Soft Tissue Injury (muscles ligaments tendons)

Soft tissue injuries affect the muscles, ligaments and tendons rather than the bones. A strain is a stretched or torn muscle or tendon, and a sprain is a stretched or torn ligament, the tough band that holds bones together at a joint. They can happen in a moment, with a fall or a twisted ankle, or build up slowly from repeated movement at work, at home or in sport.

What a soft tissue injury is, and what it is not

These injuries are not fractures, but that does not make them minor. A badly sprained ankle can keep you off your feet longer than a small break, and a torn tendon may need surgical repair. Most soft tissue injuries do not need a scan: Canadian clinicians use validated decision rules, based on where you are tender and whether you can bear weight, to work out whether an X-ray is needed to rule out a fracture.

They are also not always sudden. Tendon problems in particular tend to build gradually as load outpaces what the tissue is used to, which is why they often appear after a change in work, training or activity rather than after an accident. Recovery is not uniformly quick either, and among Canadians aged 65 and older injured in a fall, sprains or strains were the second most common injury at 27%, after fractures at 39%. Pain from a fresh injury is covered further on our page for acute pain, and injuries to the lower back on our page for low back pain.

Signs and symptoms

• Pain that starts at the time of the injury, or builds up over days of repeated activity
• Swelling and bruising around the injured muscle, tendon or joint
• Tenderness when you press on the sore spot
• Trouble putting weight on the area, or a joint that feels loose or unstable
• Stiffness, or a reduced range of movement
• Muscle weakness or spasm near the injury
• A popping or tearing sensation at the moment of injury in more severe tears

Two people with what looks like the same injury can recover on very different timelines, and swelling often lingers after the pain has largely settled.

What raises the risk

Some risk factors cannot be changed:

• Getting older, since tendons and ligaments become less elastic and falls become more common
• A previous sprain, strain or tendon injury in the same area
• Some medical conditions and medicines that affect tendon and muscle health

Others can often be worked on, usually with support from a health care team:

• Work or sport involving repeated lifting, reaching, twisting or overhead movement
• Sudden increases in activity, training load or workload without a gradual build-up
• Low muscle strength, poor balance and fatigue
• Home and workplace fall hazards such as loose rugs, poor lighting, clutter and unsafe footwear

How soft tissue injuries are diagnosed in Canada

Most soft tissue injuries are assessed by a family doctor, nurse practitioner, physiotherapist, chiropractor or emergency department clinician, based on how the injury happened and a physical examination of the area. Clinicians check for swelling, tenderness, joint stability, strength and range of movement, and apply validated rules to decide whether an X-ray is needed to rule out a fracture. Ultrasound or MRI is generally reserved for injuries that are not improving as expected, or where a significant tear or another diagnosis is suspected.

Treatment and day-to-day management

Clinical research for Soft Tissue Injury (muscles ligaments tendons) is enrolling. See the current studies ↓

Most of the work of recovery happens outside a clinic, through what you do with the injured area over the following weeks. Depending on the tissue involved and how severe the injury is, a health care team may discuss:

• Early self-care such as protection, relative rest, ice or heat, compression and elevation, followed by a gradual return to movement
• Physiotherapy and structured exercise therapy, including progressive strengthening, balance work and load management for tendon problems
• Non-opioid pain medicines chosen with a clinician, including acetaminophen and topical or oral anti-inflammatory medicines
• Braces, taping, splints, orthotics and walking aids, plus occupational therapy and workplace or activity modification during recovery
• Procedures and surgery for selected injuries, such as injections or repair of a complete tendon or ligament tear, usually after assessment by a specialist

How quickly to load an injured tendon or ligament, and whether a procedure adds anything, depends on the specific injury and on you. Those are decisions for you and your own clinician rather than something this page can settle.

When to talk to a doctor

• Call 911 or go to an emergency department for a limb that looks deformed or bent the wrong way, for heavy bleeding, for numbness or a limb that is pale or cold, or after a serious fall, crash or blow to the head.
• Seek same-day care if you cannot bear any weight on the injured leg or cannot move the joint at all, if you heard or felt a pop with immediate severe swelling, or if the area becomes hot, red and increasingly painful with a fever, which can signal infection.
• Book an appointment if pain, swelling or weakness is not improving after two to three weeks, or if a joint keeps giving way, since ongoing instability may need further assessment.

Why clinical research matters for soft tissue injuries

Recovery varies a great deal between people, and researchers still cannot reliably predict who will heal quickly and who will have pain or reduced function months later, particularly with tendon problems and ankle, shoulder and hamstring injuries. There is also genuine debate about how much rest compared with early loading helps, and about which injections and procedures add value. Trials under way are testing exercise and loading protocols, injectable and biologic treatments, non-opioid pain medicines, fall prevention programs for older adults, and rehabilitation delivered remotely by app or video.

Studies in this area often recruit soon after an injury, because that is when early treatments are tested, while others recruit people whose symptoms have lasted longer. Taking part is voluntary, you give informed consent before anything begins, and you can stop at any time without affecting the care you get from your own clinician. No one can say in advance whether a study will help you personally.

Learn more from Canadian sources

• Canadian Institute for Health Information: injury and trauma statistics
• Public Health Agency of Canada: surveillance report on falls among older adults in Canada
• Pain BC: support and self-management programs for pain
• Health Canada: Canadian Pain Task Force reports