spasm. Realigning a dislocated or subluxed joint should be done under supervision of a physician or a qualified therapist. Fractures A fracture is the disturbance of the integrity and continuity of a bone [6] . It can be either a complete fracture or an incomplete (hair- line) fracture. Sudden direct or indirect force, repetitive stresses, and bone pathologies may cause fractures. A fracture is character- ized by severe pain, marked swelling within a few hours from the onset, deformed body part, and loss of function of the affected limb. The regeneration phase During this phase, the damaged structures are repaired. This phase usually lasts from 48 hours to 6 weeks. The formation of Type III collagen fibers by the fibroblasts, the growth of capillaries and cross-linking collagen occur during this stage. As the collagen fibers accumulate in the area, the collagen production action of fibroblasts deteriorates. While the scar tissue forms, the margins of the wound begin to contract. This phase is also called the fibro- elastic phase or collagen-forming phase. The remodeling phase This phase involves the formation of a strong scar that reflects com- plete wound healing. This phase lasts from 3 weeks to 12 months. The collagen cross-linking that began during the regeneration phase continues throughout this phase and the collagen fibers are shortened to form a tighter scar. The remodeling of collagen re- stores the functional capabilities of the soft tissue.
a pink or red color, a bruise or contusion eventually changes to blue and green. As it heals, it returns to the normal skin color. A contusion can be subcutaneous, intramuscular, or periosteal [5] . Dislocations and subluxations A dislocation is the displacement of a bone in a particular joint, which results in loss of anatomical relationship and proper align- ment [6] . A partial or incomplete dislocation of the bony partners in a particular joint is a subluxation. These dislocations and sublux- ations lead to soft tissue damage, pain, inflammation, and muscle
THE HEALING PROCESS OF SOFT TISSUE INJURIES
Any soft tissue injury would follow a sequence of physiological changes to aid the healing process. These changes are divided into three main phases: inflammatory phase, regeneration phase,
and remodeling phase [7] . The inflammatory phase
In this initial phase, the body part reacts to the injury. This phase may take up to 72 hours from the injury’s onset. The five signs of inflammation are evident in this phase. During an injury, the blood flow to the area increases and the tissue repairing process begins. The body’s first reaction is to confine the area by clot formation with the aid of platelets. As the capillary permeability increases, the platelets begin to filter out of the blood vessel and cover the dam- aged edges of the vessel. Next, the clotting factors activate, lead- ing the fibrin strands to adhere to each other to seal the area. This blood clot stops initial bleeding and it dissolves with time. Then the white blood cells begin the process of ingesting the damaged cells and particles (phagocytosis) to clear the area of tissue debris.
MANAGEMENT OF ACUTE INJURIES
An acute injury has to be addressed with care. Failure of proper treatment may lead an acute injury to a chronic injury. The most important factor in the management of the acute injury is not the severity of the injury, but how quickly treatment begins. It is es- sential to act within the first 48 to 72 hours to avoid worsening the injury. Therefore, it is important to be aware of the management strategy of acute injury. There are several protocols regarding the management of acute injuries. SPRICEMMM protocol is the best strategy to manage an acute injury, whereas the HARM protocol contains the factors to avoid during an acute injury. These proto- cols are discussed in detail below. Objectives of acute injury management 1. Prevent further damage. Price protocol is a strategy of managing acute injuries. It was ini- tially used in sports medicine, though it has reached out the gen- eral public nowadays. PRICE protocol is: P Protection R Rest I Ice C Compression E Elevation As healthcare professionals discovered new methodologies and techniques, this protocol has evolved into the SPRICEMMM pro - tocol. This method should be followed from the time of injury up to 72 hours. 2. Limit bleeding (if necessary). 3. Reassure the affected person. 4. Reduce the pain. 5. Reduce the swelling. 6. Minimize tissue damage. 7. Reduce the scarring.
SPRICEMMM Protocol S Support P Protection R Rest I Ice C Compression E Elevation M
Modalities (e.g., electrotherapy)
M M
Movements
Medical reference
Support The patient should be supported to move away from the harmful environment. The injured body part should be well supported be- fore moving the patient into a place of safety. Braces, slings and splints can be used to support the injured body part. Protection The patient should be protected and precautions should be taken to prevent further damage. First, the patient should be removed from the risky environment. Further protection to the injured body part can be provided by bandaging, taping, and simple splinting and crutch- es. These actions will prevent excessive movements of the injured area. The appropriate protection should be provided throughout the early stage of the healing process (at least up to 3 to 5 days). How the protection is applied depends on the severity of the injury and part of the body affected (e.g., crutches for non-weight-bearing or partial weight-bearing leg, braces and splints for specific protection of the injured area) [8] . During this period, complete immobilization is not recommended. Complete immobilization may lead to stiffness of the affected joint/s. The ability of a muscle to stretch and contract may also affect during complete immobilization. Rest Adequate resting time should be given for the injury to heal and it should be started immediately. Applying bandages, tapes, splints, and braces can provide rest for the affected body part. The pa- tient should rest the injury for 5 days after onset. For example, if the injury is in the upper limb, the patient needs to rest the upper
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