Injuries Explained

There are many different types of injury; Muscle Injuries, Tendon Injuries, and Ligament Injuries, to name a few. There are also many different places in which you can become injured; for example feet, hands, back, and neck. Although both the location of the injury and the injured tissue can be different every time, the process of injury and repair are very similar. In fact for the large part, they are exactly the same irrespective of where or what is injured.


We have looked at many of the possible injury types and broken them down by structure and tissue. We have also looked at the overall injury and healing process for most body tissues. This should help to clarify the injury and repair process for many of the major tissue types.














Injury & Healing Process – Soft Tissue

The Injury & Healing Process for soft tissue is the same everywhere in the body. The Injury & Healing Process for Bone is not dissimilar. However,this is covered in our Bone Injuries section.


The Injury & Healing process can be broken down into three distinct stages:



This is the initial part of the injury process. Somewhere, something in your body has become damaged and it is your body’s job to identify this area, reduce the risk of further damage, and lay the foundation for repair.


Inflammation is caused when an injury to an area causes blood vessels to break. This is always the first sign of damage and can be identified by blood on the skin, or dark swelling or bruising underneath the skin. The first job for your body is to stop the bleeding and it does this by triggering a blood clot to form. This clot is made up of Platelets and essentially plugs the gap in the damaged area to prevent further bleeding. In a muscle tear, these Platelets would be located between the two torn bits of muscle.


The next job for your body is to reduce the risk of any infection and it does this by releasing white blood cells into the area. This can be seen fairly quickly in the form of swelling. This swelling forms a sticky gluey mess that kicks off the healing process. This swelling prevents further damage by limiting movement and stimulating pain receptors. This is achieved by the release of special pain chemicals that stimulate nerve fibres.


The Inflammation Stage usually continues for around 3 days but can sometimes last as long as 5. It is characterised by pain, swelling, bruising, redness, and muscle spasm.



The accumulation of white blood cells and pain chemicals is a very important part of the injury process. However, it is not always necessary. For example, if you tear a muscle you will cause damage to the body but there is usually no immediate risk of infection. In contrast, if you step on a rusty nail you will again cause damage, however, this time there is a significant risk of infection. The point is this, where damage and inflammation is present, the injury cycle will always follow. This never changes, and inflammation is always triggered by damage or bleeding somewhere in the body. So irrespective of whether you have been kicked in the leg, or have glass in your hand the Inflammation Stage will be the same.


Sometimes we try to reduce the unwanted effects of inflammation and swelling as the sticky mess it creates prevents recovery by reducing normal movement and function. We do this by using anti-inflammatories and by applying the principals of P.R.I.C.E:


  • Protection
  • Rest
  • Ice
  • Compression
  • Elevation


In addition, gentle Sports Massage and mobilisation exercises can be administered in order to promote blood flow and help remove inflammation. The quicker you can get an area moving after an injury the better the outcome and quicker the recovery. Having said this, there are certain movements and activities that you must avoid as it is easy to do too much and re-injure the area. For these reasons it is vital that you seek proper medical advice before doing anything.



Proliferation is where the body begins to grow and produce new cells and tissues. Special cells called Fibroblast begin to replace Platelets within the blood clot. These Fibroblasts create a framework of Collagen for new cells to develop, essentially sewing the two bits of damaged tissue back together. Collagen is the universal building material for most tissues in the body. In soft tissue injuries, this new Collagen is called Scar Tissue.


This framework or Scar Tissue will ultimately become new tissue. However, the type of tissue it will become is dependant upon its location. Following Muscle Injuries, Fibroblasts lay down Collagen that will ultimately become new muscle fibres; in Bone Injuries this Collagen will become new bone.


In Muscle Tissue and other form of soft tissue, Collagen is organised in nice straight lines. This organisation means that stress is dissipated evenly through the tissue when it is stretched, similar to how a steal cable is made. However, Collagen formed during the Proliferation Stage is not laid down in nice straight lines. Instead it is constructed in a random disorganised fashion with strands of Collagen going in all directions. This happens because the body is trying to repair the area quickly. As a result, the repair site is left weak and susceptible to further injury.


Over the coming days this Scar Tissue begins to contract and pull the two damaged bits of tissue back together.


In addition to Collagen and Scar Tissue formation, the body starts to bring fresh blood and nutrition to the area via new capillaries and blood vessels.


The Proliferation Stage continues from day 7 – 14. Pain is no longer continuous but movement can be painful as the injured area will be stiff and inflexible. Any swelling should have reduced and instead of a springy bouncy appearance will now feel hard and podgy. Bruising will have become darker and more diffuse.



Treatment during this stage is again aimed at managing inflammation, so again the principals of PRICE and anti-inflammatories should be maintained. In addition to this, Physiotherapy treatment can help massively.


Sports Massage applied correctly helps to break down Scar Tissue and the randomised way in which Collagen is laid down. By combining different treatment techniques and Rehabilitation during this stage, Physiotherapy ensures that Collagen is laid down in a more organised way from the outset. Your body will eventually reorganise this Scar Tissue for you; however, it will take a much longer time in order to do so. In this way, Physiotherapy during this stage significantly speeds up the healing process.


In addition to aiding the reorganisation of Scar Tissue and Collagen, Sports Massage helps to remove unwanted debris from around the injury site. This could be dried blood, dead muscle cells, old swelling, etc. In this way Sports Massage decongests the area and enables fresh blood and nutrients into the injury site.


Acupuncture can also be beneficial during this stage as it helps to promote blood flow whilst reducing muscle spasm and pain.


Rehabilitation should be aimed at targeting any newly formed Scar Tissue in a controlled way. There are particular exercises that can target Scar Tissue and help strengthen it. Because Collagen is laid down along the lines of stress, mobilising and exercising Scar Tissue in certain ways tells the body where forming Collagen needs to be laid down.


