Musculoskeletal Injury

Soft tissue injuries come about in many ways, slips, falls, sports injury, automobile accidents, and repetitive motion to name a few.

A soft tissue injury occurs when a muscle , nerve, fascia, tendon, or ligament is damaged. Tissues may be damaged suddenly, as in a whiplash type injury from a rear end automobile collision (acute injury) or over time from micro trauma to the tissues, as from the repetitive motion of keyboard entry causing carpal tunnel syndrome. Micro trauma eventually leads to a condition called Cumulative Trauma Disorder (CTD.) The term «trauma« is not really accurate when used with this description, but it is widely accepted. It would be more appropriately called Cumulative Injury Disorder (CID) as it is injured from over use, not trauma. If an acute injury is not treated properly a CID cycle may be initiated.

When soft tissue is damaged the process of inflammation occurs releasing chemicals in the area that cause swelling, heat and pain. The fourth sign of inflammation, redness, may not be visible if the tissue involved are deep to the skin.

The process of inflammation causes the formation of scar tissue. Scar tissue is an important part of the normal healing process as it forms a crude patch to knit the damaged tissue together, and impedes the invasion of bacteria when the skin is broken. However , when scar tissue forms beneath the skin adhesions between tissue layers may form, and restrict motion of all tissues involved. This presents a particular problem as we need freedom of movement between the layers of tissues, and of the joints where tendons ,ligaments, and muscles attach. Normally, the surface of the tissue layers are slippery and will slide against adjacent tissues when the body is bent, stretched , twisted , ect. As most soft tissue layers run their fibers in different directions, when scar tissue adheres them together (the fibrotic adhesions) contraction in one direction may cause a painful stretch in another, especially when a nerve is involved. Examples:1. A whiplash injury initiating a fibrotic adhesion between a muscle of the upper spine and the dura matter ( the protective covering of the spinal cord), is a major cause of chronic headaches. 2. anyone who has had abdominal surgery will remember how painful it was when the nurses had them get up and walking as soon as they could stand up. If they fail to move around enough , adhesions form between the muscle layers that cause great pain with movement and or stretching the abdominal area.

Scar tissue shortens as it ages. In the case of a muscle strain (torn muscle fibers) scar tissue forms across the contractile tissue. Usually, due to pain, it is difficult to extend and stretch that muscle. after the repair phase of healing has occurred (up to six weeks after initial injury) the scar tissue continues to modify and reform itself (remodeling phase of healing) for up to a year or longer. It continues to shorten, and gets stronger, restricting movement and or stretching of the tissues involved. A condition called «denervation supersensitivity« develops as the scar tissue begins it's formation. Nerve endings grow into the developing fibrotic tissue making it «super sensitive« further restricting the motion of the affected tissue due to pain, and may be the contributing cause of fibromyalgia. Standard soft tissue treatments (ice, heat, rest, ultrasound, massage, ect) offer limited success for the affected tissues.