S211 Injury Prevention and
Management
Problem 03: What have I injured?
Problem Statement
Problem Crafter: Poonam Pal
Reviewed by: Alex Ong (Dr) and Lee Mei Kay
Module Chair: Poonam Pal (Dr)
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Polytechnic
Problem Statement
You were told that during a football game, Andreas, an avid
foot ball player, landed on his heel after jumping to head the
ball towards the goal post. He was in severe pain and was
unable to walk. His physiotherapist assessed him and found
that he had injured a soft tissue structure above his heel.
You were asked to think what had happened to Andreas.
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The approach
• What are the structure and functions of the various soft
tissues?
• What are the causes and types of these injuries ?
• How does healing occur in these structures?
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What are the structure and functions of the
various soft tissues?
Muscle
Structure:
•Myofibrils: actin and
myosin
•Various fibre
arrangements
Adapted from Bahr and Maehlum (2004),
pg 18
Location:
•Connects bone to
bone via tendons
Function:
•Generates muscular
force
Adapted from Bahr and Maehlum (2004),
pg 18
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What are the structure and functions of
the various soft tissues?
Ligaments
Structure:
•Collagen fibers, proteoglycans
•Arrangement: parallel, oblique
or spiral
Location:
•Intra-articular; Capsular; Extraarticular
Function:
•Connects bone to bone
•Stabilizes the joints
•Proprioceptive
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What are the structure and functions of the
various soft tissue?
Tendon
Structure:
•Type I collagen
•Arrangement: parallel
Adapted from Bahr
and Maehlum (2004),
pg 10
Location
•Muscular end and bony end
Function:
•Connects muscle to bone
•Transfers muscular forces to
the skeleton
•Produce motion and joint
stabilization
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What are the causes and types of injuries?
• All injuries can be classified as
– Acute / chronic
– Total / partial rupture
• Muscle:
– Exercise induced muscle soreness (DOMS)
• pain during training (ischaemia) or 24-48 hrs after activity
–
–
–
–
–
Contusion;
Strain: mild, moderate, severe;
Rupture / avulsion;
Compartment syndrome;
Lacerations
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What are the causes and types of injuries?
Ligaments
•Intra-articular injuries or
capsular injuries
•Avulsion, midsubstance or
ligament-bone junction
•Children: avulsion injuries,
•Adults: mid-substance injury
•Middle aged patients: ligament
bone junction
Adapted from Bahr and
Maehlum (2004), pg 7
•Mild (grade 1), moderate (grade 2) or severe (grade 3)
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What are the causes and types of injuries?
Tendons
•Penetrating trauma (stab wound) or deep laceration
•Acute injury < 2weeks; sub-acute 2-6 weeks; chronic > 6weeks
•Overuse injuries
-Tendinitis (tendon inflammation)
-Tenosynovitis (tendon sheath inflammation)
-Tenoperiostitis (inflammation of tendon origin and insertion)
-Periostitis (periosteal inflammation)
-Bursitis/ hemobursitis (bursal inflammation)
•Tendinosis; focal degenerative changes/ tendinopathy (chronic
tendon pain)
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How does healing occur in soft tissues?
Phase 1 - Inflammatory process (Last for few days)
Phase 2 - Proliferative phase (Last for few weeks)
Phase 3 - Maturation phase (Last for several months)
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How does healing occur in soft tissues?
• Ligaments and Tendons
– Thicker collagen fibers formed in the direction of
tissue tension
– Network of cross bridges established between them
– Form and function depends on the degree of loading
• Muscles
– Significant muscle is not regenerated but replaced by
scar without contractile properties
– Increased risk of recurrent injuries. E.g. hamstring
injuries
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Back to the problem
• What do you think happened to Andreas?
– Injured his soft tissue; posterior leg muscle
(gastrocnemius) and / tendon (Archilles tendon).
– The mechanism of injury determines the type of injury
occurring
– Healing in various soft tissues follow the same
principles but the duration of healing varies; healing is
slower in tendons compared to muscles
– Duration of healing in soft tissue is dependent on the
severity of injury
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What have we learnt today?
• Various soft tissue structures – structure and function
• Causes and types of injuries occurring to the soft tissue
structures
• Recognize the healing process of soft tissue injuries some
unique features for each structure
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References
• Norris, C. (2004). Sports Injuries:
Diagnosis and Management (3rd ed.),
Edinburg: Butterworth-Heinemann.
• Bahr, R., and Maehlum, S. (2004). Clinical
Guide to Sports Injuries, Champaign, IL.:
Human Kinetics
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Polytechnic