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Soft Tissue Healing References

Soft Tissue Injuries

INTRODUCTION

Soft tissue is everything other than bone. When dealing with musculoskeletal injuries, we are referring to muscle, tendon, ligaments, connective tissue known as fascia, and bursa.

Soft tissue reacts to injury in a very unique manner. When an injury occurs, inflammation follows. This inflammation is the reason that patients frequently have anti-inflammatory medication prescribed by their physician. The normal healing response is the formation of fibrous, or scar, tissue in and around the injured area. The fibrosis prevents the muscle from lengthening and contracting like it once did. This causes a loss of range of motion which may be subtle or significant. Pain also occurs as well as a predisposition to re-injury at the site of trauma. This can alter the normal biomechanics of the injured area or joint, and an overall decrease in function can follow. If the muscles surrounding the injury tighten to protect the area and remain tight or are not moved adequately, then another process takes place. This process is known as adaptive shortening. Again, the muscles lose their normal length and this leads to loss or range of motion and discomfort.

A great deal of research has been performed in this area. Sometimes people, and unfortunately sometimes health care professionals, will state “There isn’t any research about this”. Research on this topic does exist and a number of articles are included in this website. These articles are meant to be a start and should not be construed as a complete set of literature. I always wanted this website to be educational, so the data has been provided.

A large number of articles have been written and published in professional journals regarding research of soft tissue healing. These articles have come from a variety of researchers in several countries. A journal article belongs to the publisher, so they cannot be reproduced here. However, the references are provided, so you may find these articles yourself at a biomedical library. These references will be updated semi-annually, but this is not meant to be a complete, or comprehensive, list of literature.

Soft Tissue and Regeneration Literature

Almekinders LC, Gilbert JA. Healing of experimental muscle strains and the effects of nonsteroidal anti-inflammatory medication. Am J Sports Med 1986, (14):303-308.

Barlow Y Willoughby J. Pathophysiology of soft tissue repair. Br Med Bull, 48:698-711, 1992.

Brooks SV, Faulkner JA. Contraction-induced injury: recovery of skeletal muscles in young and old mice. Am J Phyiol 258 (Cell Physiol. 27):C436-C442, 1990.

Carlson BM, Faulkner JA. The regeneration of skeletal muscle fibers following injury: a review. Med Sci Sport Ex 1983, 15 (3):187-198.

Devore ST, Faulkner JA. Regeneration of new fibers in muscles of old rats reducing contraction-induced injury. J Appl Physiol 1999, 87(2):750-756.

Donovan CM, Faulkner JA. Plasticity of skeletal muscle: regenerating fibers adapt more rapidly than surviving fibers. J Appl Physiology 1987, 62(6): 2507-2511.

Faulkner JA, Carlson BM. Skeletal muscle regeneration: a historical perspective. Fed Proc 1986, 45(5):1454-5.

Fleckenstein JL, Weatherall PT, Parkey RW, Payne JA, Peshock RM. Sports-related muscle injuries: evaluation with MR imaging. Radiology 1989, 172:793-798.

Foley ZM, Jayaraman RC, Prior BM, Pivarnik JM, Meyer RA. MR measurements of muscle damage and adaptation after eccentric exercise. J Appl Physiol 1999, 87(6):2311-2318.

Hardy MA. The biology of scar formation. Phys Ther 1989, (69):1014-1024.

Herfkens RJ, Sieves R, Kaufman L, Sheldon PE, Ortendahl DA, Lipton MJ, Crooks LE, Higgins CB. Nuclear magnetic resonance imaging of the infracted muscle: A rat model. Radiology 1983, (147):761-764.

Hurme T, Kalimo H, Lehto M, Jarvinen M. Healing of skeletal muscle injury: an ultrastructural and immunohistochemical study. Med Sci Sport Exerc 1991, 23(7):801-810.

Jarvinen MJ, Lehto MUK. The effects of early mobilization and immobilization on the healing process following muscle injuries. Sports Medicine 1993, 15(2):78-89.

Jarvinen M. Healing of a crush injury in rat striated muscle. Acta Path Microbiol Scand, Sect A, 83:269-282, 1975.

Jarvinen M Jozsa L Kvist M Lehto M Vieno T Isola J Kannus P. Ultrastructure and collagen composition of the myo-fascial junction in rat calf muscles. Acta Anat 1992; 145 (3):216-9.

Jarvinen TA, Jozsa L, Kannus P, Jarvinen TL, Kvist M, Hurme T, Isola J, Kalimo H, Jarvinen M. Mechanical loading regulates tenascin-C expression in osteotendinous junction. J Cell Science 1999, (112):3157-3166.

Jarvinen M. Healing of a crush injury in rat striated muscle. Acta Path Microbiol Scand, Sect A, 83:269-282, 1975.

Jarvinen M Jozsa L Kvist M Lehto M Vieno T Isola J Kannus P. Ultrastructure and collagen composition of the myo-fascial junction in rat calf muscles. Acta Anat 1992; 145 (3):216-9.

