Protocol: Acute Soft Tissue Injury/Joint Sprain
This describes various treatment procedures the physical therapist may select, as indicated by patient evaluation, re-evaluation, treatment responses.
This protocol encompasses sprains and strains in a general manner, not specific to any particular joint or muscle group.
1. MD-ER referral as indicated, if patient is a direct-referral to the physical therapist
2. Cold pack, ice massage
3. Compression, rest and elevation
4. Electric stimulation for pain and swelling control: microcurrent, interferential, HVGS, MFAC, TENS, MES, LLLT
5. Immobilization, with preventive ROM exercises.
6. Initial patient education on problem, treatment, self-care.
1. Thermal-contrast modalities
2. Electric stim or LLLT to reduce accumulated effusion and increase circulation
3. Early passive stretching, ROM, joint mobilization, soft tissue manual therapy, strain counterstrain, myofascial release.
4. Gradual recovery of weightbearing and gait functions for lower extremity injuries, in concert with physician directions.
5. Evolve active exercises: from early cautious mobilization and remedial protected activity to active range of motion exercises, to gentle resistive exercises, to progressive resistive exercises, to closed chain, to pliometrics exercises specific to recovery of function. (emphasizing home exercises)
6. Transverse friction massage and stretching for scar re-modeling at tissue injury sites
7. Trigger point identification and resolution.
8. Ergonomic job evaluation and modification; job coaching.
9. Return-to-work plan; restricted duty recommendations; employer education.
10. Reconditioning exercise plan; home and gym
11. Orthopedic referral via referring MD, as indicated
Clinic treatment may be 3-4 visits first week if acute and severe; frequency of visits decreases as recovery progresses and self-care is established.
Establish self-care skills and participation to minimize dependence on providers
Safe, early return to work; reduction of disability
Control of pain and swelling
Protection pt facilitate healing
Restoration of range of motion, flexibility, strength, stability
Restoration of function for work and ADL
Prevention of recurrence