Care Plan 5:   Acute Lifting Injury
With Sprained Noncontractile Tissue

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

ETIOLOGY: Ligamentous and tendinous sprain is common from heavy lifting and sudden loading. Resisted movements are quite painful regardless of motion range. Often associated with simple joint and muscle dysfunction and/or muscle strain. It may also be accompanied by bursitis and/or tendinitis as well. Relief comes from reducing muscle spasm and freeing associated joint restrictions. Pain control procedures include ice, heat and rest in the early stages.

APPROPRIATE CARE: Cryotherapy (ice), myofascial work, adjusting and gentle active exercise all contribute to healing. Response depends on the extent and location of the noncontractile tissue affected. This takes longer than muscle strain, but may heal without residuals if care is initiated early.

EXPECTED FREQUENCY AND DURATION OF CARE: Three sessions per week for 2 weeks, reducing to 2 sessions per week for another 3 weeks. Follow-up over next 5-7 weeks at 1/2 sessions per week.

TOTAL: 14-16 VISITS OVER 10-12 WEEKS.

WEEK	CARE	PROGRESS	M	T	W	T	F	S
1-2	Pain control (cryo, rest) Gentle myofascial work	Significant subjective pain reduction Good improvement in ROM 3 /week	X		X		X
3-5	Adjusting Myofascial work Home exercise	Better subjective pain relief Good improvement in ROM 2 /week		X			X
6-12	Myofascial work PRN Adjusting PRN Home exercise	Discharge 2-4 / month				X

ATTENUATING FACTORS: The degree and location of the initial injury and the compliance of the patient with home care will affect healing. Stress to the tissue from ADL's can cause exacerbations and extend care.

SMT = spinal manipulative therapy (adjusting)

PRN = per required need (patient requests)

ROM = range of motion

ADL = activities of daily living

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