Professional Documents
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Chapter 10
• Sub-Acute (Repair and healing) signs of inflammation decreases, pain is felt when stressing
new tissue beyond its tolerance, muscle may test weak and function will be limited; usually
lasts 10-17 days (14-21 days after onset) and may last up to 6 weeks
The Physical Therapist will examine, evaluate, and create a program to assess the impairments and
develop functional and obtainable goals for the patient. The programs will be patient specific and
appropriate for the stage of healing
Examples of Soft Tissue
Lesions-Musculoskeletal
Disorders
• Strain
• Sprain
• Dislocation
• Subluxation
• Muscle/Tendon rupture or tear
• Tendinous lesion/tendinopathy
– Tenosynovitis
– Tenovaginitis
– Tendinosis
Continued: Examples of Soft Tissue
Lesions-Musculoskeletal Disorders
• Synovitis
• Hemarthrosis
• Ganglion
• Bursitis
• Contusion
• Overuse Syndrome
Clinical Conditions Resulting
from Trauma Pathology
• Dysfunction
• Joint dysfunction
• Contractures
• Adhesions
• Reflex muscle guarding
• Intrinsic muscle spasm
• Muscle weakness
• Myofascial compartment syndromes
Severity of Tissue Injury
• Grade 1 (first degree)-Mild pain within the first 24
hours, with mild swelling, local tenderness, and pain
when the tissues are stressed
• Grade 2 (second degree)-Moderate, requires stopping
the activity, stress and palpation to the tissue causing
increase pain, when it is a ligament-some fibers are torn
resulting in increase joint mobility
• Grade 3 (third degree)-Severe, near complete/complete
tear of avulsion of the tissue (tendon/ligament) with
severe pain, stresses to the joint do not involve pain and
palpation may reveal defect, torn ligaments results in
instability of the joint
Irritability of Tissue: Stages of
Inflammation and Repair
• Acute Stage
• Subacute Stage Discussed in earlier slide
• Chronic Stage
• Chronic Inflammation (Overuse syndrome)-increase
complaints of pain, swelling, and muscle guarding lasting
more than several hours after activities, stiffness, loss of
ROM 24 hours after activity
• Chronic Pain Syndrome – persistent pain longer than 6
months-physical, emotional, and psychosocial parameters;
pain inconsistent with source of irritation, inflammation,
functional limitation, disability
Management Guidelines-
Protection Phase
• Control the effects of swelling, facilitate wound
healing and maintain normal joint function
• Patient education (HEP)
• Minimize pain/swelling by 1st 24-48 hours with
rest, cold, compression and elevation
• Prevent adverse reactions from immobilization
• Tissue specific movement to prevent abnormal
adherence
• Gentle intensity to prevent increase pain/swelling
• General movements to uninjured tissue and to aid
in circulation/lymphatic flow
Specific Interventions And
Dosage For The Protection
Phase
• PROM
• Low-dosage joint mobilization techniques
• Muscle setting
• Massage