First of all let me refresh your memory on what types of soft tissue lesions exist for example: Strain, Sprain, Dislocation, Subluxation, Muscle or tendon rupture, Tendinous lesions or tendinopathy, Synovitis, Hemarthrosis, Ganglion, Bursitis, Contusion and overuse syndromes. This is a long list of injuries and dysfunctions however they have many commonalities which allows them to be classified into a basic approach.  

Lets begin by discussing the stages of healing that is common among all these types of soft tissue lesions.

The Acute Stage (inflammatory response) has a vascular or cellular response immediately after the insult. This response is characterized by swelling, redness, heat, pain at rest and loss of function. When taking the patient through the range of motion for the area involved they will usually guard at some point during the movement.

This guarding is caused by chemical irritants coming from cellular adaptations to the injured area producing an irritant effect on the surrounding nerves heightening the pain response. Also tension in the area can be increased by excess edema restricting the patients range.  This acute stage occurs through a range of about 4 to 6 days on average.

The Subacute Stage (healing and repair) the symptoms of pain, swelling and redness will be much less and will eventually be absent. The patient’s ROM will be very specific to end range tissue tension. Meaning the patient will have little to no pain during most of the range until tension is applied at the end of a movement to the tissue.

Muscles may have weakness and function could have limitations because of this weakness. This weakness could be caused by direct tissue damage or from disuse if the area of damage is surrounding a joint. This stage will range from 10 to 17 days or it could last 14 to 21 days after the initial injury depending on the severity.

Circulation plays a major role because areas that lack circulation will take longer to heal such as tendons or ligament structures.

The Chronic Stage (maturation and remodeling) demonstrates no signs of an inflammatory response. Contractures may be present as well as possible areas of adhesion left over as a residual effect from the acute response. Muscle weakness may continue to exist in this stage which can limit function

Connective tissue will continue restructuring and strengthening during the chronic stage. Areas of tightness surrounding this connective tissue will produce pain when end range is reached on these tight areas.

Patients will show weakness, poor endurance and lack of neuromuscular control. This stage can last 6 months or up to a 1 year.

When diagnosing a patient or if you are in the process of interventions keep in mind exactly what stage these patients might be in at that current time. Have an idea of the time line for progression.

Remember if you push to hard you could send them back to the Acute Stage very quickly. These stages do not go in one direction. A patient could be in the Chronic stage cause a re injury to the tissue and end up right back in the Acute stage.

I am writing future posts in order to discuss suggestions for treatment during each stage of the healing process. Look for my next post called Guidelines for Acute Stage Interventions.

References

Colby, Lynn Allen, and Carol Kisner. Therapeutic Exercise: Foundations and Techniques (Therapeutic Exercise: Foundations and Techniques (Kisner)). 5 ed. Philadelphia: F. A. Davis Company, 2007. Print.

Related Posts:

1. Guidelines for Chronic Stage Management
2. Guidelines for Subacute Stage Interventions
3. Guidelines for Acute Stage Interventions
4. Shoulder Post Surgical Management- Capsular Reconstruction
5. Hip Abductor Weakness and Medial Knee Pain