The repairing injury is still fragile during this stage and as such, a qualified medical practitioner should be the only person to give advise on treatment or Rehabilitation.



During the Remodelling Stage the body completes reorganisation of Scar Tissue and the forming Collagen. This is where Scar Tissue becomes fully formed or ‘matured’. This process is influenced greatly by external factors such as movement and exercise.


Scar Tissue has bridged the gap between the two damaged parts of tissue and then begins to shrink due to its contractile nature. This process is usually complete at around 21 days post injury. Despite this, the newly formed Scar will almost always have less Collagen than that compared to its pre injured state. In addition there are usually less blood vessels and more disorganised fibres. In this way, Scar Tissue is always left slightly weaker than normal uninjured Soft Tissue. This residual weakness can be influenced greatly by Physiotherapy treatment and Rehabilitation.


The Remodelling Stage continues from day 14 to anything up to 90 days after injury. Pain has usually subsided at around day 14; however, there will be some tightness in the muscle or injured area until around day 28. In muscle injuries, all swelling and inflammation should have been well absorbed by the body within 4 weeks. For ligament and tendon injuries, this swelling may still be present up to 90 days later.



Following its formation, Scar Tissue continues to strengthen for around 3 months. During this period Physiotherapy treatment and targeted Rehabilitation will optimise recovery. This Rehabilitation should be made a functional or sports specific as possible in order to fully prepare the tissue. Rehabilitation should not only target Scar Tissue. It should also accommodate the muscles and joints around the injury site, as these will have been left weak and unstable following injury.


Inappropriate activity during this period will almost certainly lead to re injury. Most injuries that breakdown during the Remodelling Stage do so because the individual has failed to re strengthen the area appropriately. As Physiotherapists we see a lot of injuries at week 3 or 4 because the client has tried to return to sport or activity too early. This is because pain and other symptoms have usually subsided well before any Scar Tissue has fully matured.



Muscle Injuries


Muscles Tears, Muscles Strains, and Pulled Muscles are all terms for the same type of Muscle Injury. Most Muscle Injuries occur during sport and exercise. Common types include Hamstring Tears, Groin Tears, and Calf Tears. However, Muscle Injuries can occur in any situation given the right circumstances. Back Tears, Neck Tears, and Shoulder Tears are other common types of Muscle Injury.


If a muscle is stretched beyond its normal limit the tiny fibres that make up that muscle become damaged and torn. This causes localised bleeding, swelling, tightness, and inflammation and ultimately leads to scar tissue and pain.


Muscle Tears tend to be graded depending on their severity. Grade I is where only a few fibres are damaged, Grade II means more of the muscle is damaged but the muscle still remains intact, and Grade III is where the muscle has become completely ruptured.


Muscles can become overstretched and torn in a number of different ways. There can be a sudden overstretching, called an Acute Muscle Tear, or a gradual prolonged stretching overtime as in a Chronic Muscle Tear. Most Muscle Tears that occur during sport are Acute Muscle Tears.


For example, an Acute Hamstring Tear usually occurs whilst attempting to slow down from a sprint. This type of injury is particularly common in Football. As the body tries to slow down the Hamstrings contracts, or shortens, to stop the knee extending quite so quickly. If the muscle is not warm or loose enough this contraction causes parts of the muscle to overstretch and subsequently tear. Tears in this way can also result from overuse or a lack of sufficient rest between activities.


For a description of Chronic Muscle Tears, see Repetitive Strain Injuries.



Acute Muscle Tears are characterised by a sudden, sharp, stabbing or pulling pain. This is always localised to the muscle involved. From the minute the muscle becomes torn it is usually difficult and very painful to try and contract or stretch that muscle. If you are involved in a game of sport at the time, more often than not you will have to stop playing.


In the days following a Muscle Tear you will notice increasing pain and discomfort over the injury sight. This may be coupled with swelling and bruising. The more swollen and bruised the area the greater the damage. In severe cases the muscle becomes completely immobilised and cannot be moved due to pain and stiffness. This would be typical of a grade II or III Muscle Tear.



Physiotherapy can help Muscle Injuries repair properly. This is because Physiotherapy can aid the healing process. Often, the earlier treatment is started the better the outcome for the injury.


Treatment of any soft tissue injury can be broken down into 3 different stages. These stages usually correspond with the stages of the Injury & Healing Process, e.g. Acute or Inflammatory Stage, Soft Tissue Treatment or Proliferation Stage, and the Rehabilitation or Remodelling Stage.


During the Acute Stage (0-7 days) treatment is aimed at reducing the affects of inflammation and swelling. It is helpful to Ice the injured area every hour where possible for at least 20 minutes. This can be beneficial for up to 5 days post injury. It can also be helpful to take oral anti-inflammatories during this period, however, ensure that you seek guidance from your GP regarding the use of medication.


Physiotherapy treatment during this period can be used to gently remove excess swelling and inflammation through Sports Massage and mobilisation of the area.


The Soft Tissue Treatment Stage of treatment (7-21 days) is geared towards treating the underlying scar tissue. Scar tissue helps to repair the injury by bridging the gap between to two torn bits of muscle. Most muscle fibres are organised in straight lines as this allows the maximum amount of force to be applied through the muscle from either end. Because scar tissue is laid down quickly, it does not always form in nice straight lines and is, therefore, unable to deal with the same amount of force as regular muscle tissue. Scar tissue will gradually be remodelled into straight lines; however, this takes time and is not always completed fully. Muscles can tears repeatedly if the underlying scar tissue has not fully remodelled into straight lines.


Sports Massage applied correctly during the Remodelling Stage can help scar tissue to form straight lines potentially accelerating the healing process.


