These are injuries leading to impairment and dysfunction in muscles, ligaments and tendons.
Injury to muscle is referred to as a strain and can occur as a result of strenuous activity. They can occur during the course of normal daily activities, during sport, whilst lifting or performing work related duties.
A muscle strain is damage caused by over-stretching of muscle fibres. The muscle tissue becomes over-loaded and if the fibres tolerance level for stretch is exceeded, then a tear or partial tear occurs.
Muscle strains are categorized into 3 Grades, depending on severity.
A Grade 1 strain is mild and involves up to 5% of the muscle fibres and should resolve after 2-3 weeks with rest.
Grade 2 strains involve more extensive muscle fibre damage but the muscle remains intact. Healing usually takes up to 6 weeks.
Grade 3 strains are a complete rupture of the muscle. In a sports person surgery is usually required and the rehabilitation takes up to 3 months to complete.
Treatment in the acute initial stages involves the following of the PRICE principles, namely:
After the initial acute phase, rehabilitation including physiotherapy treatment is commenced. This involves the mobilisation and stretching of muscle to elongate the scar tissue and improve muscle flexibility and the prescription of appropriate exercises to gradually increase muscle length.
The role of the physiotherapist in the rehabilitation of these injuries also includes the introduction of sports specific exercises at the appropriate time and also to supervise a phased return to activity to minimise the risk of re-injury.
Common Muscle Injuries appropriate for Physiotherapy treatment include:
Ligaments are tissues that attach bone to bone across joints in the human body. Their function is to stabilise the joint, maximise strength and prevent excess movement within the joint.The most common ligament injuries are partial tears known as sprains.
Ligaments possess immense mechanical tensile strength. They are classified as connective tissue and are made up of collagen, a protein substance. They prevent excess unwanted joint movement that would render a joint unstable and at risk of dislocation.
Another important ligament function is to provide proprioceptive input to the brain which allows us to be aware of where a particular joint is in space which provides us with the balance necessary to step down safely from a kerb or perform more complex coordinated activities required for sport.
Ligament injuries are classified into 3 Grades of severity, from the mildest Grade 1, in which damage to a low percentage of ligament fibres has occurred causing local pain and inflammation to Grade 3, which results in extensive damage of the ligament fibres leading to complete rupture characterised by intense pain, effusion (swelling) and joint instability for which surgery may be required.
Ligament injuries are most common at the ankle and wrist but can occur in any joint. Complete rehabilitation is essential to reduce the risk of re-injury. With ankle sprains for example, returning to activity too early before the ligaments have fully healed may result in ligaments healing in a stretched position, which results in less stability. This can lead to chronic ankle instability and thus the increased risk of recurring ankle sprains.
The general principles of physiotherapy intervention in ligament injuries in the early stages are to reduce oedema and pain and limit the extent of scar tissue formation in the initial stages, to the early introduction of range of movement exercises to preserve joint movement.
Further rehabilitation in the sub-acute phase includes the prescription of flexibility exercises and progression to balance, coordination and proprioception exercises. A biomechanical assessment is also required to detect if any intrinsic factors have contributed to the injury with appropriate recommendations made regarding insoles/orthotics and footwear if indicated.
Common Ligament Injuries appropriate for Physiotherapy treatment include:
Tendons are fibrous tissues that attach muscle to bone in the human body. They can be subdivided into two broad categories, tendonopathy/tendonosus or tendonitis.
Tendonopathy or tendonosus is damage to a tendon at a cellular level, characterised by chronic degeneration without acute inflammation. It is thought to be caused by micro-tears in the connective tissue in and around the tendon and may lead to reduced tensile strength, thus increasing the chance of a tendon rupture. They can develop from a combination of extrinsic and intrinsic factors.
Intrinsic factors which may lead to the development of such problems include poor biomechanics which may cause increased loads and forces acting on the foot and ankle and may predispose towards the development of Achilles tendonopathy for example. Swelling or thickening can usually be detected visually or on palpation in the region of the micro-trauma or partial tear (which can then be confirmed on MRI). Symptoms can vary from an ache or stiffness localised to the area of damage to a burning pain around an entire joint.
Pain is usually worse during or after an activity, with increased stiffness noted the following day. Generally, tendons are very slow to heal when injured. A conservative approach to treatment is indicated including physiotherapy, rest and a gradual return to activity which caused or reproduced the symptoms. Anti-inflammatory medication on its own is usually of limited benefit as there is evidence to suggest that tendonopathy/tendonosus is not an inflammatory disorder.
Initial recovery occurs within 2 -3 months with full recovery varying between 3- 6 months. Naturally the length of rehabilitation varies with the severity of injury and presenting symptoms, in addition to the length of time between onset of symptoms and commencement of treatment. As with all soft tissue injuries, generally speaking, prompt intervention facilitates timely recovery.
Tendonitis can result from acute tendon injuries accompanied by inflammation. In addition to the symptoms generally experienced with tendonopathy as described above, swelling may occur locally and be accompanied by heat and/or redness. A conservative treatment approach as previously described is also advocated. However, the administration of anti-inflammatory medication may also be warranted as this, combined with rest, assists in the prevention of further damage to the tendon.
With careful management and effective physiotherapy treatment, initial recovery has usually occurred after 4-6 weeks. After the acute phase of the injury has subsided, if the tendon has not sufficiently healed, the development of a more chronic tendonopathy/tendonosus can occur. Early and appropriate treatment of tendonitis and adherence to advice regarding rest from activity can reduce the risks of developing this more stubborn problem which takes longer to heal.
Common Tendon Injuries appropriate for Physiotherapy treatment include: