Soft tissue injuries

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Soft tissue injuries affect the muscles, ligaments and tendons. They are normally caused by some kind of accident, overuse or chronic fatigue. When tendons or muscles become overstretched these are referred to as strains, but when the ligaments become overstretched it is called a sprain. Soft tissue injuries are graded according to their severity:

  • Grade 1 is a mild strain or sprain which may result in microscopic tearing of fibres and some swelling and discomfort.
  • Grade 2 is a moderate strain or sprain which may make you unable to put weight on the affected area without pain.
  • Grade 3 is a severe strain or sprain caused by the complete rupture of the structure. You may experience significant pain and instability and be unable to use the injured area.

A grade 3 injury may have a lengthy recovery time, whereas a grade 1 injury may be healed within a few weeks. It is important to get a diagnosis as leaving a soft tissue injury untreated can cause a significant worsening of symptoms.

Overview

Common soft tissue injuries affecting the hip and knee include:

  • Hip strains – if the muscles or tendons in the hip joint are stretched beyond their normal limits they may tear. This can occur as the result of a sporting injury or during normal everyday activities. Hip strains often occur where the muscle joins the tendon. Symptoms include pain when you use the muscle, less of movement, muscle weakness and swelling.
  • Bursitis of the knee or hip – this is inflammation of the bursa, the small, jelly-like sacs that help to cushion the bones and soft tissues and reduce friction.
  • Anterior cruciate ligament injury – this affects the ligament that runs down the front of the knee and is common in athletes who participate in contact sports or sports that involve rapid changes of direction.
  • Meniscal tears – please refer to meniscal injuries section.
  • Tendonitis of the knee (patellar tendonitis) is an injury to the tendon that connects the kneecap to the shinbone. It is common in athletes whose sport involves jumping.
  • Tendon tears such as a torn patellar tendon. This can be due to a fall or direct impact to the knee.
  • Collateral ligament injuries – this is the ligament that connects the thighbone to the shinbone.
  • Lliotibial band syndrome – this occurs when the iliotibial band, on the outside of the knee, rubs against the knee joint causing minor irritation at first but often leading to pain.
  • Posterior cruciate ligament injuries – this affects the ligament at the back of the knee that connects the thighbone to the shinbone. It often occurs due to a sudden impact on the knee when it is bent.

Causes of soft tissue injuries

Soft tissue injuries fall into these main types:

  • Acute injuries which are caused by a sudden trauma, such as a trip, fall, twist or collision which can result in tearing. Sprains, strains and contusions (a bruise due to ruptured blood capillaries) are acute injuries.
  • Overuse injuries which occur gradually over time due to repeating the same movement again and again. Tendonitis and bursitis are overuse injuries.
  • Chronic fatigue – for example, due to over-exercising while tired.

Certain factors increase your risk of soft tissue injuries such as:

  • Muscle tightness.
  • Not warming up properly before exercising.
  • Increasing your workout too much and too quickly.
  • A prior injury in the same area.

Symptoms of soft tissue injuries

The symptoms of a soft tissue injury can vary depending on the location and extent of the damage. Typical symptoms include:

  • Pain and tenderness in the affected area
  • Swelling and bruising.
  • Instability including being unable to put weight on the affected area.
  • Stiffness and loss of movement.

You may also experience:

  • Deformity of the affected area
  • Hearing a popping or cracking sound when you injured yourself.
  • Pain in the adjoining bones.
  • Pins and needles or numbness.

Diagnosis of soft tissue injuries

It is important to get a prompt diagnosis, particularly if the pain or swelling is severe, or if you had a sudden trauma. Your doctor will carry out a physical examination including applying pressure to muscles in the affected area and moving your hip or knee to assess your range of motion. You may also have an X-ray to determine whether there is also a fracture in the affected area.

Treatment of soft tissue injuries

You should immediately stop what you were doing when the injury occurred and protect the area from any further damage. Use the RICE method:

  • Rest and avoid any movement that exacerbates the pain
  • Ice can help to reduce swelling but wrap ice cubes in a damp tea towel or use a sports ice pack.
  • Compression can also reduce swelling. Apply a firm bandage but be careful not to restrict circulation.
  • Elevation of the affected area above the level of the heart can also bring swelling down.

You may also need:

  • Medication, to relieve pain such as painkillers or anti-inflammatories.
  • Physiotherapy, to help the area heal and prevent the risk of further injury. A physiotherapist will recommend exercises to strengthen the affected area and prevent stiffness, as well as advising you on how to perform day-to-day activities while you are injured.
  • To wear a brace or using walking aids until the injury heals
  • Surgery to repair the damaged muscle or tendon. In some cases this can be performed arthroscopically (keyhole surgery).

Consultants

For rapid access to specialist orthopaedic consultants who can help you with a personalised treatment plan, take the first step and arrange a consultation.