What is a soft tissue injury?

Participation in sport, recreational activities and exercise brings a risk of injury. injuries to soft tissues are the most common of all. These involve muscles, tendons, ligaments, fascia, nerves, fibrous tissues, fat, blood vessels, and synovial membranes.

The nature and severity of the injury varies – however the most commonly involved structures are:

  • Muscle – muscles are made up of fibres that shorten and lengthen to produce movement of a joint. Muscles are attached to bone by tendons. •
  • Tendon – tendons are tough bone of slightly elastic connective tissue that connect muscle to bone.
  • Ligament – ligaments are strong bands of inelastic connective tissue that connect bone to bone.

During the first 48-72 hours (acute phase), the primary characteristics are pain, swelling, discolouration and impaired function.

The optimal treatment in the first 48-72 and its aims?

The primary aim is to protect the injured structures from further damage, reduce pain and minimise / manage the inflammatory process. Although it is worth noting that inflammation is a necessary part of the early healing process, so the aim is not to completely eliminate it, just to minimise the more unpleasant side-effects.

You may have heard a number of different acronyms (RICE, PRICE, POLICE) mentioned over the years, all with the aim of prompting optimal acute injury management. Guidance follows the anagram of PEACE (for initial soft tissue injury management) & LOVE (for subsequent management) which will be discussed below.

Immediately after an injury – the injury requires PEACE


Unload from weight bearing or heavy use and restrict movement for 1-3 days after injury. This will prevent further injury, reduce bleeding and the risk of injury aggravation. However, complete or prolonged rest and inactivity is unadvised as this can lead to poor outcomes (stiffness, weakness and fear avoidance). Pain levels should help guide your return to movement and use.


When able elevate the injured limb above the heart to encourage circulation and aid swelling management


Our bodies create an inflammatory response to protect and help us heal. Taking an anti-inflammatory such as Ibuprofen or naproxen can prevent these natural processes from occurring thus negatively affecting long-term healing (especially when high doses are used). Standard acute care of soft tissue injuries should not include anti-inflammatories. Secondly the acute use of ICE which is common practice, has very limited high-level evidence to support its beneficial effects in injury management. Some reports suggest it could disrupt natural inflammation and vascularization leading to impaired tissue repair and healing.


Pressure around the injury site via taping or bandages may help to reduce local  bleeding and swelling. This in turn has been found to help with pain and quality of life.


Active rather than passive approach to recovery is essential in soft tissue injury management. Physiotherapy can aide patient education for patients on the condition and load management will help avoid further injury. This in turn reduces the likelihood of unnecessary injections or surgery, and supports a reduction in the cost of healthcare. We strongly advocate for setting realistic expectations with patients about recovery times instead of chasing the ‘magic cure’ approach

After the first few days – The injury requires LOVE


Appropriately loading the injured area with movement and exercise benefits most musculoskeletal soft tissue injuries. Gentle, gradual and progressively mechanical stress/load should be added early. Normal activities should be encouraged as soon as pain allows. Optimal loading promotes repair, remodelling and builds tissue tolerance and capacity.


Optimistic patient expectations are associated with better outcomes and prognosis. Psychological factors such as catastrophisation, depression and fear can create barriers to recovery. Beliefs and emotions are thought to explain more of the variation in symptoms following certain injuries rather than the injury itself .


Cardiovascular activity is essential in the management of musculoskeletal injuries. Pain-free aerobic exercise should be started a few days after injury to boost motivation and increase blood flow to the injured structures. Such as cycling, swimming, rowing machine, cross-trainer walking. Early mobilisation and aerobic exercise improve physical function, supporting return to work and reduce the need for pain medication in individuals with musculoskeletal conditions.


There is a strong level of evidence supporting the use of exercise for the treatment of soft tissue injuries and for reducing the prevalence of recurrent injuries. Exercises help to restore mobility, strength and proprioception early after injury. Pain should be avoided to ensure optimal repair during the subacute phase of recovery, and should be used as a guide for exercise progressions

Things to avoid

  • Heat: Increases swelling and bleeding. Avoid heat packs, a hot bath and saunas.
  • Alcohol: Increases swelling and bleeding. Plus, it can delay healing.
  • Massage: Increases swelling and bleeding. Direct massage to the injured area may aggravate the damaged tissues and is normally best avoided for the first 48 to 72 hours. Indirect massage (away from the injury site) may be helpful. Please consult your health practitioner for the best advice for your injury

For more general information please click here.

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