Soft Tissue Injury

What is a soft tissue injury?

A soft tissue injury happens in the soft parts of your musculoskeletal system, like your muscles, tendons and ligaments. These are the tissues that support your skeleton and help it move. You can injure these tissues during physical activity or in an accident. Sudden, excessive force can also cause a traumatic injury, or chronic overuse may cause a repetitive strain injury. Most soft tissue injuries heal with time and rest.

What are the different types of soft tissue injuries?

Acute (immediate) soft tissue injuries include:

• Strains. A strain is when you overstretch or tear a muscle. You can strain a muscle by pulling it too hard or for too long. Sudden movements with a lot of force or repetitive movements with normal force cause muscle strains. Groin strains and hip flexor strains are common sports injuries. You can also strain or tear a tendon, the tissue that attaches a muscle to a bone.
• Sprains. A sprain is a tear in a ligament that holds a joint together. Ligaments connect and stabilize the muscles and bones in a joint. When something forces a joint too far out of its normal range of motion, it can stretch and tear the ligament, weakening your joint. For example, you might sprain your ankle by twisting it or sprain your wrist by falling onto your hand.
• Contusions. A contusion is a bruise, which is what you see when broken blood vessels cause discoloration under your skin. A forceful blow may break blood vessels deep within your soft tissues, including your muscles. A muscle contusion may not be visible, but it’s painful and takes time to heal. If it doesn’t heal completely, it can sometimes lead to long-term complications.

Repetitive strain injuries that may affect your soft tissues include:

• Tendonitis. Tendonitis is inflammation and swelling in a tendon. It has several causes, but the most common cause is repetitive strain. This is when overuse causes tiny, microscopic tears in the tendon fibers. When your tendon becomes inflamed, it needs time and rest to repair itself. Chronic (long-lasting) tendonitis can lead to destructive changes in your tendon (tendinopathy).
• Bursitis. Bursitis is inflammation and swelling in your bursae. These are soft tissues that cushion the space between your bones and other tissues and provide shock absorption when they move. Too much stress on your bursae from too much force or friction can cause painful swelling. It’s common in your elbows and knees. It’s also common to have bursitis along with tendonitis.

How serious can soft tissue damage (injury) be?

Acute soft tissue injuries can be mild to severe. A healthcare provider may grade your injury as first-degree, second-degree or third-degree. If you have a first-degree strain or sprain, the tissue is “pulled” but not torn. A second-degree injury is a partial tear. A third-degree injury is a complete tear through the tissue. Most soft tissue injuries heal with time, but a third-degree injury might need surgical repair.

Similarly, muscle contusions heal on their own with time, but a very severe one can cause extra complications due to severe swelling. These complications may require special treatment and a longer recovery. Repetitive strain injuries heal when you stop the activity that’s irritating the tissue. But if you go back to those activities too soon, they can become chronic injuries that cause lasting damage.

What are the symptoms of a soft tissue injury?

The most common symptom of soft tissue injuries is pain, usually accompanied by swelling. Swelling is a sign of inflammation, which is your body’s way of responding to an injury. Your body is sending extra blood and resources to the area to begin the healing process. But swelling can add to your discomfort.

Other possible symptoms include:

• Stiffness and lost range of motion
• Difficulty moving or putting weight on the body part
• Visible bruising, if blood vessels are broken
• Numbness or tingling, if a nerve is damaged

What causes soft tissue damage?

The two major causes of soft tissue injury or damage are repetitive strain (from overuse) and trauma (from a sudden force). A forceful impact from a direct blow, fall or collision may cause a contusion. A sudden, jerking movement or many strong pulls may strain a muscle or tendon or sprain a ligament.

Soft tissue injuries are different from bone injuries, but sometimes, they can occur together. For example, a broken bone, or one that’s been dislocated, may penetrate or pull the surrounding tissues. The bone injury might be more obvious, but you might also have damaged soft tissues with it.

What are the possible complications of soft tissue injuries?

Immediate (acute) complications that can occur with soft tissue injuries include:

• Blood vessel damage. Most bruises or contusions are from mildly damaged, leaking blood vessels. But a severe injury may cause more serious blood vessel damage. This could lead to serious internal bleeding (hemorrhage) or loss of blood supply to your tissues (ischemia).
• Nerve damage. Trauma that causes soft tissue damage can also cause mild nerve damage, called neuropraxia. This can temporarily interfere with sensory and motor signals between your brain and body part. Swelling from tendonitis or bursitis can affect your nerves by compressing them.
• Compartment syndrome. Compartment syndrome is severe swelling within a muscle compartment — a collection of muscles wrapped in fascia. It’s intensely painful and can cut off the blood supply to the muscles. You might need emergency surgery to relieve the pressure.

