Soft tissue injuries (STI) are when trauma or overuse occurs to muscles, tendons or ligaments. Most soft tissue injuries are the result of a sudden unexpected or uncontrolled movement like stepping awkwardly off a curb and rolling over your ankle. These are injures we see every day at our Edinburgh physiotherapy and sports injury clinics. However, soft tissue damage can also occur from excessive overuse or chronically fatigued structures, especially muscles and tendons. For example, if you were to do a long run when already fatigued (from a previous run or exercise), then it is possible to cause trauma or a strain to key running musculoskeletal structures like your calf muscles or achilles tendons, also see: “How to prevent running injuries”.
What is the difference between a strain and a sprain?
Tendons are fibrous bands that attach muscles to bone. Trauma to muscles or tendons due to overstretching is referred to as a ‘strain’. Ligaments are also fibrous bands that hold bones together. Trauma by over-stretching of ligaments is referred to as a ‘sprain’. Strains and sprains are both very common, and can occur from accidents during sport, at home or at work.
There are three levels or grades of severity:
Grade 1 strain or sprain (mild)
Minimal over-stetching. Possible minor microscopic tearing of fibres
Mild tenderness and minimal swelling
Grade 2 strain or sprain (moderate)
Partial tear of fibres
Moderate pain, tenderness and swelling
Unable to apply loading to injured area without pain
Grade 3 strain or sprain (severe)
Complete rupture of structure
Significant pain and swelling
Inability to use the injured structure
Instability of the affected joint
What are the symptoms of soft tissue injuries?
When soft tissue is damaged, there is usually immediate pain along with immediate or delayed swelling (excessive swelling can slow the healing process – see treatment below). Stiffness is also very common as a result of the trauma and swelling. Bruising may also develop after 24-48 hours.
In the case of moderate to severe soft tissue injuries of muscles, tendons and ligaments around a joint, there may be instability experienced, especially to weight bearing joints like the hip, knee and ankle.
How long will it take to recover from a soft tissue injury?
The recovery time from grade 1 soft tissue injuries in one to two weeks and three to four weeks for a grade 2. Grade three soft tissue injuries require immediate assessment and treatment, with much longer recovery times. Recovery times can also depend on your age, general health and occupation. If you are not sure of the nature or extent of your injury, contact an experienced Specialist Physiotherapist for advice.
Should I go to hospital with a soft tissue injury?
With severe trauma, there may also be a fracture and as with all severe trauma, it is advisable to go direct to A&E for an detailed assessment and diagnosis. A good gauge for when a soft tissue injury requires a full examination is, for example if:
You are unable to put any weight on the injured structure
There is any unusual deformity or shape
You heard a pop or crack at the time of injury
Any surrounding bony structures are painful
There is presence of neurological signs like numbness or pins and needles (either at the injury site or anywhere else)
Treatment for soft tissue injuries:
There are principally three stages of treatment and recovery from soft tissue injuries like ankle sprains
Stage one: During the first 24-72 hours, it is important to protect the injured area, gain an accurate diagnosis and follow the PRICE regime (see below). If possible, gentle pain free movement should be encouraged.
Stage two: Reduce swelling and stiffness and begin to regain normal movement.
Stage three: Regaining of normal function and return to normal activities.
Protect Minimise using the affected area the area and initially avoid stretching which could further weaken the damaged tissue.
If trauma is severe, protect the injury from further damage. Stop any activity that will aggravate the injury. Use of crutches to take the weight off an injured knee, hip or ankle injury may be necessary. A sling may help to protect an arm or shoulder.
Rest Rest and avoid activities that cause significant pain (for example walking, raising your arm). Allow sufficient rehab time for even small injuries. Choose alternative.
Ice Wrap ice cubes in a damp tea towel, use frozen peas or a sports ice pack. Use the ice pack for 15–20 minutes every three to four hours when awake.
Very cold products can induce hypothermia or cold burns so wrapping the ice in a cloth is advisable.
Compression Apply a firm bandage that does not restrict circulation or cause additional pain. The bandage should cover the whole joint.
Elevation Raise the limb above the level of your heart, if possible in order to help reduce the swelling. Support the limb with cushions or a sling to keep it raised when not walking or using the limb.
Pain relief may also be required. If you are not sure what medication to use, your Specialist Physiotherapist, Pharmacist or GP can advise you.
What to avoid when you have a soft tissue injury?
In the first 48-72 hours, it is important to avoid the following:
Heat Increases blood flow and swelling.
Alcohol Increases blood flow and swelling, and will slow up the healing process.
Massage Promotes blood flow and can increase swelling and can therefore increase damage if begun too early.
Physiotherapy treatment for soft tissue injuries
An experienced Physiotherapist can assess your injury, and confirm both the diagnosis and extend of damage. They will provide you with advice, hands-on treatment and exercises which will promote a prompt and effective recovery, as well as reduce the risk of further injury in the future. (see also “how to avoid running injuries”) Your Specialist Physiotherapist will also advise you on a progressive return to normal activities and alternative exercises to follow whilst you are injured.
Phil has over 17 years of experience working with professional and international athletes and teams throughout UK, Australia and South Africa, including the South African Springboks, Leicester Tigers and Ulster Rugby as well as the South African Triathlon Team.