During the final Rehabilitation Stage (14-28 days), it becomes important to re strengthen any muscles or joints that were left weak after the injury. It is another important part of treatment. Without appropriate Rehabilitation the injured area may remain weak and susceptible to further injury. At Physio 1st we have a number of specialised Rehabilitation programs depending on which muscle has been torn.


Treatment of Muscle Injuries usually lasts between 4-6 weeks and normally requires at least 6 session of Physiotherapy.



Muscle Tightness


Muscle tightness can be a common consequence of sport, exercise, and stress. Muscle Tightness usually occurs when abnormal stress is placed on a muscle due to overuse, muscle imbalance, or poor Biomechanics. If this stress is not reduced or the Biomechanics not corrected, the muscle may tear. In this way, muscle tightness can be a warning sign that the muscle is about to tear.


Over time, increased stress can cause the muscle to tighten up. This may ultimately create Scar Tissue as the muscle breaks down. This process is similar to the mechanism behind Repetitive Strain Injuries.


This tightness is what’s commonly known as Muscle Knots or Trigger Points. If left untreated Scar Tissue may become tighter and cause pain. This can reduce flexibility, therefore further reducing the muscles ability to deal with stress. In this way, Muscle Tightness can get worse the longer it is left.


Calf Tightness is a common type of Muscle Tightness. Tight Calf muscles usually occur because of poor Biomechanics, i.e. where the foot and ankle is not supported properly during walking or running. As a result it is common in Runners and Footballers and in people who have flat feet or who over-pronate.


Hamstring Tightness and Groin Tightness is another common type of Muscle Tightness. Again, both of these can be related to poor Biomechanics as well as weaknesses in the Core and Postural Muscles.


Tightness in the Upper Traps or neck muscles is usually related to posture. It can also be related to the sports and hobbies that you pursue.



Symptoms included a tight, pulling, or cramping feeling within the muscle. This is usually present during the initial stages of exercise when the body or muscle is cold. As the muscle warms up, symptoms tend to reduce. You can notice an increase in symptoms towards the end of exercises, for example, in the last 20 minutes of a football game. It is also usual to feel stiffness and pain within a few hours of stopping exercise, and especially the day after exercise.


If symptoms persist for longer than a day, or are more severe than just a tightness or cramp, it is likely that the muscle has torn.



Muscle Tightness can be treated effectively with Physiotherapy. There are several important stages to treating Muscle Tightness.


Relative Rest – It is important to rest the muscles that feel tight. For example, if you are a keen runner, you should reduce the amount of running whilst you undergo treatment. The rest period is usually at least 4 weeks. We call it Relative Rest because there may be other exercises you can do whilst you rest from whatever activity is causing the Tightness.


Biomechanics – Muscle tightness is usually related to poor Biomechanics. Therefore, it is important to correct any Biomechanical problems that may be present. This can be done via an Insole or Orthotic.


Sports Massage – Sports massage is helpful to breakdown underlying scar tissue. Sports Massage is usually applied over a 4-6 week period.


Acupuncture – Acupuncture can be used to treat Muscle Knots or Trigger Points. Acupuncture is often used when treating stiffness in the Upper Traps and neck muscles.


Rehabilitation – When the quality of the muscle tissue has improved it is important to Rehabilitate the area. This usually involves specific strengthening exercises as well as looking at technique, i.e. running style, core strength, etc.


Treatment for Muscle Tightness usually lasts around 4-6 weeks and requires 6 treatment sessions. If the Muscle Tightness has been around for a longer than 3 months it may be necessary to have occasional treatment with Sports Massage every 6-8 weeks thereafter.



Tendon Injuries


Tendons connect muscles to bones. Tendon Injuries or Tendinopathies are usually caused when the tendon becomes over stretched, over used, or torn. Depending on the type and cause, Tendon Injuries are categorised in the following way:


Tendinitis/Tendonitis/Tenosynovitis – This is where the tendon or tendon sheath has become acutely inflamed. By acute we mean within the last few days. This usually only lasts a few weeks or so. Increased stress and overuse, coupled with potential Biomechanical problems can cause micro-tears in the tendon. This creates inflammation and subsequently causes Scar Tissue to form. Any tendon can be susceptible to Tendinitis. Common types of Tendinitis include Jumpers Knee (Patellar Tendinitis), Biceps Tendinitis, Tennis Elbow (Lateral Epicondylitis), Golfers Elbow (Medial Epicondylitis), De Quervain’s Tenosynovitis (inflammation of the Thumb tendons), Trigger Finger or Thumb, Peroneal Tendinitis, and Achilles Tendinitis. Usually these injuries are caused by a sudden increase in activity, i.e. playing a lot of tennis as in Tennis Elbow, or running more frequently as in Achilles Tendonitis. They can also be caused by the cumulative effect of overuse or repetitive strain as in De Quervain’s Tenosynovitis.


Tendinosis – Tendinosis is a chronic Tendon Injury. Chronic generally relates to injuries over 3 months old. A tendon that is subjected to prolonged stress and overuse will begin to breakdown. By this we mean the continual cycle of Scar Tissue formation and subsequent breakdown leaves the tendon weak and painful. Untreated Tendinitis will usually lead to Tendinosis. Any tendon can therefore suffer from Tendinosis.



Symptoms of Tendinosis/Tendinitis can include localised burning and throbbing pain. This pain tends to get worse the more the area is moved, and will settle down when the area is rested. Tendon Injuries can also look swollen, red, and feel hotter to the surrounding areas when felt with the back of the hand. Swelling between the tendon and the tendon sheath may cause a grating or crackling sound as it moves. Pain in the tendon may also cause weakness in the surrounding muscles.


In chronic Tendon Injuries the tendon can become thickened and develop lumps or bulges along the tendon.



Treatment for Tendon Injuries is similar to the treatment for Muscle Tears and other soft tissue injuries. Tendon Injuries can take longer to heal than Muscle Injuries because there is less blood flow into a tendon, when compared to that of a muscle. Less blood flow means less nurturance and, therefore, the potential to heal is reduced.


