About Soft Tissue Treatment
By Caitlin Lukacs
Most DCs would list soft-tissue injury treatment as a major component of their practices. But what exactly does such treatment entail? Soft-tissue injury covers a large variety of health issues, from over-use or repetitive-motion injuries to acute traumas such as ankle sprains. Because of the range of problems that are categorized as soft-tissue injuries, there are also a variety of treatments that can be used to care for them.
What Makes a Soft-tissue Injury?
There are two main types of soft-tissue injuries: focal lesions and global lesions, according to Michael Schneider, DC, PhD, assistant professor in the University of Pittsburgh’s School of Health and Rehabilitation Sciences and postgraduate faculty member at several prominent chiropractic colleges. Focal lesions are localized to one tissue area. An example of a focal lesion is tennis elbow. “Tennis elbow consists of very discrete pain in a particular area—not the entire arm,” Dr. Schneider explains. There are three types of tissue affected by focal lesions: muscle, tendon and fascia.
Another way to describe the three types of focal lesions, according to Gregory Doerr, DC, CCSP, head physician at the Bergen Chiropractic and Sports Rehabilitation Center, is structural, neurologicallymediated and microcirculatory. Structural issues include tendinopathy and ligament sprains. Neurologically- mediated issues consist of problems such as scapular dyskinesia. Microcirculatory issues include edema and inflammation caused by acute injuries.
Global lesions are a weakness or tightness in an entire muscle. An example is a tight hamstring.
How Does a Soft-tissue Injury Occur?
“Typically, soft-tissue injuries are caused by an overuse problem—repetitive motion—or an acute trauma,” explains Vincent DeBono, DC, CSCS, vice president for academic services at National University of Health Sciences. “Over-use injuries are relative,” he continues. “For example, postural deficits such as upper-cross syndrome may result in an over-use injury to the muscles that are correcting for the postural syndrome—the muscles are accommodating a biomechanical defect.” In other words, over-use injuries can occur when a muscle is used for an activity that it was not meant to be doing.
According to Dr. Schneider, the type of soft-tissue injury you’ll see depends on the patient population you treat. If you treat mostly athletes, you’ll probably see lots of over-use injuries and fascial problems, but if you treat mostly seniors or young children, it’s not very likely that you’ll see over-use injuries. Instead, acute trauma injuries are more common.
Are Soft-tissue Injuries Preventable?
“We’d love to be able to prevent soft-tissue injuries, but the reality is there is no way to do that. Accidents happen; no matter how much exercise you do. However, there are things we can do to help our patients reduce the likelihood of an injury,” says Dr. Doerr.
“It’s all about living a healthy lifestyle,” explains Dr. DeBono. “If you’re not getting regular exercise, proper rest and a balanced diet, you’re definitely going to be more prone to injury.” He goes on to explain that once your body sustains one injury it’s much more susceptible to future injuries or illness.
Dr. Doerr agrees, saying that proper conditioning and stabilization are key to protecting your body from injury. DCs are uniquely equipped to discuss healthful lifestyles with their patients— they can make exercise recommendations, give nutrition advice and even comment on healthful sleep habits.
How Are Soft-tissue Injuries Treated?
First and foremost, you always perform an evaluation, says Warren Hammer, DC, DABCO, and soft-tissue expert, who practices in Norwalk, Conn. For most soft-tissue injuries, you want to perform a standard active, passive and resistive testing of the area. Active testing determines the range of motion of an area, while passive testing or stretching, differentiates the passive tissues involved— ligaments, capsules or fascia. Resistive muscle testing confirms the muscle and/ or tendon involvement. “In order to properly treat a soft-tissue injury you need to know the specific part of the soft-tissue that is involved. Is it the ligament? Muscle? Tendon? Fascia? All of the above?” Often, the type of treatment depends on the specific area of involvement.