Kannus P Jozsa L Kvist M Lehto M Jarvinen M. The effect of immobilization on myotendinous junction: an ultrastructural, histochemical and immunohistochemical study. Acta Physiol Scand 1992; 144 (3):387-94.

Kasemkijwattana C, Menetrey J, Somogyi G, Moreland MS, Fu FH, Buranapanitkit B, Watkins SC, Huard J. Development of approaches to improve the healing following muscle contusion. Cell Transplantation 1998, 7(6):585-598.

Kasemkijwattana C, Menetrey J, Bosch P, Somogyi G, Moreland MS, Fu FH, Buranapanikit B, Watkins S, Huard J. Use of growth factors to improve muscle healing after strain injury. Clinical Orthopaedics and Related Research 2000, (370):272-285.

Kent-Braun JA, Ng AV, Young K. Skeletal muscle contractile and noncontractile components in young and older women and men. J Appl Physiol 2000, (88):662-668.

Korthius RJ, Granger DN, Townsley MI, Taylor AR. The role of oxygen-derived free radical in ischemic-induced increases in canine skeletal muscle vascular permeability. Circ Res 1985, (57):119-126.

Kvist M, Hurme T, Kannus P, Jarvinen T, Maunu V, Jozsa L, Jarvinen M. Vascular density at the myotendinous junction of the rat gastrocnemius muscle after immobilization and remobilization. Am J Sports Med 1995, 23(3):359-364.

Leadbetter WB. Cell-matrix response in tendon injury. Clin Sports Med 11:533-77, 1992.

Lee JY, Qu-Petersen Z, Cao B, Kimura S, Janowski R, Cummins J, Usas A, Gates C, Robbins P, Wernig A, Huard J. Clonal isolation of muscle-derived cells capable of enhancing muscle regeneration and bone healing. J Cell Biology 2000, 150(3):1085-1099.

Lehto M, Sims TJ, Bailey AJ. Skeletal muscle injury – Molecular changes in the collagen during healing. Research in Experimental Medicine 1985, (185):95-106.

Lehto M Jarvinen M Nelimarkka O. Scar formation after skeletal muscle injury. A histological and autoradiographical study in rats. Arch Orthop Trauma Surg 1986 104 (6):366-70.

Lehto MU Jarvinen MJ. Muscle injuries, their healing process and treatment. Ann Chir Gynaecol 1991; 80 (2):102-8.

MacGregor J, Parkhouse WS. The potential of insulin-like growth factors in skeletal muscle regeneration. Can J Appl Physiology 1996, 21(4):236-250.

McCully KK, Faulkner JA. Characteristics of lengthening contractions associated with injury to skeletal muscle fibers. J Appl Physiol 1986, 61 (1):293-299

Menterey J, Kasemkjwattana C, Day CS, Vogt M, Fu FH, Moreland MS, Huard J. Growth factors improve muscle healing in vivo. J Bone Joint Surg (Br) 2000, 82-B:131-137.

Mishra DK, Friden J, Schmitz MC, et. al. Anti-inflammatory medication after muscle injury. A treatment resulting in short-term improvement but subsequent loss of muscle function. J Bone Joint Surg 1995 77A:1510-1519.

O’Driscoll SW, Salter RB. The repair of major osteochondral defects in joint surfaces by neochondrogenesis with autogenous osteperiosteal grafts stimulated by continuous passive motion. An experimental investigation in the rabbit. Clin Orthop 1986, (208):131-40.

Rantanen J, Ranne J, Hurme T, Kalimo H. Denervated segments of injured skeletal muscle fibers are reinnervated by newly formed neuromuscular junctions. J Neuropathology and Experimental Neurology 1995, 54(2):188-194.

Rupert R, Song X, Wang Z. Behavioral changes from soft tissue manipulation. Proceedings of the 2002 International Conference on Spinal Manipulation 2002.

Russell B, Dix DJ, Haller DL, Jacobs-El J. Repair of injured skeletal muscle: a molecular approach. Med Sci Sport Exer 1992, 24 (2):189-196.

Salter RB, Simmonds DF, Malcolm BW, Rumble EJ, MacMichael D, Clemente ND. The biological effect of continuous passive motion on the healing of full-thickness defects in articular cartilage. An experimental investigation in the rabbit. Journal of Bone and Joint Surgery [Am] 1980, 62(8):1232-51,

Salter RB. The biologic concept of continuous passive motion of synovial joints. The first 18 years of basic research and its clinical application. Clin Ortho 1989, (242):12-25.

Sayers SP, Peters BT, Knight CA, Urso ML, Parkington J, Clarkson PM. Short-term immobilization after eccentric exercise. Part I: Contractile properties. Med Sci Sports Exer 2003, 35 (5): 753-761.

Sayers SP, Clarkson PM. Short-term immobilization after eccentric exercise. Part II: Creatine kinase and myoglobin. Med Sci Sports Exer 2003, 35 (5):762-768.

Shellock FG, Fukunaga T, Mink JH, Edgerton VR. Exertional muscle injury: Evaluation of concentric versus eccentric actions with serial MR imaging. Radiology 1991, (179):659-664.

