Considerations for clinical assessment and treatment of soft tissue injury Red flags

What does aetiology mean?

What caused an injury or condition?

Give an example of aetiology

An ankle sprain caused by twisting the ankle while playing football.

What is a chronic injury?

An injury caused by repetitive strain that develops over a period of time

What is an example of a chronic injury?

Achilles tendinopathy (Achilles tendonitis)

What is an acute injury?

An injury that happens suddenly, straight away

What is an example of an acute injury?

A dislocated shoulder

What does superficial mean?

Close to the surface of the body

Give examples of superficial structures?

Skin and surface-level muscles that can often be seen or felt easily

What does SOAP stand for?

• Subjective

• Objective

• Analysis

• Plan

What is the purpose of SOAP?

To reflect on an experience, understand your performance and identify improvements.

What does subjective mean in reflection?

Your personal thoughts and feelings about the experience

What should you include in the subjective section?

• What happened

• The situation

• The context

• Your thoughts and feelings

What should you include in the objective section?

A summary of the interventions and skills you performed

What should you consider when writing the objective section?

Reconsider the experience from multiple perspectives

What is the analysis section?

Self-analysis of your performance

What should you identify in the analysis section?

• Lessons learned

• Any questions

• Areas where you need further learning

What should you include in the plan section?

How you will improve, make changes or take on new challenges

What is the purpose of the plan section?

To prepare for and improve how you handle similar situations in the future

What is a subjective assessment?

Information the client tells you about their injury

What does a subjective assessment involve?

Listening to the clients story, symptoms, feelings, and experiences

How is a subjective assessment carried out?

Through talking and asking questions, not physical testing

Why is a subjective assessment important?

It helps the therapist understand the injury and the clients symptoms before physical assessment

What are some questions to ask during a chronic injury assessment?

• What do you do for work?

• Do you do physical activity?, if so what?

• When did the injury first happen?

• How did the injury happen?

• Where exactly is the pain?

• What does the pain feel like? (sharp, aching, burning, etc.)

• How bad is the pain? (0–10)

• Is the pain always there or does it come and go?

• What makes the pain worse?

• What makes it feel better?

• Has the injury changed over time?

• Have you had any previous treatment? (physio, massage, medication, etc.) 

• Have you had any other injuries or medical problems?

• Are you taking any medication?

What are some questions to ask during an acute injury assessment?

• When did the injury happen?

• How did it happen?

• Where is the pain?

• What does the pain feel like? (sharp, aching, throbbing)

• How bad is the pain? (0–10)

• Did you hear or feel a pop, crack or snap?

• Is there any swelling or bruising?

• Can you move the injured area?

• Can you put weight on it?

• Has this happened before?

• Have you had any treatment so far?

• Are you taking any medication?

• Have you experienced numbness or tingling?

What are the differences between an acute injury assessment and a chronic injury assessment?

• Chronic = Focuses more on how the injury developed over time, lifestyle, and previous treatment

• Acute = Focuses more on what happened suddenly, immediate symptoms, swelling, movement, and possible nerve symptoms

What are contraindications?

Signs, symptoms, or conditions that mean an assessment or treatment may be unsafe or should not take place

Why is the therapist responsible for when identifying possible serious conditions?

Identifying concerns and recommending or requesting medical assistance when necessary

What might indicate a serious pathology?

A clients reported symptoms or signs identified by the therapist

What must be completed before an assessment takes place?

Appropriate screening, including asking about and checking for contraindications

Why must contraindications be recorded?

To provide evidence of what was assessed, what was asked and how the client responded

What does contemporaneous evidence mean?

Information recorded at the time the assessment takes place

What is a red flag?

A sign or symptom that could indicate a serious underlying condition

What should a therapist do if they identify a red flag?

They should not simply treat it as a normal musculoskeletal injury. They should arrange appropriate medical assessment or referral.

What are some examples of red flags?

• Severe, unrelenting or worsening pain

• History of malignancy

• Severe pain with no apparent history of injury

• Night pain

• Pain unrelated to movement

• Severe spasm

• Loss of appetite

• Recent unexplained weight loss

• Significant neurological symptoms (e.g. cauda equina

syndrome; drop attacks etc)

• Significant cardiorespiratory symptoms (e.g. shortness of

breath; warm, discoloured, swollen limbs)

• Feeling generally unwell (e.g. unexplainable fever or fatigue)

• Lesions which have failed to heal

• Unusual lumps or growths

What is Cauda Equina Syndrome?

Compression or pressure on the nerves at the bottom of the spinal cord

Why is Cauda Equina Syndrome serious?

It is a medical emergency because it can cause permanent nerve damage

What should a sports therapist do if they suspect Cauda Equina Syndrome?

DO NOT TREAT. Arrange immediate emergency assessment at A&E.

What are some warning signs you should check for Cauda Equina Syndrome?

• Saddle numbness – numbness/tingling around the groin, genitals, buttocks or inner thighs

• Bladder problems – difficulty starting to pee, inability to pee, or loss of bladder control

• Bowel problems – loss of bowel control or difficulty controlling bowel movements

• Leg weakness – new or worsening weakness in one or both legs

• Severe nerve symptoms – pain, numbness or tingling travelling down the legs

• Reduced sensation around the saddle area

What is informed consent?

When a client understands what treatment involves and freely agrees to it.

Why is informed consent important?

It is a legal and ethical requirement that ensures clients are respected, empowered and involved in their healthcare

What does informed consent allow the client to do?

Make their own informed decisions about their treatment

What must therapists do to protect the public and avoid legal/ethical consequences?

 Clearly communicate all necessary and relevant information

• Respect the clients authority to withdraw consent at any time

• Obtain 'Explicit consent' (clearly and freely given by the individual oral or written

• Formally and appropriately document and accurately record the IC process

What are the 3 requirements for valid consent?

• Capacity

• Voluntary

• Agreement

• Sufficient information

What does capacity mean?

The individual must be able to understand and make the decision

What does voluntary consent mean?

The individual must agree freely, without pressure or force

What does Gillick competent mean?

A child under 16 has enough understanding and intelligence to make their own decisions about treatment