft tissue injuries helps reduce the pain, decreases inflammation, and speeds up
recovery. The ice itself causes vasoconstriction (narrowing of the arteries) around the area reducing inflammation,
then when taken off the vessels dilate (vasodilation) allowing the blood to flow through with a momentary increase in
the inflammatory response that allows waste removal and new nutrients to be delivered for repair.
Compression
Compression is vital in the management of soft tissue injuries as it helps to reduce or control the inflammatory
response and stabilises the joint (if injured). Compression involves the application of a compression bandage or
garment around the injured area. The pressure applied helps force fluid away from the area reducing the
inflammation at the area. The bandage can also help reduce movement, limiting re-injury, and provide support
for the injured area.

Elevation
In the management of soft tissue injuries it is important to get elevation correct. Often athletes put their injured
ankle on a chair and think it is elevated, but elevation of the injured soft tissue must be above the heart. This
means an injured elbow could be rested on the chest as a person lies down or an ankle needs to be placed on a
pillow or 2 while the athlete lies flat. Elevation only works in the management of soft tissue injuries if the sight
injured is above the heart.
Elevation above the heart means gravity can assist in the removal of fluid from inflammation. Gravity helps to
move the blood and other fluid back towards the heart reducing or controlling the inflammatory response.
Referral
Finally, referral of the athlete to a health or medical profession should be done in the management of soft tissue
injuries. This allows for proper diagnosis and rehabilitation to be applied if needed. This will help improve
recovery and prevent future injury to the site. Often GPs will provide an anti inflammatory drug to help reduce
pain and improve recovery.
It is important to control the inflammatory response after suffering a soft tissue injury because of left to its own
devices, the inflammatory response will cause further damage to the area because too much inflammation
increases the pressure around the injury which damages the nearby cells delaying recovery.