The musculoskeletal system is made up of all the bones in the skeleton and the muscles that attach onto them. The bones create a stable base from which movement can occur and the muscles have the ability to shorten and lengthen to allow movement of the skeleton. Both of these structures can suffer injury, either from overuse or from trauma and the treatment will depend on the nature and severity of the injury.
Traumatic injuries to the bone can happen by falls, abnormal movements or direct force to the bones. This can result in the bone breaking and is referred to as a fracture. There are many types of fractures and the nature of the injury will determine the treatment.
Closed fractures occur when there is no piecing of the skin
Open fractures occur when the bone pushes through the skin producing an open wound
Non displaced fracture
Non displaced fractures occur when the bone breaks, but the pieces stay in position
Displaced fracture occur when the bone breaks and the pieces move out of position
Sometimes, when the soft tissue is stronger than the bone, a small piece of bone can tear off with the muscle or tendon and create an avulsion fracture. Children have softer bones and can bend easily which makes it more difficult to break. However, if the bending or twisting is too much, the bone can snap causing a “greenstick” fracture. Other bone injuries that can occur are stress fractures and these develop as an overuse injury of repetitive small trauma. This causes small cracks in the bone that can be painful and restrict movement.
The radiological findings are matched with the history and mechanics of the injury as well as a good clinical examination. Treatment is then determined accordingly.
For traumatic fractures the treatment will be determined by the orthopedic surgeon and will depend on the alignment of the bone and if there is an open wound. The treatment can include surgery to correct the bone position or casting and rest to give the bone time to grow and heal.
Healing will usually take about 6 weeks, depending on the injury. The role of the physiotherapist after the bracing is removed is to decrease the joint stiffness that has occurred and to strengthen the weakened muscles. This is done manual techniques such as mobilization and stretches, soft tissue massage, electrotherapy and strengthening exercises.
The process of physiotherapy rehabilitation can last from 2- 12 weeks depending onthe injury and weakness involved. The aim of the rehab is to achieve maximal possible range of movement, good muscle strength for daily activity, return to sport/exercise and to be as pain free as is possible.
For the body to move we need to joints. These joints allow us to move in various directions and are usually surrounded by a capsule of ligaments and are controlled by muscles. The bony surfaces of the joints are covered with a softer cartilage that allows for the movement to be smooth and even.
As we age, this softer tissue can become worn down by over use and can lead to the bony surfaces touching each other. The surface of the joint also becomes less even and can produce rough edges that can cause irritation to the surrounding soft tissue. This can lead to inflammation and swelling of the joint and can become a chronic problem which results in pain and loss of movement and function.
This will depend on the severity of the symptoms and the amount of joint damage present. Conservative treatment will include physiotherapy to decrease swelling and inflammation, improve muscle strength and length and produce normal movement patterns. Bracing or strapping may also be used at this stage, together with crutches and slings to protect the joint.
If conservative treatment doesn’t work, a surgical solution may be needed. This can vary from the arthroscopy to cleanup the rough surfaces to complete joint replacement. A joint replacement is when the moving parts of the joint are replaced by synthetic or metal parts to help restore the smooth surfaces and increase the joint space thus allowing for normal pain free movement. Some common replacements include:
- Knee replacement
- Hip replacement
- Shoulder replacement
- Ankle replacement
- Radius head (elbow) replacement
Rehabilitation following surgery is important to achieve full range of movement, decrease swelling and restoring normal muscle action. The recovery period can range from 6-12 weeks post surgery.
SOFT TISSUE INJURIES
This includes all the muscles, tendons and ligaments in the body. A muscle is a soft tissue that can contract to shorten and lengthen to create movement. A tendon is a type of soft tissue that cannot contract and it attaches a muscle to the bone. The ligaments are the same type of tissue as tendons, but they only attach bone to bone (over a joint) and can also not contract.
Tears and Sprains
Injury can occur in of these tissues is overstretched or is suddenly placed under abnormal stress. This can result in small tears developing which can cause localized bleeding and inflammation. If enough force is applied to the soft tissue, they can tear completely which will result in a loss of function as well as create an unstable joint. These type of injuries include ligament sprains/tears, muscle tears and tendon tears.
Repeated strain of the tissue can lead overuse injuries that can become chronic. There is no trauma involved and the injury usually develops over a couple of days to weeks. The repeated strain can create inflammation in the tissue which can cause pain and loss of movement. Muscle weakness can develop over time as the patient tries to avoid the painful movements, thus making the problem worse. This group of injuries includes:
- Tendonitis and tenosynovitis
- Rotator Cuff Syndrome
- Tennis Elbow
- Golfer’s elbow
- Plantar fasciatis
- Jumper’s knee
The diagnosis of soft tissue injuries starts with a good clinical evaluation. If trauma is involved and a tear is suspected, then an ultrasound can be sufficient to determine any damage and the underlying inflammation, and exclusion of more severe injuries.If this is unclear, a CT scan or MRI scan can also be used.
If there is a complete tear, then surgery is required to repair the injury and is followed by physiotherapy rehabilitation to recover full movement and muscle strength. If there is only a partial tear, then the correct bracing and rest can be sufficient to help the recovery process. The role of the physiotherapist is then to protect the structure from further damage, decrease any pain and swelling and to maintain and improve movement and strength.
Overuse injuries can become chronic and may respond slower to treatment. The physiotherapist should try and determine the underlying cause of the injury and try to modify this activity. This can include changing the office/computer set up or by providing bracing for a limited period. Treatments then focus on decreasing pain and swelling by using soft tissue massage, ultrasound and electrotherapy. Movement and strength are then improved with mobilization, stretches and rehab strengthening.
Healing time will depend on the severity of the injury and the nature of the problem. Surgical repairs and physiotherapy rehabilitation usually follow a pre-set program and can last 6-12 weeks. For the overuse injuries this may be longer or shorter depending on how severe the injury is and how well the home/work modifications can be done.