Shellock FG, Fukunaga T, Mink JH, Edgerton VR. Acute effects of exercise on MR imaging of skeletal muscle: concentric vs eccentric actions. Amer J Radiology 1991, (156):765-768.

Takai S Woo SLY Horibe S Tung DKL Gelberman RH. The effects of frequency and duration of controlled passive motion on tendon healing. J Ortho Res 1991, (9):705-713.

Thorsson O, Rantanen J, Hurme T, Kalimo H. Effects of nonsteroidal anti-inflammatory medication on satellite cell profileration during muscle regeneration. Am J Sports Med 1998, 26(2):172-176.

Vaittnen S, Lukka R, Sahlgren C, Hurme T, Rantanen J, Lendahl U, Eriksson JE, Kalimo H. The expression of intermediate filament protein nestin as related to vimentin and desmin in regenerating skeletal muscle. J Neuropathology and Experimental Neurology 2001, 60 (6):588-597.

Van der Meulen JH, McArdle A, Jackson MJ, Faulkner JA. Contraction-induced injury to the extensor digitorum longus of rats: the role of vitamin E. J Appl Physiol 1997, 83(3):817-823.

Vierck JL, Icenoggle DL, Bucci L, Dodson MV. The effects of ergogenic compounds on myogenic satellite cells. Med Sci Sports Exer 2003, 35 (5):769-776.

Wilczewski K. The Graston technique: Changing the treatment of soft tissue injuries. American Chiropractor 2002, 24(6):34-35.

Woo SLY, Buckwalter JA. Injury and repair of the musculoskeletal soft tissues. Journal Orthopaedic Research 1988, 6 (6):907-931.

Wright M. The influence of Dr. James Cyriax on the management of low back pain. Manual Medicine, 1988 3(3):118-9.

Zerba E, Komorowski TE, Faulkner JA. Free radical injury to skeletal muscles of young, adult, and old mice. Am J Physiol 1990, 258:C429-C435.

MRI of Muscle Injury Literature

Further studies on MRI findings of muscle injuries can add more insight into the complicated process of muscle healing.

De Smet AA, Fisher DR, Heiner JP, Keene JS. Magnetic resonance imaging of muscle tears. Skeletal Radiol 1990;19:283-286.

Fleckenstein JL, Shellock FG. Exertional muscle injuries: Magnetic resonance imaging evaluation. Topics in Magnetic Resonance Imaging. 1991;3:50-70.

Fleckenstein JL, Weatherall PT, Bertocci LA, et al. Locomotor system assessment by muscle magnetic resonance imaging. Magn Reson Q 1991;7:79-103.

Fleckenstein JL, Weatherall PT, Parkey RW, Payne JA, Peshock RM. Sports-related muscle injuries: evaluation with MR imaging. Radiology 1988; 172:793-798.

Ehman RL, Berquist TH. Magnetic resonance imaging of musculoskeletal trauma. Radiol Clin N Am 1986;19:283-286.

Herfkens RJ, Sievers R, Kaufman L, et al. Nuclear magnetic resonance imaging of the infarcted muscle: a rat model. Radiology 1983;147:761-764.

Polak JF, Jolesz FA, Adams DE. Magnetic resonance imaging of skeletal muscle prolongation of T1 and T2 subsequent to denervation. Invest Radiol 1988;23:365-369.

Pressman BD, Shellock FG, Schames J, Schames M. MRI evaluation of TMJ abnormalitiess associated with cervical hyperextension/hyperflexion (whiplash) injuries. Journal of Magnetic Resonance Imaging, 2:569-574, 1992.

Shellock FG, Fukunaga T, Mink JH, Edgerton VR. Serial MRI evaluation of exertional muscle injury: concentric vs. eccentric actions. Radiology 1991;179:659-664.

Shellock FG, Fukunaga T, Day K, Mink JH, Edgerton VR. Serial MRI and Cybex testing evaluations of exertional injury: concentric vs. eccentric actions. Med Sci Sports Med 1991;23:110.

Shellock FG, Fukunaga T, Mink JH, Edgerton VR. Acute effects of exercise on MRI of skeletal muscle: concentric vs. eccentric actions. American Journal of Roentgenology 1991, 156:765-768.

Strength and Conditioning
Strength and conditioning has always been part of our practice, but its role has increased over the years. Strength and conditioning, and rehabilitation can be viewed as extensions of each other. Low-level strength and conditioning can be considered rehabilitation. There is no clear cut point where one ends and the other begins. We do know we are clearly in the realm of strength and conditioning and coaching when the athletes are at the highest level of sports performance.
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The staff at the Soft Tissue Center serves many roles in spine care. We often serve as the first stop for the patient, so the entire diagnostic work-up is completed. The patient has either conservative care recommended, or is referred for a combination of pain management and conservative care, or is referred for a neurosurgical consultation. We are also sought for second and third opinions because our reputation is one for allowing enough time to hear the entire history and perform a thorough clinical examination. We can then review the previously performed tests and make our recommendations.
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