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Injury Centre

Physiotherapists see patients with injuries of many different kinds, each of which require different kinds of treatment. Crucially, physiotherapists are concious of the benefits of early treatment whatever the injury.

Injuries happen

Injuries are very common and we all suffer from them from time to time. How we treat our injuries is important, as it makes a difference to how we manage in the future. A poorly healed injury can restrict our ability to do things or cause us long term pain. The focus should therefore be on injury management.

Acute injury

An acute injury is recent, and tells you nothing about how severe or painful it is. In medical speak, pain is divided between acute and chronic conditions, with chronic being long term and acute being recent

Types of injury

Whatever the injury you have, a cut, strain, sprain or fracture, many of the underlying inflammation and healing processes are the same. So it doesn’t matter much whether you’ve just been rear-shunted in your car, you’ve pulled your back lifting a box of books in the roofspace or twisted your ankle playing sport, understanding about inflammation, treatment and healing applies to all of them.

Advantages of early treatment

People often ask about how soon they should get treatment. With acute injuries, getting early diagnosis (if necessary) and treatment is very important. The recovery time and pain endured can be minimized, and any costs and time away from work and activities reduced.

It is much easier to treat a new injury straight away and settle it down with the right approach, rather than wait until secondary problems or reinjury occur.

Soft tissue injuries

Most commonly injured are the soft tissues (some of which can be quite hard!) but this relative softness distinguishes them from bone. Examples of soft tissues are muscle, ligaments, tendons, nerves, discs and other fibrous tissues.

In significant injuries it is important to be sure there is no bony injury, but the soft tissues are always injured in any kind of trauma. In general, sprain refers to an injury of the ligaments round a joint and strains refers to damage to muscles or tendons.

Inflammation

Inflammation is the body’s response to injury, and leads to successful healing in the vast majority of cases. The end result of healing is scar.

Severity of the injury

Injuries vary enormously in their size and severity and it is important to recognize the grade of injury so that appropriate help and treatment can be sought.

First degree injury (mild) occurs when there is a minor stretch to a ligament or joint capsule, or a stretch of or direct blow to a muscle. There is little bruising or swelling and some pain may be felt when the area is stretched or the muscle contracts.
There are no worrying factors such as an inability to use the part, muscle spasm or instability of a joint.
Second degree injury (moderate) indicates a bigger stretch to a ligament or joint capsule, or a greater blow or stretch to a muscle.
There is more swelling and perhaps bruising, and tearing of ligament or muscle fibres gives pain at rest and which increases with movement or muscle contraction, causing a loss of the ability to use the part normally. A joint may have some instability when stressed.
Third degree injury (severe) indicates a severe overstretch of a ligament or joint capsule, or a severe stretch to or hard direct blow to a muscle. The injury results in a significant tearing of soft tissue, with bleeding, swelling and severe pain, even at rest.
A ligament injury of this degree can give joint instability and protective muscle spasm, leading to loss of the ability to use the joint or contract the muscle. The use of the area is severely restricted.

Soft tissue alone?

It is not safe to assume that when someone has a soft tissue injury, they only have that. Different body systems may be injured in any damaging event and these possibilities should not be ignored.

If there is a problem, medical care may be needed promptly. This list of potential injuries is in alphabetical order and should not be taken as an indication of relative importance.

Abdominal or thoracic injury could cause chest or abdominal pain, shortness of breath or blood in the urine.
Airway obstruction could cause choking, gasping or wheezing, collapse and respiratory arrest.
Cuts and lacerations show as frankly bleeding wounds.
Fractures or dislocations may be present where there is severe pain, deformity of a limb or inability to use a part of the body.
Head injuries may show up as confusion, head pain, loss of consciousness, disorientation or aggression.
Nerve injuries may show up as weakness, numbness, pins and needles and inability to use part of the body, perhaps without significant pain.
Spinal injuries must always be considered when any significant force is involved in the trauma, with neck or back injuries resulting in pain and perhaps inability to use a part of the body.
Vascular injury can result in loss of normal pulses, a change in colour or temperature of a limb or a drop in blood pressure as bleeding occurs inside the body.

A suitably trained person should be on hand to assess the individual’s state of health in order to rule out any serious injury before soft tissue management is instituted.

To progress further now, we need to look at the process of inflammation.