Soft tissue injury - Sprains, strains and bruising

Pain, heat, redness and swelling are the main indicators of an inflammatory condition and can be a sign an abnormality has occurred to a joint, muscle, tendon or ligament. Soft tissue injury can occur from sporting, exercise or any physical activity, accidents and even normal, everyday activity. Injury commonly affects muscles, tendons and ligaments causing strains, sprains, contusions, tendinitis and bursitis.

The pain from soft tissue injury may be so severe a fracture may be suspected.

The cause of soft-tissue injuries

The cause of soft-tissue injury is considered either an acute injury or an over-use injury.

Acute injury occurs from a sudden trauma such as a fall or a blow to the body. Strains, sprains and contusions are examples of acute soft-tissue injury.

Over-use injury is an injury which occurs over time and is due to an exercise or activity being repeated so often it prevents the body being able to successfully recover (repair). Examples of over-use injury are tendinitis and bursitis.

Signs and symptoms of acute soft-tissue injury

Sprains

Sprains result in intense pain, restricted movement of the joint, rapid swelling and bruising. A sprain can stretch or even tear a ligament. Ligament are strong connective tissue which provide support and stability to a joint. Sprains commonly affect ankles, knees and wrists.

Sprains are graded depending on level of damage.

• Grade 1 sprain is considered mild with stretching and fibre damage to the ligament.
   
• Grade 2 sprain is considered moderate with partial tearing of the ligament and reduced support to the joint (laxity).
   
• Grade 3 sprain is considered severe and result in complete tearing of the ligament and significant joint instability.

Treatment may begin with the RICE protocol rest, ice, compression and elevation of the injury. In moderate sprains  bracing may be need and physical therapy. Severe sprains may require surgery to repair any damaged ligaments.

Strains

Strains are felt as a sudden sharp pain at site of injury, loss of strength and muscle tenderness. Strains affect the muscles and/or tendons. Tendons are cords of fibrous connective tissue which attach muscles to bone. Calves and hamstrings at the back of the legs are common areas of muscle strains. A strain can occur as a simple stretching of the muscle or tendon or be as severe as a partial or complete tear. Treatment protocols follow the RICE principles followed by gentle exercise to restore mobility. Surgery may be required to repair torn tendons.

Contusion (bruising)

Contusions occur when a blunt force is applied to the body, crushing and damaging muscle and connective tissue beneath the surface, without actually causing any external breaks to the skin.

Colour changes to the skin occur due to pooling of blood below the surface from broken blood vessels.

Generally, first aid applications using RICE are sufficient treatment for bruising, but in some cases, medical advice may need to be sort if symptoms persist.

Acute injuries should be rested. Refrain from exercise or activity which affects the injured area to avoid exacerbating damage and do not apply heat or massage. 

Signs and symptoms of over-use injury

Tendinitis

Tendinitis (inflammation of the tendon or sheath covering the tendon) occurs when a continuous aggravating stress is applied. Symptoms of swelling and pain – especially on resuming the activity. Treatment consists of avoiding the stressor and reducing inflammation (anti-inflammatory medication and sprinting). Identifying the cause, improving flexibility and correcting any muscle imbalances can often alleviate the problem, although severe tendon damage may require surgery.

Bursitis

Bursitis is inflammation of the bursa. Bursa are fluid-filled sacs which act to cushion joints. They are located through-out the body in places where friction between bone and soft tissue can occur - such as the knees, elbows, shoulders and hips and act as cushions. Bursa can swell when aggravated from repeated use or repeated stress. Changing the action causing the bursa, and the use of anti-inflammatory medication is often all that is required to reduce the bursa. In severe cases, or if infection has occurred, fluid may need to be drained away by needle aspiration. 

Preventive measures 

In the case of accidents, soft tissue injury may be unavoidable, but by recognising and changing an action a repetitive strain/ over-use way be prevented.

There are also some measures which can be taken to prevent injury occurring in the first place. 