Again, treatment for Tendon Injuries can be broken down into stages.


Relative Rest – Reduce the stress placed on a tendon. This can be anything from 4-12 weeks depending on the area and/or severity. Supports can also help reduced the stress on a tendon.


Biomechanics – Tendon Injuries in the lower limb, e.g. Jumpers Knee (Patellar Tendinosis) and Achilles Tendinosis, can be helped with Orthotics or Insoles,


Sports Massage – Sports Massage can be used to help breakdown and remodel underlying Scar Tissue. Sports Massage is usually applied over a 6-8 week period.


Acupuncture – Acupuncture is again helpful when treating Chronic Tendon Injuries. In Achilles Tendinosis acupuncture needles can be inserted between the tendon sheath (paratendon) and tendon to help reduce adhesions created by inflammation and Scar Tissue. This should allow the tendon to move more freely within the tendon sheath. At Physio 1st, we often use this technique at the end of a treatment session.


Rehabilitation – As the quality of tendon tissue improves you can begin to re strengthen and re-condition the tendon. This requires a specific, targeted Rehab program. It is important that Rehabilitation is not started too early otherwise the tendon can become re-irritated. As there are often contributing factors relating to performance and technique, reviewing style and movement patterns are usually an important part of Rehabilitating Tendon Injuries.


Treatment for Tendon Injuries can last anywhere from 4-12 weeks and may require up to 10 sessions of treatment. Occasionally Physiotherapy is not effective at reducing all the symptoms. Where this is the situation it may be necessary to look at changing or modifying the activity that has caused the problem. In sever cases surgery may be required.



Tendon Ruptures


Given sufficient force, or following a prolonged period of Tendinitis/Tendinosis, a tendon can completely rupture. This would be classified as grade III injury.


Tendons that become chronically injured can contain large amounts of scar tissue. The quality of this scar tissue is poor and inflexible and overtime results in a weakening of the tissue. If sufficient force is placed through a weakened tendon it can snap. Tendons can also rupture as a result of poor blood flow to. Tendon Ruptures are usually more common the middle-aged to older generation; however, these injuries but can happen at any age given the right circumstances.


Tendon Ruptures can also occur as a direct result of trauma. For example, breaking a fall with an outstretched arm, or landing from a height on your feet.


Common Tendon Ruptures include Achilles Tendon Rupture, Peroneal Tendon Ruptures, Quadriceps Tendon Ruptures, Biceps Tendon Ruptures, and Rotator Cuff Tendon Ruptures.



The characteristics of a Tendon Rupture are a sudden excruciating localised pain. With an Achilles Tendon Rupture, some people describe the pain as feeling as though they had ‘been shot’ or been kicked in the back of the leg. There will usually be a complete loss of movement in the area as well as rapid or immediate bruising and swelling. The muscle connected to that tendon will often look deformed immediately after a Tendon Rupture, as in the Popeye Sign with a Biceps Tendon Rupture.



Tendon Ruptures can result in permanent disability if left untreated. Where possible Tendon Ruptures will be surgically repaired as quickly as possible. The longer the tendon is left ruptured, the harder it can be to repair it surgically.


The prognosis following surgery can be anything from 3-9 months depending on the site and severity of tear; an Achilles Tendon Rupture will usually take longer to recover than a Rotator Cuff Tendon Rupture.


Not all Tendon Ruptures are treated surgically. If the tendon is partially torn, and/or if surgery is not deemed suitable, Tendon Ruptures can be treated conservatively. Often Rotator Cuff Tendon Ruptures are treated conservatively as the outcome from surgery is no better than if it was left to heal naturally.


Surgical Repair – Surgical repair usually involves stitching the two ends of the tendon back together. The area is often immobilised following surgery for a period of between 6-12 weeks. Following immobilisation, the tendon can be treated with a combination of Sports Massage, Mobilisation, Acupuncture, and Rehabilitation in order to regain strength and quality of tissue.


Conservative Management – Conservative management of Tendon Ruptures can again last anything from 3 – 9 months depending on the severity and area of rupture. Again treatment revolves around Sports Massage, Mobilisation, Acupuncture, and Rehabilitation.


At Physio 1st we have specialised treatment plans for each and every potential Tendon Rupture. Depending on the treatment approach, as well as the site and severity of Tendon Rupture, you can expect to be in treatment for anywhere between 3-9 months. Tendon Ruptures may require up to 30 treatments in total.



Ligament Injuries


Ligament Injuries or Ligament Sprains usually occur as a result of trauma, e.g. falling over, tripping over, twisting a joint, direct blow from a bad tackle, etc. For this reason, Ligament Injuries are common in sport and exercise.


Ligaments hold bones together to form joints. They are naturally elastic and will stretch and twist in order to allow joints to move freely. When stress is applied through a ligament it will stretch to a certain point, then return to its normal length when the stress is released. However, ligaments can only stretch so far. Ligament Injuries or Ligament Sprains usually occur when the ligament has been stretched too far. As with Muscle Injuries, Ligament Injuries tend to be graded depending on the damage caused.


Grade I – The ligament has been stretch too far and there are some small micro tears in the ligament. The ligament would not be left permanently lengthened by a Grade I Ligament Injury. There will be no residual instability of the ligament following a Grade I Ligament Tear.


Grade II – If a ligament is stretched too far it will go beyond its normal elasticity limit and a more significant partial tear will occur. The ligament will be left slightly longer than it was before. In this way it will become permanently lengthened and there will always be some instability following a Grade II Ligament Sprain.


Grade III – A Grade III Ligament Injury is a complete rupture of the ligament. That is, the ligament has been completely torn in half. Grade III Ligament Injuries will leave the affected joint unstable and in larger ligaments, will almost always require surgery to connect them back together.


