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 injuries.

2. Bleeding

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.

3. Haematoma (Clot Formation)

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 larger.

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

4. Oedema Formation

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 & Oedema

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.

6. 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.

7. Regaining Function

Regaining 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 different injuries.