Long-term complications that can occur with improper healing include:

• Contracture. You may need to immobilize your injured body part while it’s healing. But too much immobilization can make soft tissues tighten and contract, sometimes, permanently. Your healthcare provider will prescribe specific physical therapy exercises to prevent this.
• Joint instability. A sprain that doesn’t heal completely can leave your joint unstable and more likely to sprain again. Some severe sprains may need surgery to fix this. Other soft tissue injuries that don’t heal can affect your joints by shifting weight and stress to tissues that support a joint.
• Chronic inflammation. Repetitive strain injuries that don’t heal completely can lead to chronic tendonitis or bursitis. This can cause chronic pain and eventually, long-term soft tissue damage. Your tissues may weaken and stiffen, becoming less functional. Weakening can lead to rupture.
• Heterotopic ossification. Severe soft tissue injuries can cause a sort of scarring in which bone tissue develops within your soft tissue. Myositis ossificans, bone tissue in your muscle, can occur after a muscle contusion. Enthesophytes, bone spurs in your entheses, can follow tendonitis.

How are soft tissue injuries diagnosed?

A healthcare provider will physically examine your injury and ask you questions about how it happened or what type of stress might have caused it. Sometimes, they’ll want to take images to see the injury in more detail or to check for additional injuries or complications. An MRI can show soft tissue damage.

What is the best treatment for a soft tissue injury?

Most soft tissue injuries heal at home with conservative care. Rarely, you might need surgery for a severe injury. Head to the ER if you think you have a severe injury, or if you have alarm symptoms like increasing pain, numbness or faintness. You should still see a healthcare provider for minor injuries.

Conservative care for soft tissue injuries consists of pain relief and standard protocols like RICE or its recent update, PRICE (protection, rest, ice, compression and elevation). Recently, healthcare providers have introduced a new protocol to guide your recovery after the first few days: PEACE and LOVE.

PRICE

RICE is a well-known acronym for treating acute musculoskeletal injuries. PRICE is a recent update.

It stands for:

• Protection. To protect the injury during healing, you might need to wear a cast, brace or splint.
• Rest. Rest is the most important part of healing for any musculoskeletal injury.
• Ice. Ice helps reduce pain and inflammation. Apply an ice pack for 20 minutes at a time.
• Compression. An elastic bandage around your soft tissues can reduce swelling and bleeding.
• Elevation. While resting your injury, keep it elevated to reduce blood flow and swelling.

PEACE and LOVE

The longer acronym, PEACE and LOVE, offers additional advice for the later stages of your recovery.

It stands for:

• Protection. To protect the injury during healing, you might need to wear a cast, brace or splint.
• Elevation. While resting your injury, keep it elevated to reduce blood flow and swelling.
• Avoid anti-inflammatories. Providers now recommend pain relievers that don’t suppress inflammation, like acetaminophen or arnica, after the first few days of recovery.
• Compression. An elastic bandage around your soft tissues can reduce swelling and bleeding.
• Education. This is to remind healthcare providers to educate you about your role in your own recovery. Specifically, they should encourage you to play an active rather than passive role.

and

• Load. Loading means gradually returning some mechanical load (weight or stress) to your injured part. Your provider might refer you to a physical therapist to guide this process.
• Optimism. Research has found that a positive approach to recovery can affect your prognosis. Believe in your own capacity to heal, and don’t neglect your mental health during recovery.
• Vascularization. This means increasing blood flow to your injured tissues. While you might use ice and compression to reduce blood flow earlier on, later on, blood flow can help with healing.
• Exercise. Physical therapy can help restore strength and flexibility to your weakened tissues. This can help prevent reinjury as you return to your activities, especially for unstable joints.

What can I do to prevent soft tissue injuries?

Most injuries are accidents, which are hard to prevent entirely. But some people are more at risk of soft tissue injuries than others. If you’re among them, you can reduce your risk with a little preparation.

Risk factors for soft tissue injuries include:

• Practicing sports and physical training
• Tasks that require repetitive movements
• Poorly designed equipment or workstations
• Becoming suddenly active after not being active

To reduce your risk of soft tissue injury, remember to:

• Stretch your muscles before using them and after sitting still for many hours.
• Check your technique before beginning training or repetitive tasks.
• Make sure your tools and work area are clean, safe and ergonomic.
• Listen to your body and its limits and ease up when it tells you to.

How long does it take for a soft tissue injury to heal?

Recovery from a soft tissue injury can take weeks to months, depending on how severe it is. Your healthcare provider is the best person to tell you what to expect. Following your provider’s advice during your recovery will help ensure it goes smoothly. If you return to activities too soon, you could reinjure your tissues. But if you wait too long to start moving again, your recovery might take longer.