Common types of Ligament Injury include:


  • Lateral Ligament Sprain
  • Inversion Injury
  • Torn Ankle Ligaments
  • Anterior Talofibular Ligament Sprain
  • Medial Collateral Ligament Injury
  • MCL Injury
  • Anterior Cruciate Ligament Injury
  • ACL Injury
  • Acromioclavicular Ligament Injury
  • AC Ligament Injury.



Ligament injuries are usually very painful. If there has been a tear as in a Grade II or III injury, there is normally are cracking or popping noise. Swelling is usually present straight away and will increase with time. Bruising is normally present within a day or so. In weight-bearing joints such as the ankle or knee, damaged ligaments usually prevent the individual from walking on that leg. This may be the case for up to a week in bad Ligament Injuries.


Movement of the associated joint is painful and becomes very stiff in the days following a Ligament Injury.



Ligament Injuries follow the same injury process as all other Soft Tissue Injuries. Again like Tendons, Ligaments have less access to blood when compared to muscles. Therefore, recovery following a Ligament Injury takes longer than that of a Muscle Injury. Typically, Ligament Injuries will take around 4-12 weeks to recover, depending on severity and location.


The Acute Stage of treatment is aimed at reducing inflammation and swelling. Gentle mobilisation exercises can also be given during this stage. It may be necessary to keep off the injured area or avoid using it for a few days following the injury.


As soon as possible you should attempt to start using the injured area again to avoid unnecessary compensations developing. You should seek guidance on this from a qualified medical practitioner.


As swelling and pain settle, movement should get easier and so you can begin to Rehabilitate the area. For weight-bearing joints, it is important to re educate balance and proprioception (awareness of body position) as Ligaments play an important role in maintaining this. It is also important to re strengthen associated joints and muscles, as these will be left weak following Ligament Injury.


Throughout treatment of a Ligament Injuries, Sports Massage applied to the ligament and surrounding soft tissue can help to recondition and manage the forming Scar Tissue. Mobilisation and Manipulation techniques can also be used to regain movement and flexibility.


Treatment for Ligament Injuries can last anywhere from 4-12 weeks and may require up to 10 sessions of Physiotherapy. For severe ruptures and tears, surgery is usually required to regain function. For a knee ligament injury, such as those to the Anterior Cruciate Ligament/ACL, surgery is always necessary if you wish to partake is sport again.



Joint Injuries


There are three types of Joints; Synovial joints, Cartilaginous joints, and Fibrous joints. Synovial Joints are them most common type. They are held together by ligaments and have Cartilage covering the articular surface, i.e. the ends of both bones where movement occurs. Synovial Joints also contain a fluid called Synovial Fluid. This provides lubrication between the two bone ends. As a result, Synovial Joints allow a great deal of movement and as such can be more susceptible to injury.


Cartilaginous Joints are again held together by Ligaments and too have Cartilage between the two bone ends. However, Cartilaginous Joints do not have Synovial Fluid and therefore have much more restricted movement. Cartilaginous Joints are situated in areas where stability is more important than flexibility, e.g. in the spine and ribs. Cartilaginous joints can still become injured, however, there is usually less risk due to the limited movement.


Fibrous Joints or Fixed Joints are connected only by dense fibrous connective tissue. There is almost no movement. The separate sections of the Skull are held together with Fibrous Joints. Injuries to Fibrous Joints more commonly relate to Fractures. Please refer to Bone Injuries if you wish to know more about this.


There are usually three ways in which joints become injured. Overstretched, Compressed, or Overused. Quite often, it is a combination of these three factors that causes the resulting Joint Injury.


Overstretching or forcing a joint beyond its normal range will usually cause Ligament Injury. Potentially over stretching may cause injury to the Cartilage, however, this is more common in Joint Compression injuries. For example, falling on an outstretched arm can force the wrist joint beyond its normal range causing injury to the surrounding ligaments and potentially damaging the Cartilage within the joint. Likewise, landing awkwardly on your leg may cause your knee to twist and bend at the same time. This again will likely cause damage to the ligaments and Cartilage within the knee. Meniscal Cartilage Injuries and tears tend to occur in this way. Overstretching a joint will usually cause joint swelling as the synovial membrane, the part that houses Synovial Fluid, can become inflamed causing more Synovial Fluid to be produced.


In severe cases, Overstretched Joints will dislocate. This is where the joint comes completely out of position.


Common Joint Injuries from Overstretching include, Meniscal Tears/Torn Knee Cartilage, Glenoid Labrum Tear/SLAP Lesion/Shoulder Joint Injury, Hip Labral Tear/Hip Joint Injury, Shoulder Dislocations, Finger Dislocation, and Knee/Patella Dislocation.


Compressing a joint will usually cause Cartilage damage. If this compression is coupled with movement or twisting, as seen in a Meniscal Tear, ligaments can also become injured. If there is sufficient compression and movement within the spinal joints, Disk Bulges or Slipped Disk can occur. This is where the Cartilage or Disk between spinal vertebrae is forced out of position. Again damage to the synovial membrane will usually cause joint swelling following a Compression Injury.


The types of injury that occur through joint Compression are similar to that of overstretching; Meniscal Tears/Torn Knee Cartilage, Glenoid Labrum Tear/SLAP Lesion/Shoulder Joint Injury, and Hip Labral Tear/Hip Joint Injury. In addition, to these, Slipped Disks/Disk Hernia/Herniated Disc/Intervertebral Disk Injury, Facet Joint Injury, and other Neck and Back Joint injuries are common types of Compression Injury.


Overuse of a joint can cause a gradual breakdown of the articular surface. This again can affect all aspects of the joint, however, wearing of the Cartilage is usually the most profound. Overtime Cartilage can become worn due to repeated stress. This can be likened to a hinge becoming rusty. In addition, we lose fluid from within our Cartilage as we age. This reduced the potential for Cartilage to absorb shock and further increases the chances of injury.