• Too much, too intense or too frequent exercise or physical activity can often result in injury.
• Increase or incorporate new activities cautiously.
• Wear sturdy foot wear to help with body stability.
• Balance cardiovascular exercise, strength and flexibility.
• Warm up to prepare the body for any physical activity. Warm-ups increase heart rate and blood flow and ensure muscles, tendons, ligaments, and joints are loose and warm. Warm ups are gentle exercises such as walking or mild actions with are identical to exercise to be performed.
• Stretch to help with flexibility – but only after body is warm. It is important to stretch through-out activity, but be careful not to over-stretch.
• Cool down from physical activities by lessening the intensity for at least 10 minutes before ceasing activity completely.

Try to get at least 30 minutes of moderate physical activity every day to help with strength and flexibility and rest to help recovery.

The Processes of healing

After an injury the body begins the healing process. This begins with an inflammatory phase when the body recognises and injury has occurred to the extracellular matrix (the part of the tissue which contains cells). Immune cells are recruited – neutrophils to clean up the wound (a process called phagocytosis) and then macrophages which continue the clean-up processes and secrete factors for the process of healing. These factors start with pro-inflammatory (needed to bring in the resources for healing) and then become anti-inflammatory. Growth factors direct the healing process. They tell cells within the wound to begin proliferating (multiplying), migrating and moving.

It is important to note the inflammatory process is needed for an injury to begin healing.

The RICE protocol

To ice or not to ice. It has always been considered applying ice to a wound is necessary to reduce swelling, pain and post-injury bleeding, all of which may hinder the healing process. But now are concerns over whether ice should be applied immediately to an injury.

The reasons being suggested  - the importance of the inflammation and whether the application of ice, which reduces inflammation, may result in a delay in healing or cause an extention in the duration. 

One size does not fit all, but the general consensus is - if there is pain and swelling, the application of RICE is suggested.

Natural therapies which can assist healing

Herbal and nutritional medicine can often help with pain relief, reducing inflammation and support the healing process. These are especially beneficial for over-use injuries and chronic conditions.

• Magnesium is a mineral which can help relieve tight muscles, muscle spasm, muscle cramps and pain.
• Fish oil - omega-3 polyunsaturated fatty acids found in fish is an effective natural anti-inflammatory.
• White willow bark is a traditional herbal remedy used for pain and inflammation.
• Turmeric/Curcumin (Curcuma longa) is a flowering plant of the ginger family. It has a traditionally used in both Ayurvedic and Chinese medicines as an anti-inflammatory and to enhance wound healing. Several clinical trials have demonstrated curcumin’s antioxidant and anti-inflammatory actions.
• Boswellia serrata resin (Frankincense) possesses anti-inflammatory and analgesic properties.
• Uncaria tomentosa (cat’s claw) traditionally the bark of cat’s claw is used to treat arthritis and bursitis.
• Resveratrol is a plants-based polyphenol found in many plants. Resveratrol has shown to have significant anti-inflammatory and antioxidant activity.
• Pycnogenol is derived from the bark of the maritime pine tree (Pinus maritima) and has been used in ancient times in helping wounds heal. It is also a potent antioxidant.
• Arnica montana can help reduce bruising and swelling and promote recovery after local trauma.
• Rosmarinus officinalis (rosemary). The volatile oil applied topically may offer pain relief.

Contact your doctor if any symptoms of injury persist.

References

1. https://orthoinfo.aaos.org/en/diseases--conditions/sprains-strains-and-other-soft-tissue-injuries/
2. https://stjohn.org.au/assets/uploads/fact%20sheets/english/Fact%20sheets_sprain%20and%20strain.pdf
3. https://www1.racgp.org.au/newsgp/clinical/is-it-time-to-rethink-rice-for-soft-tissue-injurie
4. Effectiveness and Safety of Arnica montana in Post-Surgical Setting, Pain and Inflammation https://pubmed.ncbi.nlm.nih.gov/25171757/
5. Rosmarinus officinalis L. (rosemary) as therapeutic and prophylactic agent https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6325740/
6. Natural anti-inflammatory agents for pain relief https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3011108/
7. Magnesium in Prevention and Therapy https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4586582/
8. An in-depth review on the medicinal flora Rosmarinus officinalis (Lamiaceae) https://pubmed.ncbi.nlm.nih.gov/24584866/