General Symptoms from Trauma

Often more than one tissue is injured as a result of trauma. The extent of the tissue involvement may not be detectable during the acute phase.

• There is pain, localized swelling, tenderness on palpation, and protective muscle guarding regardless of whether the injured tissue is inert or contractile. Muscle guarding serves the immediate purpose of immobilizing the region. If the muscle contraction is prolonged, it results in the buildup of metabolic waste products and sluggish circulation. This altered local environment results in irritation of the free nerve endings so the muscle continues to contract and becomes the source of additional pain.

• Ligamentous strains cause pain when the ligament is stressed. If torn, there is hypermobility of the segment.

• As healing of the involved structures occurs, there may be adaptive shortening or scar tissue adhering to surrounding tissue and restricting tissue mobility and postural alignment.

Common Impairments and Functional Limitations Associated with Muscle and Soft Tissue Injuries

Acute Stage

• Pain and muscle guarding
• Pain with contraction of the muscle or stretch on the muscle
• Interference with ADLs (rolling over, turning, sitting, sit to stand, standing, walking)

Subacute and Chronic Stages

• Impaired muscle performance
• Impaired mobility: may have contractures in muscle and related connective tissue or may have adhesions at site of tissue injury
• Impaired spinal control and stabilization during functional activities
• Impaired postural awareness
• Limited IADLs, work, and recreational activities (difficulty with repetitive or sustained postures, lifting, pushing, pulling, reaching, and holding loads)

Common Sites of Lumbar Strain

A common site for injury in the lumbar region is along the iliac crest. This is where many forces converge around the attachment of the lateral raphe of the lumbodorsal fascia, quadratus lumborum, erector spinae, and iliolumbar ligament. Injury to this region frequently occurs with falls and with repeated loading of the region during lifting or twisting motions.

Common Sites of Cervical Strain

Common injuries in the neck and upper thoracic region occur with flexion/extension trauma. Serious cervical trauma may result in vertebral fractures and spinal cord injury.

Extension injuries. When the head rapidly accelerates into extension, if nothing stops it (such as a headrest in a car) the occiput is stopped by the thorax. The posterior structures, especially the joints, are compressed. The anterior structures (longus colli, suprahyoid, and infrahyoid muscles) are stretched. The mandible is pulled open, the condylar head of the temporomandibular joint translates forward, stressing the joint structures, and the muscles controlling jaw elevation are stretched (masseter, temporalis, internal pterygoid).

Flexion injuries. When the head rapidly accelerates into flexion and nothing stops it (such as the steering wheel or air bag in a car), the chin is stopped by the sternum. The mandible is forced posteriorly so the condylar head is forced into the retrodiskal pad in the joint. The posterior cervical muscles, ligaments, fasciae, and joint capsules are stretched.

Postural Strain

Strain to the posterior cervical, scapular, and upper thoracic muscles and fasciae is common with postural stresses such as prolonged sitting at a computer terminal, drawing table, or desk. Structures in the low back region are strained with faulty standing and sitting postures.

Emotional Stress

Emotional stress is often expressed as increased tension in the posterior cervical or lumbar region.

Functional Limitations/Disabilities

Impaired muscle function underlies most spinal problems that demonstrate pain or poor spinal control and stabilization during functional activities. When acute, muscle guarding interferes with basic activities such as rolling over, sitting, standing, and walking. With the subacute and chronic conditions, muscle impairments result in poor stabilization and spinal control in prolonged upright postures and activities. Proximal stability of the spine is imperative for most activities and needs to be addressed for improved function.

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