1. Tissue Damage
Some degree of tissue damage occurs in any
injury. It is easy to appreciate how the overstretching of the
muscle or ligament tissue may cause the tissue to be torn and
therefore damaged. In other soft tissue injuries the crush injury
resulting from the direct blow will cause a variable degree of
tissue compression and stretching and hence, tissue damage. Healing
must take place before recovery is complete in all soft tissue
All cells require a constant supply of oxygen
and glucose which are carried to the cells by the blood. If muscle
tissue is torn then blood capillaries with the tissue also must be
torn at the time of Injury.
A consequence therefore is a degree of
capillary bleeding. The degree of capillary bleeding depends on the
amount of tissue damage.
The bleeding which occurs as a result of
damage to the capillaries within the damaged tissue will form blood
clots (Haematoma) within that tissue. Capillary bleeding will
continue for a short period of time after the injury. If the clot is
disturbed, then bleeding will continue, and the haematoma will be
If there is damage to the capillaries, blood
flow to other cells in the area is disrupted, and they will not gain
the supplies of oxygen and glucose they need to survive. After the
initial damage from the injury secondary injury will also occur
around the area of the primary injury. This is known as a
Secondary Hypoxic Injury which results
in the cells dying from lack of oxygen
Swelling is caused by capillary bleeding and
by oedema formation. Oedema is an accumulation of tissue fluid in
the tissues. The tissue fluid is drawn into the area by the
breakdown of tissue debris from the primary injury. Oedema formation
may also cause further secondary hypoxic injury because of
compression on the blood vessels decreasing circulation to the area,
and by an increased distance between the blood vessels and tissue
cells, which makes it more difficult for oxygen and nutrients to
diffuse from the blood vessels to the tissues.
5. Removal of Blood Clot &
As a result of tissue damage
a haematoma will form and some degree of oedema will occur within
the tissue. To begin the healing process the body starts breaking
down the haematoma. This begins to occur as soon as the haematoma
has formed and continues until it has been completely removed.
Tissue fluid forming the oedema is also slowly removed by the body.
Both the haematoma and the oedema must be completely removed before
healing can effectively occur.
Healing of Tissue
As the blood clot is being removed, the body
begins to heal the tissue damage by the formation of
Fibrous Scar Tissue. One of its
features is that as it heals over the damaged tissue, it will
contract in size thereby shortening the length of the affected
muscle, ligament, etc. It is estimated that if proper precautions,
such as R.I.C.E.R is taken, tissue repair generally starts around 72
hours after injury.
function of the injured area begins as the haematoma is being
removed and the Fibrous Scar tissue is
being laid down. Different rehabilitation routines are used for