SOFT TISSUE INJURIES – ARE THEY IMPORTANT? Yes, argues Connor Salter, Chiropractor.
Soft tissue damage is a type of injury that occurs to us all at some time in our lives. For active people even relatively minor soft tissue injuries can cause unavoidable loss such as loss of earnings, treatment costs and care. So if these injuries are inflicted upon the individual from an accident that was not their fault why shouldn’t they be able to claim compensation?
Before getting into this subject, it is worth remembering that there is hard tissue too; bone being one of them. Tissue is a word used to describe different parts of the body. For example, cardiac tissue describes the structures of the heart.
Soft tissue damage is mostly ascribed to muscles and joints. So, if we hurt our knee from a fall or hurt our neck after a road traffic collision, we will have mostly hurt ligaments, muscles and their tendons. Remember though, soft tissues also includes blood vessels and fat as well as other structures that can all signal pain from being injured.
Ligaments are fibrous bands of tissue (much like elastic bands), that hold bones together. So, where two bones meet to make a joint; knee, elbow, knuckles, jaw, vertebrae and all the others, ligaments are holding them together. Ligaments also form part of joint capsules that surround joints to hold the lubricating fluid in joints in a water-tight environment. Further, they stabilise joints and help to support the body.
Muscles and their tendons are also soft tissues with elastic properties. All muscles have tendons at their ends and it is the tendons, that attach to bones across joints, that allow for movement to take place when muscles contract.
Now, if you were to trip and fall, you would most likely reach out with one of your hands to protect your head. However, there is a chance that you may hurt your wrist by spraining many of the ligaments and tendons in that wrist. Clearly, this is going to hurt but, it all depends on how much damage occurs.
Before describing the damage from the injury, it is important to know the difference between acute and chronic injuries. Injuries to ligaments and tendons can come on suddenly or may get worse gradually.
- A sudden injury is related to a specific incident and is labelled as acute. This means it has occurred within 24 to 72 hours. Acute injuries are caused by a sudden trauma, such as a fall, twist, or blow to the body.
- An injury that gets worse over time (for example, over three months) is labelled as chronic. These are commonly caused by overuse or stress. For example, it is possible to suffer sprains and strains from sitting for too long over many years whilst at work.
The descriptions of acute and chronic are NOT the same as severity. Severity is a measure of how painful the injury feels and is often very difficult to score because of its highly subjective nature. The most-used rating for pain is the Numerical Rating Scale (NRS), which rates pain from zero (no pain), to ten (the worst pain imaginable).
Therefore, it is possible to have an NRS of 7 after a road traffic collision that could be felt just as severely years later when it has not been treated. It is also possible to suffer mild to severe pain in acute and chronic injuries.
Sprains and strains are classified at three levels of severity to describe their signs and symptoms. They include, as the name suggests, the ligaments, muscles and their tendons……
Grade 1 strain or sprain (mild)
- Minimal over-stretching. Possible minor tearing of ligaments and tendons
- Mild tenderness, minimal swelling and stiffness
- The joint will feel stable and if it is a weight-bearing joint, walking will be possible with minimal pain.
- Strength and function will be mostly unaffected
Grade 2 strain or sprain (moderate)
- Partial / incomplete tears of ligaments and tendons
- Moderate pain, tenderness, swelling with resultant stiffness and bruising
- Joints can remain stable but, the damaged areas are tender to pressure from direct touch on examination and walking is painful for a weight-bearing joint.
- Some loss of strength and function
Grade 3 strain or sprain (severe)
- Complete rupture of structure usually with immediate pain along with immediate or delayed swelling
- Significant pain, marked swelling and marked bruising (blood seeping along muscles before surfacing to the skin) that can track. For example; from an injured knee to the foot.
- Inability to use the injured structure (weight-bearing joint or not)
- Instability of the affected joint which may feel ‘wobbly’
- Considerable loss of strength and function
In common with all three of the injury levels described above is the varying intensity of the pain, the degrees of bruising and swelling - excessive swelling can slow the healing process.
Muscles deserve a special mention here…
Myofascial trigger points are more well-known as knots in your muscles. They are felt as palpable nodules in taut bands of muscle fibres. They can create incapacitating pain; restrict movement of joints and distortion in posture. Although there is a fair bit of controversy about these knots, many manual medicine practitioners work on them including chiropractors, osteopaths, physiotherapists and massage therapists.
They are important because they are exceptionally good (or bad), at generating pain and can also refer the pain to distant sites in the body that do not appear related to the problem. An example is a trigger point in the neck referring to a temple of the skull. The patient may complain more of headache pain than neck pain even though the neck muscle is the source of pain.
Soft tissue injuries such as trigger points are often overlooked as sources of pain. One reason most likely is that they are not sinister; they will not kill the patient. However, they do dramatically reduce the quality of life of the sufferer and those about them are affected too. When they are not recognised, the sufferer is often labelled as neurotic, or has a psychogenic or behavioral problem.
Muscles make up about 50% of body weight and are therefore collectively, the largest single organ - approximately 200 paired muscles (400 individual muscles). They can all develop trigger points and of course, can be part of a sprain-strain injury.
When to consider seeking medical help…
A fracture may have occurred with no obvious signs or symptoms. So when in doubt, go to A&E for a check-up when:
- pain is particularly severe especially when weight-bearing (a leg may give-way)
- There is any unusual shape or deformity (not swelling)
- You heard a pop or crack at the time of injury
- Any surrounding bony structures are painful
- There is numbness or pins / needles / coldness (either at the injury site or anywhere else)
- Symptoms haven't started to improve within a few days of self-treatment
At Tollers Personal Injury we believe that ALL injuries matter and where an individual has suffered an injustice from an accident that was not their fault we want to fight their corner to be compensated and ensure that they receive the very best treatment.
If you have an enquiry relating to an injury Talk to Tollers on 0333 414 9123 or email email@example.com for FREE No Win No Fee advice.
We are not Personal Injury Lawyers by accident!