Soft Tissue Injury

• How can a soft tissue injury result in a chronic pain state when all the tests come back normal?
• Can the invisibility of soft tissue injury of be explained?
• How can your health status pre-trauma affect post-trauma healing?
• Does the outcome of a soft tissue injury depend on treatments that speed the healing or treatments that direct the healing?

Soft tissue injury is a common springboard to a chronic pain state. Similar to many forms of chronic pain, non-resolving soft tissue injuries are difficult to objectively quantify through diagnostic imaging or other forms of testing. Whiplash would be a primary example. With regard to treatment, let’s consider questions that are rarely asked:

• What was the condition of the injured person prior to the injury?
• Is the injured person capable of healing properly?
• Is the treatment focus to speed and support the healing or to direct the healing?
• If the injury is non-resolving after a period of 3-6 months, is it possible that the tissue has completed the healing process and has simply not healed properly?
• If there are no objective findings, is malingering the only viable explanation?

To answer these questions we must first understand the nature of soft tissue. Looking at the differences between bone and muscle will give us some insight.

Bone is a static tissue. By this, we mean a bone does not change it’s shape. When you break a bone, the treatment is fairly straightforward. You set it, you stabilize it (cast or splint) and then you give it time to heal. Generally this takes 6-8 weeks. After this period if the bone does not heal correctly, your options are limited. Since the body identifies the incorrectly healed structure as normal anatomy, you either live with it and the problems that result from it, or you have it re-broken and reset.

Muscle, on the other hand, is dynamic tissue. By this, we mean muscles do change shape. They can lengthen, shorten, thicken, etc. Dynamic tissue derives its health through motion under appropriate mechanical stress. Most treatments for dynamic soft tissue injury focus on rest and limited motion through the critical healing phase. This encourages dynamic tissue to heal in a static environment. Could these treatments encourage aberrant healing?

As with bone, the body now identifies this aberrantly healed tissue as normal anatomy. The degree of aberrant healing will be directly proportional to the residual pain that you carry forward. Over time, this aberrant healing will adversely affect surrounding biomechanics, adding abnormal mechanical stress to adjacent joint structures and soft tissue.

• Could this phenomenon explain the inevitable appearance of osteoarthritic changes years after a soft tissue injury?
• Are there ways to mitigate these collateral issues by altering current available treatments?

By changing the focus of soft tissue injury treatment from supporting and/or speeding the healing process to directing the healing process, we will show that soft tissue injury is much simpler to deal with than one might expect.