SOFT TISSUE

DAMAGE AND
HEALING
HELLO!
Riza Pahlawi

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MECHANISMS OF
INJURY
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“ Many factors produce
mechanical injuries in sport.
Soft tissue damage occur
through direct or indirect
trauma to muscle, ligament,
and joint capsules.

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SOFT TISSUE DAMAGE

▰Direct trauma
Injury occurring from blunt trauma or
sudden overload (MACROTRAUMA)
▰Indirect trauma
Result from repeated submaximal loading,
leading to clinical sign and symptoms
(MICROTRAUMA)
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THREE STAGES OF INJURY

Acute subacute chronic

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Tissue elongation curves 7
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EXAMINING SOFT
TISSUE INJURIES
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1. History
• Onset
• Pain location
• Mechanism of injury
• Prior treatment and 3. Assessment
rehabilitation 4. Treatment Goal
• Goals of athlete
5. Treatment Plan
2. Physical Exam
6. Treatment Procedures
• Inspection
• AROM/PROM
• Palpation
• Neurological
• Strength and motor control
• Special test
• Functional exam
• Gait analysis

Exammination of soft tissue injury 9

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SOFT TISSUE HEALING
PROCESS
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SOFT TISSUE HEALING PROCESS

Acute Phase
Subacute Phase

Soft tissue
healing

Chronic Phase

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ACUTE/INFLAMATORY RESPONSE PHASE

Involves a
Accumulatio
Up to 72 number of
n of exudate
hours inflammatio
and edema
n response

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ACUTE/INFLAMATORY RESPONSE PHASE

Sign of inflamation
▰Redness (rubor)
▰Swelling (tumor)
▰Tenderness and pain (dolor)
▰Increased temperature (calor)
▰Loss of function (functio
leasa)
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“ This initial inflammatory response is
critical to the entire healing process.
If this response does not approach
what is supposed to, or if it does not
subside, normal healing cannot take
place

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 SUBACUTE/FIBROBLASTIC REPAIR PHASE

Fibroblast begin to
48 hours – 6 Structures rebuilt
synthesise scar
weeks and regeneration
tissue

Capillary budding occur; collagen cross-linking begins

This phase ends with the beginning of wound contracture
and shortening of the margins of the injured area
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 MATURATION/REMODELING PHASE

Increase
3 weeks-12
Strong scar functional
months
capabilities

Regeneration of the injured muscle does not fully

restore muscle tissue to its prior levels, as fibrous scar
tissue slows muscle healing 16
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MANAGEMENT AND
REHABILITATION
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“ Rehabilitation programme
should be designed with
individual short-term and long-
term goal. Overall programme
should progress safely and
effectively.

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 Incorporate
How to therapeutic Evaluate the
assess modalities outcomes
and exercise

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STAGE 1: ACUTE INFLAMMATORY PHASE

Characterised by inflammatory reaction that

involves pain, redness, swelling, and increased
local pain that can last up to 72 hours.

Initial treatment of this phase usually

immobilisation or restriction of motion

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REHABILITATION GOAL

Protect the athlete from further

injury

Control pain

Limit swelling

Promote normal healing

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 STAGE 1 – PHYSICAL MODALITIES

P - Protection R – Rest I - Ice

▰ What is PRICE? Lindungi daerah cedera

dari gangguan yang bisa
Istirahatkan bagian yang
cedera agar tidak semakin
Kompres menggunakan es
sesegera mungkin untuk
memperparah keadaan parah mengurangi nyeri dan
▰ How long does 1-2 hari 1-2 hari
mengurangi bengkak

PRICE should be 48 jam

given?
C - Compression E - Elevation

Penekanan dengan Angkat bagian cedera

menggunakan bebat lebih tinggi dari jantung.
(bandaging) untuk
mengurangi bengkak dan
perdarahan

1-2 hari 22
 EFFECT OF PROLONGED IMMOBILIZATION

Actual loss of
collagen fibers Muscle atrophy

Contractures, Disorganization
of collagen
fibers

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STAGE 1 - THERAPEUTIC EXERCISE

