My beef with the term “Soft Tissue Damage”
I cringe when a client tells me “well my doc said it’s just muscular,” and/or “soft tissue damage,” ESPECIALLY when they are seeing me for something that is still bothering them from an injury that happened 20 years prior.
I was triggered to write this post by an email I received from a client, who felt after hearing a podcast on CBC’s Spark, she may be listening more to her wearable (Fitbit) than to her body and causing “soft tissue damage.” While I was pleased with her awareness and self-directed research into her soreness, I cringed at her paraphrasing/referring to preventing “Soft tissue damage.”
I feared this client was convinced her overdoing it with her workouts lately, which had caused an increased sensitivity in her persistent low back pain, believed she had caused “soft tissue damage” around her spine or SI joints. I feared she would just do nothing and rest to allow it to “heal,” which as you may or may not know—usually makes a flare-up of low back pain worse and more prolonged.
There are two parts to responding to the idea of preventing “Soft Tissue Damage” which I will address: 1. Are we talking about preventing pain associated with damage to soft tissue from cardio or strength training, which is referred to as “Delayed onset muscle soreness” or “DOMS?” 2. If we are referring to avoiding causing oneself pain in a previously painful or injured area, who says the pain is from “soft tissue damage?” Please see the explanation: What your doctor (usually) doesn’t explain about pain.
A 2012 Consensus statement in the BJSM on grading muscle injury grades muscle damage outlines the history of 4 previous muscle injury classification systems (1). Consistently on a scale from Grade 1-4, a Grade 1 injury refers to DOMS. DOMS requires little actual muscle tissue damage (actually a desirable amount if you want to make strength gains), can be QUITE painful (I.e.: walking downstairs for several days after doing too many squats), but only lasts typically from 1-3 days. Note: It can actually be life-threatening if progresses to Rhabdomyolysis (Rhabdo). Link for S&S of Rhabdo:https://thebarbellphysio.com/working-out-after-rhabdo/
Addressing my second point, soft tissue damage to muscles heals in 24-hours in the case of DOMS, to up to 6-12 weeks in the case of significant muscle tearing. If you haven’t experienced an incident of overstretching or over-contraction or serious trauma to the area (crush, bruise, laceration), or the soreness passes in 1-3 days then it likely isn’t significant “Soft Tissue Damage.” What my hang-up is, are docs that refer to low back pain as a muscle strain or soft tissue damage. This could only be the case if you have experienced one of the above things. The lowest back pain you feel in muscles (they feel hard or go into spasm when you move) is due to guarding. The muscles themselves are not damaged, they are protecting a structure within the spine such as a disc, nerve root, or joint capsule, which MAY or MAY NOT be damaged. Lastly, certainly, if you have low back pain, or pain anywhere in your body that has lasted more than 12-weeks, if it is likely, NOT due to “Soft Tissue Damage,” no matter what you’ve been told. This language leads people to feel they are broken and still need rest or healing, which is an unhelpful and outdated paradigm.
For a VERY comprehensive guide to muscle injury, please refer to: