Care Plan 2C:   Acute External Trauma
With Soft Tissue Trauma - Severe

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:    Frankp@chiro.org

ETIOLOGY: A slip and fall, strike, or jolt typically creates spinal problems with unique characteristics. Falls to the buttocks cause intra-articular "jamming". Being struck by a moving object can also "jam" joints, as well as producing contusion of surrounding soft tissues.

These painful conditions are associated with varying degrees of soft tissue trauma and may result in formation of adhesions. Early intervention is desirable to prevent chronic scar formation and development of myofascitis. Rapid return to light and modified activities is thought to yield best results.

APPROPRIATE CARE: Early passive assisted movements, early use of ancillary procedures to reduce pain and inflammation, spinal adjusting, gentle myofascial soft tissue work, resisted isometric and stretching rehabilitative exercise and home cryotherapy (cold packs).

EXPECTED FREQUENCY AND DURATION OF CARE: Based upon degree of trauma 3-5 sessions per week initially, decreasing in frequency thereafter. Long term followup is essential since many symptoms may not begin until 6-8 weeks post trauma. Followup should be expected FOR 3-6 months, but may be longer if treatment is delayed. Modified work restrictions likely for 6-8 weeks.

TOTAL: 24-30 SESSIONS OVER 3-6 MONTHS.

WEEK	CARE	PROGRESS	M	T	W	T	F	S
1	Pain control (Ice) Rest, bracing Passive assisted movements	20% subjective pain reduction Minor improved ROM 3-5 /week	X		X			X
2-3	Heat, increased movement Gentle adjusting Light ROM & work	30-50% pain reduction Flare up with ADL's 30-50% imp. ROM 2-3 week		X			X
4-8	Myofascial work Adjusting Aggress. act. exercise	50-75% pain relief Return to full ADL's 1-2/ week			X
9-12	Adjusting PRN Myofascial work Aggress. act. exercise	Gradual improvement Residuals possible 2-3/month
12-24	Myofascial work & adjusting PRN Continue exercise	Gradual improvement Discharge Residuals possible 1-2/ month

ATTENUATING FACTORS: Activities of daily living or repetitive postural stresses are likely to cause a flare up requiring 1-3 additional sessions. The likelihood of this diminishes with good compliance in home instructions. Older aged individuals or those with general health problems may delay recovery or require greater frequency after week 2.

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