Lecture 1

• Types of Soft tissue injuries

  1. Muscle contusions
  2. Muscle strain
  3. Ligament sprain
  4. Tendonitis or tendonosis
  5. Bursitis
• What is a muscle contusion?

   the result of a sudden traumatic blow where a muscle is crushed between two unyielding objects
• The extent of the injury of a muscle contusion depends on what?

  upon the area of the muscle and the depth in which the blood vessels, nerves, and bone are located
• Muscle Strain is what?


  A pulling apart, stretch, tear, or rip of a muscle, tendon, or fascia
• • Strain = Muscle
  • Sprain = Ligament
• • Strain occurs at weakest part of the musculotendinous junction
• Ligament Sprain: Disruption in the function or integrity of a ligament caused by a force that moves the bones apart
• • Tendonitis/Tendinosis: inflammation within the tendon or the tendon sheath
  • Characterized by a gradual onset of pain and swelling
  • Occurs where the muscle attaches onto the bone or at the musculotendinous junction
• • Bursitis: Inflammation of the bursa, the pocket of fluid within the synovial lining designed to decrease frictional forces between the tissues surrounding the joints
  • Bursitis is characterized by a sudden onset of pain and swelling
  • Common sites include the olecranon process of elbow and the patellar bursa of the knee
• Physiological Level

  →Blow to area

  →bleeding into the muscle

  →Hematoma develops

  →bruise of the bone

  →Pain, swelling, bruising, and muscle spasm (Clinical Presentation)
• Signs and Symptoms

  • History of acute onset
  • Mechanism of injury is due to a compressive force
  • Pain is localized over the injury of the site
  • Ecchymosis may be present if the hemorrhage is superficial
  • Bruising or swelling in area = Ecchymosis
  • Range of motion may be limited due to swelling and hemorrhage
  • Swelling may compress nerves leading to pain and temporary paralysis and numbness
  • Injury may occur in the muscle tissue or in the bone
• Muscle Properties and Function

  • A muscle is viscoelastic (stretch and pulled apart)
  • Extensibility: ability to be stretched
  • Elasticity: ability to return to normal length
  • Viscoelasticity:allows the muscle to stretch to a greater lengths over time in response to a sustained tensile force (muscle will become more flexible but it takes a long time)
  • Irritability is the ability to respond to a stimulus
  • Electrochemical: nerve impulse
  • Mechanical: external blow
  • Contractility is the ability to develop tension
  • Three types of Contractility 1.isometric 2.concentric 3.eccentric
• Ligament Properties and Function

  • Connects bone to bone
  • Collagen is parallel and interwoven
  • Resists large tensile loads along the long axis of the ligament and smaller loads from other directions
  • Collagen and elastin intermixed (more elastic than tendons)
  • Elastin allows ligament to stretch
  • Ligament bends more that tendon
  • Two times as strong as muscle (yields 5-8% in length)
  • Something happens over time = Tendon
  • Something happens immediately = Muscle
• More About Tendinosis/Tendonitis

  • Tendinosis implies a pathology of chronic degeneration without inflammation
  • Longer than 6 weeks = tendinosis
  • Shorter than 6 weeks = tendinitis
  • Caused by micro tears in the connective tissue in and around the tendon
  • Leads to an increase in tendon repair cells and fatty infiltration into area
  • Results in decreased tensile strength and increased chance of tendon rupture
  • Often misdiagnosed as tendinitis 
• Tendinitis

  • Tendon becomes inflamed = Tendinitis
  • Less than 6 weeks
  • Exercise is good
• Tendinosis

  • Inflamed
  • Longer than 6 weeks = Tendinosis
  • Causes scar tissue around muscle belly
  • Exercise is good for it
• Tenosynovitis

  • Teno = tendon
  • Syno =synovial
• Enthesitis

  • When the injury is right at the site of the bone attachment = Enthesitis
  • May not respond to treatment (elbow and achilles common)
• Tendinitis and Tendinosis

  • Common sites include the elbow, achilles, and the patellar tendon
  • may be caused by repetitive trauma
• Signs and Symptoms of T/T

  • history of gradual onset
  • mechanism of injury is due to overuse repetitive stretch or overload
  • pain is localized throughout the length of tendon on palpation
  • swelling may range from minor to major and thickening of the tendon may be present
  • crepitus may be present (noise - something rubbing, ex.grinding like kneecaps)
  • pain occurs at the extremes of range during passive and active range of motion
  • pain increases during stretching and with resistance testing
  • muscle weakness may be evident
• Bursa Properties & Function

  • fluid filled sacs
  • reduced friction
  • common sites areas of friction

  *When sudden swelling occurs fast, you must first rule out a fracture*
• Signs & Symptoms of Bursitis 

  • history of sudden onset pain
  • mechanism of injury is due to a single traumatic compression or by repeated compression associated with overuse of the joint
  • localized swelling may be minor to major
  • localized pain and warmth on palpation
• Roles of the Kinesiologist

  • School and collegiate settings
  • Professional sports team
  • Medical clinics and hospitals
  • Industrial and occupational settings
  • Physician practices
  • Community based athletic facilities
  • Independent practises 
• Negligence: Failure to provide duty of care
• Malfeasance: commits an act that is not his/her responsibility to perform
• Misfeasance: commits and act that is his/her responsibility to perform but uses wrong procedure or does the right procedure in an improper manner
• • Nonfeasance: fails to perform his/her legal duty of care
  • Malpractice: commits a negligent act while providing care
  • Gross negligence: total disregard for the safety of others
  • Criteria required to prove negligence
  • Failure to warn: patients must be informed that risk of injury exists and understand the nature of that risk
  • Foreseeability of Harm: Recognizing a potential danger and removing that danger before injury occurs
• Informed Consent

  • Injury party has been reasonably informed of needed assessment and treatment, possible alternatives, advantages, and disadvantages of each course of action
  • Obtain prior to any assessment and treatment via verbal and written consent to provide information about treatment the patient will undergo
• Force and its Effects

  • Depends on what causes force and what is accepting that force
  • Two potential effects of force (Acceleration and deceleration)
  • Factors that determine injury (Magnitude of force and material properties of tissues involved)
• Response to Force

  Small Load

  • Load is removed and material returns to original shape recoils similarly to an elastic
  • Plastic Response

  Load reaching Yield Point

  • Load is removed and some amount of deformation remains
  • Plastic Response

  Yield Point

  • Max load a material can handle without permanent deformation
  • Any further laid may go past yield point and result in damage

  Failure

  • Force causes loss of continuity, rupture of soft tissue or fracture of a bone
  • Caused when you go past the yield point
• 1. Compression: Decrease in volume of any object or substance resulting from applied force
• 1. Tension: Distractive force is applied perpendicular to to the tissue for both compressive and tensile forces
• 1. Shear: Force is parallel to body or tissue
• Magnitude of Stress

  Stress

  • Force is divided by the area over which the force acts
  • A given force over a large are versus a small concentrated area can  have very different results
  • More risk of injury with more force concentrated force in smaller area
  • If force is dissipated over larger area, there is less risk to the patient