• Minimise deconditioning and promote

rapid transition to the second stage

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STAGE 2 – REGENERATION AND REPAIR

The structure
REPAIR OR 48 HOURS
are rebuilt and This is a risky
FIBROBLAS UP TO 6
regeneration period
TIC PHASE. WEEKS
occurs

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REHABILITATION GOAL

▰ Allow normal healing

▰ Maintain function of uninjured parts
▰ Minimize deconditioning of the athlete
▰ Increase ROM and flexibility
▰ Improve muscle strength, endurance and power
▰ Increase aerobic capacity
▰ Improve proprioception, balance, and coordination 26
STAGE 2 – PHYSICAL MODALITIES

▰ HEAT THERAPY
▻ Increase temperature, blood flow, extensibilty
of soft tissue
▻ Useful at the start of rehabilitation session

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STAGE 2 – THERAPEUTIC EXERCISE

▰ Flexibilities exercise
▰ Strength conditioning
▰ Muscular endurance
▰ Aerobic conditioning
▰ Neuromuscular
▻ Proprioception, coordination, and balance

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 STAGE 3 – REMODELLING PHASE

3 weeks to 12 months

Remodelling of collagen
• Increase the functional capabilities of the muscle, tendon, etc.

Critical issues
• Residual strength deficit in individual muscles
• Imbalance between agonist & antagonist groups of muscle
• Side to side asymmetry
• Loss of sports specific skills
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 STAGE 3 – MANAGEMENT & REHABILITATION

Continued
conditioning

Development of
sports-specific Return of
skills the
Rehabilitatio
training &
competitio n Goals
n
Prevention of further
injury
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THANKS!
Any questions?

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INTERMEZZO
CEDERA YANG TIMBUL AKIBAT BENTURAN ATAU
PEMBEBANAN BERLEBIH, DISEBUT ?

a. Microtrauma
b. Macrotrauma
c. Indirect trauma
d. Blunt trauma

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CEDERA YANG TIMBUL AKIBAT PEMBEBANAN YANG
DILAKUKAN BERULANG ULANG DALAM WAKTU YANG LAMA

1. Direct trauma
2. Indirect trauma
3. Macrotrauma
4. Microtrauma

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CEDERA YANG TIMBUL AKIBAT PENAMBAHAN BEBAN SECARA
BERTAHAP SELAMA LATIHAN DISERTAI ADANYA INFLAMASI

a. Acute phase injury

b. Subacute phase injury
c. Chronic phase injury
d. Inflamatory phase injury

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TAHAPAN YANG PALING MENENTUKAN KESELURUHAN PROSES
PENYEMBUHAN CEDERA JARINGAN LUNAK ADALAH..

a. Remodeling phase
b. Proliferasi phase
c. Inflamatory phase
d. Fibroblastic repair phase

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DAMPAK NEGATIF YANG DITIMBULKAN OLEH IMOBILISASI
DAPAT TERLIHAT DALAM WAKTU..

a. 6 jam
b. 72 jam
c. 7 hari
d. 4 minggu

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PEMBENTUKAN JARINGAN IKAT SUDAH SEMAKIN KUAT DISERTAI
DENGAN PENINGKATAN KEMAMPUAN FUNGSIONAL

a. Inflamatori phase
b. Subacute phase
c. Fibroblastic repair phase
d. Remodeling phase

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PENANGANA AWAL UNTUK MENCEGAH DECONDITIONING

1. PRICER
2. Isometric exercise
3. Active ROM exercise
4. Pasive ROM exercise

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GOAL REHABILITASI PADA FASE KE 2 ADALAH

1. Mengontrol bengkak dan nyeri

2. Mempertahankan fungsi dari bagian yang
tidak cedera
3. Melindungi atlet dari cedera lanjutan
4. Peningkatan kekuatan, ketahanan, dan
power otot

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KAPAN TERAPI PANAS DAPAT DIGUNAKAN DALAM FASE
REHABILITASI CEDERA JARINGAN LUNAK ?

1. Acute phase
2. Inflamatory phase
3. Remodeling-maturation phase
4. Regeneration-repair phase

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