Soft tissue injuries

Soft tissue refers to the muscles, tendons, cartilage and ligaments in the body, alongside fat and fascia. These differ in both function and structure from hard tissue, such as bones.  

Examples of soft tissue injuries are: 

• Bruising: Damage to the small blood vessels which bleed and as a result, produce the typical purple colour and swelling. 
• Sprain: Refers to the stretching / tearing of the ligaments at a particular joint. 
• Strain: Refers to an injury to a particular muscle or tendon. These can vary from low level, to higher grade tears 

Full ruptures / tears of soft tissues can also occur alongside significant bruising that does not disappear within 2 weeks.

The 3 most common symptoms of soft tissue injuries are pain, bruising and inflammation. The severity of each is dependent on the level of the injury. Other symptoms that can be present are; 

• Swelling 
• Local stiffness 
• Muscle cramping or spams 
• Difficulty weight-bearing 
• Feeling of weakness in the affected region 
• Restriction in joint range of movement 

Go straight to A&E if: 

• You have a new and visible deformed or misshapen part of your body
• The pain was caused by a serious fall or accident (eg. a fall from height or high speed road traffic collision)
• A recent fall or trauma if you have osteoporosis 
• You're unable to move your joint or put any weight through your leg 
• You have pain with a temperature and feel unwell, especially after recent surgery or injections in the area - this can be a sign of infection

You should see your doctor if you: 

• Have pain that doesn’t show any signs of improvement, within a couple of weeks of self help
• Have pain that has rapidly deteriorated or suddenly worsened despite self help
• Have a history of inflammatory arthritis, immuno-suppression, cancer, Tuberculosis (TB), drug abuse, AIDS or other infection
• Feel unwell, have a fever, or unexplained weight loss
• Are experiencing significant and regular changes to your usual sleeping pattern
• Have complete loss of function, severely restricted range of movement and can recall hearing a pop or tear at the time of injury. 
• Have severe numbness / altered sensation / pins and needles 
• Have a new hard, immovable lump / mass appears 
• Have similar symptoms occur on the opposite side of the body

If you do not have any of the above, you may be able to effectively self manage your condition

• Overuse: Repetitively overusing the same muscle group, such as painting and decorating for a prolonged period.
• Overloading: A sudden increase in load to a particular muscle group can result in a soft tissue injury. Overloading tends to mean exercising at a greater level than you are normally used too. For example, lifting an object which is heavier than usual or suddenly increasing your normal activity.  
• A Fall or Slip 
• A sudden change in direction: Twisting, turning or overstretching are all examples of movements that can cause an injury. 
• Blunt force: A blow to the body, such as dropping something on your foot.

There are 4 stages of soft tissue healing: 

• Immediate – Occurs immediately following an initial injury. Lasting on average for 4-8 hours, this phase consists of a bleed local to the injured area, commonly resulting in bruising and tenderness. 
• Early stages – Swelling and redness starts rapidly around 6-8 hours after an injury, and at its most active 48 hours after injury. It should start to reduce after 2-3 weeks, but can take much longer to fully disappear. Swelling is part of the natural healing process at this stage.
• Re-building – The body contiunes its repair process for a period of time which varies in duration, during which time you should start to notice some improvement. 
• Finishing touches – Lasting from 3 weeks to up to 2 years, this remains the longest and final phase of healing. The overall healing time will vary depending on the severity of the injury and the individual factors such as age, medical conditions and lifestyle. 

Unless you have a serious injury or have sudden continuous severe pain, you can usually treat your muscle injuries without having to see your doctor. If after 2 weeks of treating yourself you feel the pain isn’t any better or worsening, you should see your Health Care Professional (such as your doctor, a physiotherapist or FCP).

A diagnosis is normally made via an appointment with your Health Care Professional. This will usually involve a discussion surrounding the onset of your symptoms, the nature and severity of your symptoms and a functional assessment.  

The majority of soft tissue injuries do not require imaging and tend to recover over a period of time.

There are varying phases of soft-tissue injury management which are listed below to assist with self-recovery.  

Phase 1:

Utilizing the R.I.C.E. acronym can be useful: 

R = Rest – It is important to get a balance between rest and activity by Keeping Active

I = Ice – 10-20 mins every 2-3 hours is optimal. Follow our advice on cold treatment.

C = Compression – An elastic bandage may be appropriate to help reduce initial swelling, but should not be overly tight to restrict blood flow. This should only be used during activity and should not be relied upon.  

E = Elevation – When and where possible, keep the injured area elevated to reduce pain and swelling.

Phase 2:

Once signs of swelling reduce, gentle exercises can begin, working the affected area to a pain free low level.  

Phase 3:

Once basic movements can be completed and pain free, start to do a little bit more of your daily activities.

Phase 4:

This stage is a return to your usual level of function or activity, which may include gardening, walking, arts & crafts, swimming, or gym activities. You should start to do your usual activites gradually and increase the amount you do over time.