Sports Injuries:

Physical Therapy for Soft Tissue Injuries

Most sports injuries involve soft tissue, affecting the muscles, ligaments or tendons. Sports injuries generally include:

  • Sprains
  • Strains
  • Bruises or contusions
  • Muscle spasms and cramps
  • Myofascial conditions

Any of these can follow a single episode of trauma, such as a fall, a sudden twist or a blow to the body. Sufferers might also sustain an injury because of repeated overuse, often as part of an ongoing athletic activity. In this case, body stress accumulates slowly but steadily. The end result? Damage and pain.

For mild injuries, physical therapists often recommend a combination of home-based treatments known as "R.I.C.E.": rest, ice, compression and elevation. But more severe cases require treatment, as soft tissue can take six to eight weeks to heal.

The most common soft-tissue injuries:

Sprain. This condition results from a stretch or tear of the ligaments, which support the joints of the body. Ligaments are strong bands of tissue that connect one bone to another at the joints.

The areas most vulnerable to sprains are ankles, knees and wrists. A sprained ankle can occur when the foot turns inward, putting extreme tension on the ligaments of the outer ankle and causing a sprain. A sprained knee may follow a sudden twist, while a wrist sprain most often occurs by falling on an outstretched hand.

If the injury is recent, a physical therapist may first treat a sprain with ice and then heat. If the injury is to the lower body and affects gait or walking, crutches or a cane may be prescribed.

A therapist works with patients on exercises to build range of motion and promote stretching and strengthening. Other treatments include massage, ultrasound, bandaging or taping, and possibly a brace or another form of immobilization.

Strain. This follows an injury to either a muscle or a tendon, usually in the foot or leg. The strain may be a simple stretch in the muscle or tendon, or it may be a partial or complete tear in the muscle-and-tendon linkage.

Physical therapists treat strains by first alleviating pain, and then working with the patient to heal the injury and prevent recurrence.

If the strain is recent, the first treatments may involve ice and possibly heat if the swelling has stopped. Then the therapist may massage the injured area, or use ultrasound treatment to promote healing.

Often treatment includes stretching, both manual stretching by the therapist and self-stretching performed by the patient. In addition, the therapist teaches strengthening exercises to both quicken healing and prevent recurrence by building the muscles associated with the injury.

Contusion or bruise. Among the most common of sports injuries, contusions result from a blow to muscles, tendons or ligaments. Blood pooling around the injury discolors the skin. Athletes often experience contusions of the thigh, knee and lower leg.

Severe contusions require medical attention. Physical therapists initially work to minimize bleeding and inflammation and to reduce pain, using ice and then heat. Sometimes they prescribe crutches.

Once the injury is stabilized, the therapist works with the patient to restore range of motion, flexibility, endurance and strength. Finally, the therapist educates the patient, teaching new routines to help prevent recurrence.

Muscle spasms. Cramps that won’t stop cause muscle spasms. While they can affect any muscle, they appear most often in the legs and feet, and in muscles that cross two joints. Cramps can involve part of a muscle or all the muscles in a group.

The exact cause of muscle cramps is unknown, but they often are associated with:

  • Dehydration and extreme heat
  • Depletion of electrolytes (sodium, potassium, calcium and other nutrients critical for organ functioning)
  • Poor conditioning
  • Muscle fatigue
  • Starting a new activity

If cramps and spasms persist, a physical therapist can help. Sometimes the spasm is so intense that it requires manual stretching to relax and straighten the muscle. Severity varies from mild soreness to extreme pain.

Therapists also teach simple exercises to relieve pain and mobility. Often this includes helping a patient devise a pre-exercise routine of stretching and massage to prevent recurrence.

Myofascial pain. This chronic, sometimes severe, syndrome causes muscular discomfort. Patients experience a steady aching and deep pain. Knots may be visible or felt beneath the skin on the muscles or fascia, the connective tissue surrounding muscles.

While medical professional aren’t certain of the cause, myofascial pain is often linked to a muscle injury or from excessive strain on muscle or muscle group, ligament or tendon. The pain does not resolve on its own, even after typical first-aid care such as rest, ice, compression and elevation Physical therapists often use a type of massage therapy called myofascial release to relieve pain. This approach relaxes contracted muscles, increases circulation and drainage of the lymphatic system, and stimulates muscles and overlying tissue.

Physical therapists may also recommend gentle stretching and exercise to recover full range of motion and coordination, and instruction to improve posture. Additional exercises build strength and can prevent recurrence.