As Cartilage wears out the two ends of bone can come into contact and cause damage. As this bone tries to repair itself little spurs of bone form called Osteophytes. This is known as Osteoarthritis.


Common types of Joint Overuse Injury include Osteoarthritis/OA/Degenerative Joint Disease/Degenerative Arthritis, Cervical Spondylosis/Neck Arthritis, Degenerative Disc Disease.



Acute symptoms of Joint Injury may include swelling, pain, laxity in the joint, bruising of surrounding soft tissue (ligaments, tendons, muscles), stiffness, and lack of movement. Acutely injured joints can also be painful to walk on or put pressure through and may give way during exercies. Most Overstretching and Compression Injuries will result in the above acute symptoms.


Overuse injuries usually give rise to more Chronic symptoms. This can include swelling, pain around the joint, and stiffness in the morning. The joint will usually appear redder and feel hot when compared to other joints. Cracking and grating can also be heard from within the joint when it is moved. These symptoms will normally ease off with activity or exercise; however, they are usually more profound following in the hours or days after.



Treatment for Joint Injuries depends on the type and severity of injury. For acute injuries it is helpful to reduce the inflammation via the usual methods; Protection, Rest, Ice, Compression, and Elevation. In addition to this, oral anti-inflammatories can help reducing swelling. Again medical advice should be sought prior to taking any medication.


Where overstretching has caused Ligament Injury, the protocol for treating Ligaments will need to be applied.


Where Compression or Overstretching has caused damaged to the Cartilage, as in a Meniscal Tear or a Laberal Tear, surgery is often required in order to retain optimum function. This is usually performed via Arthroscopy or Key Hole Surgery. Depending on the site and severity of injury will depend on the recovery time following surgery. It can take as long as 9 months to recover from Joint Surgery, however, standard surgery to trim or remove Cartilage should take no more than 3 months. Following any form of joint surgery, Physiotherapy can be used to improve soft tissue quality and regain joint function and stability. Joint Mobilisation and Manipulation techniques are often used to regain movement and Sports Massage is used to improve soft tissue quality. Specialised Rehabilitation programs can target the muscles and tendons around a joint to provide more stability and strength. Co-ordination training is also helpful to regain control and agility.


Physiotherapy following Joint Surgery can last up to 9 months and require in access of 20 sessions. For those less serious injuries such as Meniscal Tears, treatment can be completed within 12 weeks and will usually require no more than 10 Physiotherapy sessions.


Occasionally where damage to the Cartilage is minimal, conservative management of just Physiotherapy can help minimise symptoms enough to avoid surgery. Physiotherapy treatment under these circumstances is often aimed at improving mobility and reducing pain. Treatment techniques can include Joint mobilisation and Sports Massage. Treatment will usually last around 6 weeks and require 6 session of Physiotherapy.


For Overuse and Degenerative Joint Conditions, the aim is often long-term management of symptoms. Controlling the inflammation is helpful as this reduces pain and improves mobility. This can be done via the usual methods, Rest, Ice, Elevation, and Compression. Heat can also help promote blood flow and aid movement. Long-term use of oral anti-inflammatories is often not advised as this can cause unwanted side effects. Your GP will be able to advise you further on this.


In degenerative conditions such as Osteoarthritis, scar tissue often develops in the surrounding muscles, tendons, and joints. This can be down scar tissue forming in the joint capsule and may result from lack of movement. This scar tissue can be a source of pain and as such can benefit from Sports Massage, Acupuncture, and other Physiotherapy treatments.


For severe cases of Arthritis, steroid injections can help reduce pain and swelling. Steroid injections can usually be given up to three times per joint. However, because degenerative conditions cannot be stopped or reversed, ultimately badly damaged joints may need replacement surgery in order to function properly.


Typically surgeons will replace the joint articular surface with metal or ceramic implants. Recovery following this type of surgery can take around 3 months and may require intensive Physiotherapy treatment. This often comprises of Sports Massage, Joint Mobilisation, Acupuncture, and specialised Rehabilitation. This type of treatment usually requires around 10 sessions of Physiotherapy.



Bone Injuries


Bone Injuries, known medically as Fractures, are caused when there is a break in the bones continuity. Generally Bone Injuries are usually caused by direct Trauma, Stress or Overuse, or underlying Pathology.


Traumatic Fractures – Traumatic Bone Injuries usually occur when there is excessive internal or external force applied to the bone. For example, a skier may fall on an out stretched arm and break their wrist, or you may twist your ankle badly and end up breaking the end of your shin bone. Whatever the reason, Traumatic Bone Injuries are usually characterised by sudden onset.


The process of injury is in some ways identical to the process of injury and repair in soft tissue. Much like when muscle fibres tear, a sudden incident causes a break in the bone. This causes bleeding, swelling and inflammation at the injury site. A blood clot forms between the two bone fragments and within a few days fibroblast begin to lay down collagen. Where as this Collagen becomes new muscle fibres following Muscle Injury, in bones, Collagen is strengthened with minerals to become new bone. Over the subsequent weeks and months this new bone strengthens and remodels to form bone that is close to that of its original strength. Although you can normally weight bare on this new bone at around 6 weeks, the total process can sometimes take up to 18 months, and in extreme cases it can even take years.


Fractures tend to be described according to how they appear. Common types of Traumatic Fracture include, Open Fractures, Closed Fracture, Avulsion Fractures, Complete Fractures, Linear Fractures, Transverse Fracture, Oblique Fractures, Spiral Fracture, Comminuted Fracture, and Impacted Fracture.


Stress Fractures – Stress and Overuse related fractures are a common type of Sports Injury. This is because they can occur with repeated overuse. As such Stress Fracture are more common in the bones of the lower leg, ankle, and feet. They are sometimes called incomplete or hairline fractures because stress has caused the bone to separate slightly, rather than snap completely in half.


