Soft Tissue Injuries

When muscles, tendons, or ligaments of the body are injured due to participation in sports, exercises or doing daily activities, it causes a soft tissue injury. 

Soft tissue injuries are typically classified into two types: 

1. Acute
2. Overuse

Acute Soft Tissue Injuries

1. Sprain - A stretch or partial tear in the ligament mainly caused due to sudden twisting, turning, and rolling movements. Ligaments are elastic tissue bands connecting one end of a bone with another. These ligaments provide stability to the bones keeping them in one place. Ankles, knees, and wrists are most vulnerable to sprains. Depending on the severity, sprains are classified in the following ways:-
   1. Grade I (mild): Slight stretching of the ligaments. There may be some damage to the fibres of the ligament.
   2. Grade II (moderate): Stretching and partial tear of the ligament. The affected individual may also experience slight joint instability and pain while applying weight to the injured joint. 
   3. Grade III (severe): Complete tear of the ligament. Significant instability in the affected joint and restricted range of motion. 
2. Contusion - If an individual experiences a sudden blow (or repeated blows) by a blunt object, it can result in a bruise or contusion on the affected surface. In this injury, the object doesn’t pierce the skin but crushes the ligament tissues and muscle fibres in the affected area beneath the skin. A forceful kick or fall can also cause a contusion. The affected individual will experience pain, swelling, and discolouration due to bleeding in the tissues.
3. Strains - It is an injury of the muscle or a tendon. Tendons are fibrous tissues that connect muscles to bones. The severity of strains is similar to that of sprains. An individual may experience both a partial and a complete tear of the muscles. The back and leg are most commonly affected by strains. 

Overuse Soft-Tissue Injuries

1. Tendonitis - When repeated movements cause tendon inflammation, it is known as tendonitis. It is often named after the sports or movement that causes the inflammation, along with the name of the affected area as a suffix, for example, a golfer’s elbow, jumper’s knee, swimmer’s shoulder, etc. 
2. Bursitis - An inflammation in the bursae- sacs filled with liquid located throughout the body. It provides a cushion and prevents friction between the bone surface and soft tissues. Bursitis commonly affects the elbow, knee, ankle, foot, hip, and shoulder. Like tendonitis, it can be caused due to repeated stress, overuse, or direct trauma to a joint. 
3. Stress Fracture - Stress fractures are cracks in the bones due to repetitive force on the weight-bearing bones, including legs, hips, and feet. An increase in physical activities or overuse can also cause a stress fracture. Sometimes, osteoporosis- a condition in which the bones grow weaker with age also results in stress fractures.

The symptoms may vary depending on the type of injury, but some of the common symptoms may include:-

1. Immediate pain
2. Swelling
3. Stiffness due to swelling
4. Redness or bruising can also occur after 24-48 hours
5. Restricted range of motion

Patients with severe to moderate soft tissue injuries may also experience instability, especially in the weight-bearing joints like the hip, knee, and ankle.

As already discussed, soft tissue injuries are of two types: acute and overuse. 

1. Acute injuries can occur due to a sudden trauma or fall. Unexpected or awkward movement resulting in overstretch or twisting of the muscles or ligaments can also cause an acute injury. Examples include wrist fracture, ankle sprain, shoulder dislocation, and hamstring muscle strain. 
2. Overuse injuries, as the name suggests, occur due to the overuse of tissues when people suddenly increase the intensity and duration of their activities. Repeated movement of the same joint, exercising for a long duration or speeding up a movement without giving proper time for rest and recovery leads to an overuse injury. Examples include tennis elbow, swimmer’s shoulder, youth pitching elbow, runner’s knee, jumper’s knee, etc. 

 Risk Factors

Soft tissue injuries are common in the following sports:-

1. Football
2. Hockey
3. Kabaddi
4. Basketball
5. Badminton
6. Tennis
7. Golf
8. Swimming

During the physical examination, the doctor checks for swelling and tenderness in the affected area. It helps in determining the severity and extent of the injury. If the muscle or tendon has been critically damaged, the patient may require an imaging procedure like an X-ray or an ultrasound to identify the intensity of the defect in order to pursue the right approach for treatment.

RICE protocol is usually the most effective way to treat soft tissue injuries. It is the initial treatment method usually followed by physiotherapy and medication.

1. Rest: The person must avoid doing the activity that caused an injury for at least the first two days. Rest will also help in preventing further bruising. Weight-bearing is often restricted for 24-48 hours in case of soft tissue injuries. 
2. Ice:  Ice is the most effective solution to reduce pain and inflammation. Apply an ice pack for about 20 minutes at a time. Repeat this procedure every two to three hours for the first two days after the surgery. Note: Don’t apply ice directly on the skin. Cover it in a towel to avoid frostbite. Frozen peas or corn can also be used to reduce swelling. 
3. Compression: Wrapping the injured area with an elastic compression bandage is also beneficial to avoid swelling. The bandage should not be wrapped too tightly, or it can interrupt the blood flow. After wrapping the injured area, if the skin below the bandage turns blue or cold, or the person experiences numbness or tingling in that area, it is important to loosen up the bandage. If these symptoms persist, he/she should consult a doctor. 
4. Elevation: Raise the affected body part above the level of the heart. It might seem complicated to do, but it is not that tricky. Elevation helps in reducing pain, throbbing, and swelling. For example, a person with an ankle sprain can raise his/her leg with the support of pillows or cushions while sitting on a sofa or lying on the bed.  

There may be some variations in the treatment depending on the type and severity of the injury. For example, some injuries like sprains require a period of bracing to keep the affected limb immobilised.

Medication

The doctor may also suggest taking non-inflammatory medicines like Ibuprofen and Naproxen along with the RICE treatment. If swelling persists, a corticosteroid injection may be required. It is stronger than the anti-inflammatory medication taken orally and helps reduce pain and swelling. 

Surgery

The surgical approach is rare to treat soft tissue injuries. Although in some cases, if the severity of the injury is high and RICE protocol is ineffective, the patient may need to undergo surgery. It can be open surgery - a traditional approach, or arthroscopic surgery - a minimally invasive (small incisions) technique for treatment. 

Physiotherapy Treatment

Physiotherapy can speed up healing and help the patient regain normal functionality in less time. The doctor may refer the patient to a physiotherapist who assesses the injury and gives appropriate exercise advice for a prompt recovery.

People often avoid immediate treatment in case of a soft tissue injury so they don’t have to take a break from their everyday activities. But ignoring muscle or tendon injuries can lead to serious health risks in the long run. 

Grade I soft tissue injuries can be easily treated at home following the RICE protocol. But if left untreated, these injuries can cause intense pain and discomfort for the person. If the problem gets more severe over time, it will cost the patient a great deal of money and time for treatment.