Synopsis
In order to better understand the phenomenon of soft tissue pain and disability one must find factors that relate pain and functional impairment in all the joints of the body. These factors develop along this line:
- Functional anatomy of the involved segment of the body
- Neuromuscular pattern of the moving parts
- Tissue sites capable of eliciting pain
- Responsible faulty neuromuscular mechanism
The four primary tissues are:
- Epithelial tissue for protection, secretion and absorption
- Muscular tissue for contraction
- Nervous tissue for irritability
- Connective tissue for support nutrition and defence
Disorders of connective tissue
That is fascia tendons ligaments and cartilage.
- Metabolic disorders
- Aging of connective tissue
- Hereditary disorders
- Systemic inflammatory disease
- Organ fibrosis
- Tumours of connective tissue
- Miscellaneous connective tissue diseases
Symptomatic connective tissue disorders that result from trauma, misuse, or abuse are less well understood and documented. All these are grouped together as soft tissue injuries or diseases causing musculoskeletal or neuromuscular pain and dysfunction.
Joint motion
The type and extent of normal movement occurring in any joint depends upon
- The form of the articular surfaces
- The restraining influences of the ligaments
- The atmospheric pressure within the joint
- The control exerted by the muscles as they act upon the joint
Ligaments and fibrous capsule once damaged are slow to heal because of poor blood supply. However, ligaments and fibrous capsules have a rich nerve supply and, thus are an important source of pain so characteristic of many joint diseases.
Constant pressure or constant tensions upon ligaments are known to cause wasting, whereas intermittent pressure and tension cause growth and an increase in their strength, especially in their attachment to bone. This fact plays and important role in the reaction of ligaments to stresses and injuries and in their response to treatment.
Muscular action
Muscle contraction is a physiological voluntary reversible change in muscle length from the normal resting state. Muscle contracture is an abnormal permanent state of muscle length that deviates from normal. Contracture may be caused by:
- Dynamic imbalance: failure of the agonist-antagonist relationship
- Impaired innervation: peripheral or central
- Intrinsic changes with fluid or cellular infiltration and fibrosis