The body replaces and strengthens bone on a regular basis. In areas of high stress, such as the bones of the lower leg or feet, bone-forming cells called Osteoblasts work over time to repair and strengthen bone. If the area is subjected to stress for a prolonged amount of time the Osteoblasts are unable to deal with the demand and weakness develops in the bone. This weakness can cause the bone to gradually separate.


The injury and healing process is the same as that seen in Traumatic Bone Injuries. However, the time taken to recover can take longer. This is because the underlying mechanism of injury is stress or overuse and as such, this usually needs to be identified and resolved if the injury is to repair properly.


Common types of Stress Fracture include Metatarsal Fractures and some types of Tibial Fractures. Shin Splints can also develop into Stress Fractures. With Shin Splints, repeated stress causes the shin muscles to lift off the surface of the shinbone or Tibia causing a hairline fracture underneath.


Pathological Fractures – Pathological Fractures are caused by underlying pathology. Disease weakens the bone so much that just standing can cause bones to break. They are not common and require immediate medial treatment. Physiotherapy is not normally a suitable treatment intervention if you have a Pathological Fracture.


Common causes of Pathological Fracture include osteoporosis, cancer, infection, inherited bone disorders, and bone cysts.



For Traumatic Bone Injuries symptoms will usually include immediate pain, swelling, inflammation and potential bleeding if the bone and come trough the skin, as in an Open or Compound Fracture. Often you will hear a cracking sound if a large bone has broken. There is usually a complete inability to use the affected area, i.e. to weight bare on a broken leg, or carry something with a broken arm. Where the fracture is less sever, i.e. an Avulsion Fracture (when a tendon or ligament pulls away small piece of bone) symptoms can be less obvious. In these cases it becomes clear after a few days that the area is broken as it is still very painful to weight bare on the area, and/or movement is severely limited. Avulsion Fractures can be common with Lateral Ligament or Inversion Injuries to the ankle, and also with Rotator Cuff Injuries to the shoulder.


Symptoms for Overuse or Stress Fractures are often more generalised. Pain and tenderness are usually associated with weight bearing. For example, a runner with a Stress Fracture will usually have severe pain during the initial part of the run that generally eases slightly during the run. However, towards the end of exercises, and particularly afterwards, this pain returns and is usually worse than it was at the beginning. This would be typical of someone with Shin Splints or Metatarsal Stress Fractures.



Effective treatment for Bone Injuries almost always requires immobilisation of the broken fragments. This is in order to allow Osteoblasts to repair the injury site. Typically immobilisation is achieved by way of a cast or splint. Casts or splints are usually applied for around 4-6 weeks. The reason for this is that it takes roughly 4-6 weeks for bone density to increase sufficiently to weight bare or tolerate everyday stresses and strains.


I severe cases, surgery is required to immobilise the area. This can be achieved via Open Reduction Internal Fixation or ORIF.


Whilst the bone is being held in place, it is important to keep the other joints as mobile as possible. Secondary injuries can arise as a result of immobilised Bone Injuries. For example, it is not uncommon to cause a secondary Frozen Shoulder following a broken arm. This is because the shoulder joint is not moved sufficiently throughout the immobilisation period.


Following immobilisation, it can be helpful to treat the surrounding soft tissue and joints with Sports Massage and Mobilisation/Manipulation techniques. This is because Bone Injuries often coincide with Muscle, Joint, Tendon, and Ligament Injures. In addition to soft tissue treatment, Rehabilitation is usually important to encourage new bone to strengthen. This strengthening process can continue for months and sometimes years following Bone Injury.


Physiotherapy can reduce the chances of re injury following Bone Injuries. Providing a suitable Rehabilitation program is followed, strength and function will return quickly following a Fracture. Physiotherapy treatment is usually started after immobilisation once the bone has set. 6-8 sessions is usually conducted over a period of 6-8 weeks. However, following serious Fractures the necessary treatment and Rehabilitation can take considerably longer.



Myofascial Injuries


Myofascial Injuries affect fascia. Fascia is a connective tissue that surrounds the whole body and keeps everything in place, much like cling film keeps sandwiches together.


As with all soft tissue, Fascia is susceptible to stress and strain, and the affects of inflammation.


Myofascial Injuries can be common in those areas where a lot of movement occurs, i.e. around joints, or where stress is likely to build up, i.e. near large weight bearing muscles. Myofascial Injuries can also occur from overuse or lack of rest.


Scar tissue forming within the injury site can give rise to abnormal adhesions between collagen fibres. Over time this can cause fascia to tighten up and therefore reduce its ability to stretch and remain flexible. This in tern may limit movement and thus further reduces the load bearing potential. This is often the case in one of the most common forms of Myofascial Injury; Plantar Fasciitis. Plantar Fasciitis is usually caused by an overuse of the foot and ankle, as in increased running or physical exercises, or when there has been a sudden change in footwear, the training terrain or where the ground has hardened. It can also be related to an increase in training intensity or training frequency.


When fascia runs close to bone it can be susceptible to overuse injuries as repeated movement may cause inflammation and pain due to friction. This is often the case with Runners Knee or ITB Syndrome.



When fascia becomes injured, the forming scar tissue can give rise to pain, swelling, inflammation, lack of flexibility, and reduced movement.


Acutely inflamed fascia can appear puffy or podgy to touch. Pushing and prodding the area may also bring on the symptoms. This is usually a deep burning type of pain. In Plantar Fasciitis, pain is usually felt when initially putting pressure on the foot, e.g. first thing in the morning when you get out of bed. This can ease off a little as you move about more, but on the whole, will get worse the longer you walk or run about. Again it is often a deep burring heel pain that can spread around the ankle and down the foot as it becomes more intense. It is generally easier when you are not walking or running about.


