Dr. Ronald G. Ritchie
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Soft Tissue Injuries

Soft Tissue Injuries

Soft Tissue Injuries is a classification or group of conditions such as sprains, strains, stretch or tear injuries to any ligament, tendon, muscle, cartilage, nerve and blood vessel. These would then include things such as sprained ankles, ACL injuries, shoulder strains, back strains and even injuries from automobile accidents or work events.

Having been referred to as sprain/strain injuries in the past, this group of injuries has been renamed to more aptly describe what is really happening. Strain/sprain refers primarily to ligament and tendon damage whereas soft tissue injury also includes the damage that occurs to all “soft” tissues.

Soft tissue injuries are graded into four classifications and are merely numbered 1 through 4. A grade 1 soft tissue injury is where there is less than 25% disruption of the tissues and a grade 4 soft tissue injury is where there is 100% tear through the soft tissues. Grade 1 soft tissue injuries are self-healing. In other words within a matter of a few days to a week or so they will heal all by themselves. On the other hand, grade 4 injuries usually require surgery. By far the most common degrees of soft tissue injury are grade 2 and 3, especially of the neck, back, shoulder and knee.

Soft tissue injuries can occur in many different ways and very often have little in the way of symptoms. Slip and fall injuries or a strain of the shoulder or back from work or sports events are extremely common. They usually present with some pain initially but more frequently involve stiffness, swelling and muscle tightness with only modest pain and that “stiff and tight” sensation.

At the initial stages after injury patients and doctors usually make colossal errors. They treat these injuries as something unimportant or so common that it needs little attention and doctors fail to properly diagnose the condition. When it comes to the back, neck and shoulder very often doctors prescribe the completely wrong therapy. They have the patient put heat on the area and rest the injured site so that it causes less pain and dysfunction. Current guidelines on the treatment of soft tissue injuries are completely the opposite and years of practice have proven to me that rest and heat will only prolong and worsen the condition.

The major problems with soft tissue injuries are failure to properly diagnose the condition, failure to treat quickly and initiate therapy immediately, and I failure to treat long enough to completely resolve and rehabilitate the injured area.

Failure to Diagnose
Most doctors do not know how to treat soft tissue injuries. They either lacked the education and experience or consider them of so little consequence that they throw medication and heat at the patient and tell them they will be fine. It is true that patients usually do not die from soft tissue injuries but this does not mean the condition is insignificant or unworthy of proper diagnosis and treatment. According to numerous guidelines the initial treatment for soft tissue injuries of any degree is the application of ice until the swelling and inflammation present is completely resolved, passive assisted motion (gently moving the injured part without much force many times daily), and the brief use of anti-inflammatory medications for three to four days after the injury. Failure to appropriately diagnose the degree and type of injury will allow scar tissue formation which will then have tremendously negative consequences for many years.

Failure to Treat Quickly
Often patients and doctors will put off the institution of treatment for days to months while waiting for swelling to go down or because it’s inconvenient to or troublesome to begin any type of therapy. Without proper care, scar tissue begins to form within 72 hours of the injury, and once formed will cause degenerative arthritis within the joint or contractures within a tendon or ligament. Either of these circumstances will produce arthritis and loss of function in the years to come. Most doctors fail to appreciate the consequences of their Cavalier attitude towards soft tissue injuries. I do not know about you, but if two or three weeks of therapy will save me 10 or 20 years of pain, stiffness, immobility and joint replacement surgery; I will take the two or three weeks today!

Failure to Treat Long Enough
Most patients are impatient. They want to feel better today and no effort to be applied to get that improvement immediately. We have a true Burger King society when it comes to health care. We want our health care our way today. Well that just does not happen! Unfortunately most doctors, when it comes to soft tissue injuries, have the same disposition. They tell the patient take it easy and you will be fine implying that as soon as the pain goes away their condition is healed. This simply is not true. With soft tissue injuries when the pain is resolved is an indicator of decreased inflammation not healed tissues. Think of it this way, when you get a cut is it healed when the pain and itching have stopped? Of course it is not. A scab forms and healing goes on for a period of one to two weeks but the pain went away in two or three days. This is especially true when it comes to soft tissue injuries of the large weight-bearing portions of the bodies such as the shoulder, neck, back, hip and knee. The initial pain from an acute injury can be resolved in a matter of a few days to a week. But the real healing of the soft tissues can take four to eight weeks. To terminate treatment for any reason prior to this time virtually guarantees arthritis. The only problem is that the arthritis will not occur for 5 to 10 years yet will last a lifetime. Yes, to continue therapy for four to eight weeks is time-consuming and troublesome but the long-term benefits to health are tremendous. Many of my patients fall into this category. They had seemingly small injuries from normal daily events or “minor” automobile accidents and now at age 55 have degenerative arthritis that prevents them from functioning or is forcing them to have joint replacement surgery. This could have been simply avoided by a following through with proper care.

Soft tissue injuries are common and commonly misdiagnosed and under-treated. Have your injury properly diagnosed by a trained physician who is willing to take the time to do things correctly. And you likewise follow the doctor’s recommendations to their conclusion. Although the consequences of lack of care will take years to develop, the old saying “an ounce of prevention is worth a pound of cure” is absolutely true. Take the ounce of prevention today by properly treating soft tissue injuries.