Runners Knee or ITB Syndrome is generally felt during and after running or activity. It will usually take a few minutes to come on but will generally not ease off the more you do. Usually it will get worse the more exercise or running you do. Stopping the activity should cause the symptoms to reduce. Runners Knee or ITB Syndrome can be felt anywhere from the side of the hip down to the knee joint. On the whole, it is more commonly felt on the outside of the knee as a deep burning pain.



Treatment of Myofascial Pain is similar to the treatment of all other soft tissue injuries. Again, the elements of rest, inflammation management, soft tissue treatment, and rehabilitation all come into play.


Relative rest is often required for at least 4 weeks. This means stopping the activity that is causing the pain, e.g. running. This rest can be coupled with Physiotherapy treatment.


When you have addressed the irritating activity, it is important to manage the inflammatory element of the injury. To do this you should ice the area as much as you can, every hour where possible, for at least 20 minutes. Be careful not to cause an ice burn when doing this. In addition, your GP may be able to advise you on the potential use of oral anti-inflammatories. This routine should continue for about 2 weeks.


In addition to this, Physiotherapy treatment can often be started straight away. Myofascial Injuries like Runners Knee/ITB Syndrome and Plantar Fasciitis can be treated effectivitly with Physiotherapy. Sports and Soft Tissue Massage can help to improve the underlying tissue quality whilst specifically targeted Rehabilitation Programs can help to recondition and alleviate the unnecessary stress that may have caused the injury in the first place.


For all lower limb Myofascial Injuries it is important to assess Biomechanics and potentially fit an Orthotic. Biomechanics can be the cause of a number of lower limb Myofascial Injuries.


Treatment for Myofascial Injuries usually takes around 6-8 weeks, depending on the area and severity of Injury. During this period you can expect to have between 6-8 Physiotherapy sessions.


If there is no response to treatment after 4 sessions, you may require an MRI scan to investigate the underlying pathology in more detail. Following on from this Myofascial Injuries are usually treated with Steroid Injections, and in extreme cases require surgery.



Nerve Injuries


Nerves are the bodies wiring system. They carry message to and from the brain and allow the body to function properly. Injuries to the Nervous System can cause major disability as these messages are disrupted and instructions from the brain are not delivered properly. Likewise, messages may be unable to travel back to the brain meaning sensations such as touch, movement, and pain may not be detected.


Nerves can become injured during trauma, such as Peroneal Nerve Injury, or gradually over time, as in Trapped Nerves or Sciatica.


Traumatic Nerve Injuries can be caused by direct blows to the body, or when a foreign object penetrates and breaks the skin causing deep lacerations to the soft tissue. Because nerves are often situated next to, or around bones, serious bone injuries can also result in Nerve Injury. Because the nerve is often severed or stretched excessively during Traumatic Nerve Injuries, recovery can take a long time, and may not ever return fully. This is generally governed by whether or not the nerve sheath has been damaged. Where the nerve sheath remains intact, nerves fibres can often re-grow overtime gradually restoring function. However, if the sheath is itself severed, the chances of recovery are greatly reduced.


Non-Traumatic Nerve Injuries can be caused by Postural Problems, Muscle Tightness, Degenerative Joints, Overuse, or Biomechanics. Examples included, Trapped Nerves, Sciatica, and Carpal Tunnel Syndrome. Non-Traumatic Nerve Injuries usually involve the compression of, or irritation of a nerve through increased pressure and tension in the surrounding soft tissues. Nerves can also be irritated by inflammation in the surrounding soft tissue and joints.


Slipped Disks can often compress and damage nerves in the Spinal Column. These can arise both in traumatic situations, i.e. lifting something too heavy, and non-traumatic events, such as Postural Problems or muscle imbalance within the Spinal Column.



Traumatic Nerve Injuries usually result in sudden loss of sensation and/or severe pins and needles. In extreme cases, loss of power and movement may be experienced. Initially there is usually little pain felt from the actual nerve damage itself. However, as time goes on, a deep burning and shooting pain can develop, the area may be hyper sensitive to touch, and an inching feeling can be felt. These are usually signs that the nerve is repairing.


Non-Traumatic Symptoms will often start out as an aching that radiates from the injury site. For example, with Sciatica an aching pain can be felt radiating down the leg from the buttocks. If left untreated this aching can quickly progress into as shooting pain, and then into intermittent or constant pins and needles. Again, if this is left untreated this Nerve Impingement or Trapped Nerve can cause more advanced paraesthesia including total loss of sensation and paralysis of muscles.


Common symptoms for Trapped Nerves and Slipped Disks in the neck and back include pins and needles in the arms or legs, and in severe cases, problems with the bladder or bowl, and problems walking. Should you experience any of these symptoms, you should seek emergency aid from a hospital as life threatening problems can result.



Serious Nerve Injuries will often require surgery. Where a nerve is completely severed or cut in half, surgeons can stitch the outer part or sheath of the never back together. Over time this will encourage the nerve cells to re-grow within the repaired sheath.


Less serious injuries and Non-Traumatic Nerve Injuries will usually benefit from Physiotherapy. This is because they often arise as a secondary consequence of tension or injury in the surrounding soft tissues. If these primary injuries are treated, usually the secondary Nerve Injury will settle down as well.


Another side effect of nerve damage is scar tissue deposits between the nerve and its sheath. This scar tissue limits mobility within the nerve and can give rise to the neural symptoms associated with Adverse Neural Tension (ANT). The presence of scar tissues means that this type of injury can benefit from conventional scar tissue treatments such as Sports Massage, Mobilisation, Neural Stretching, and Rehabilitation. In addition to this, here at Physio 1st we will use Manipulation, Biomechanical Correction, Postural Exercises, and Acupuncture to treat Nerve Injuries.