Sequelae in Soft Tissues after Beating, Suspension, and Fixation

Prip, K. (1994), Torture Quarterly, Suppl. 1, 28-31.
 
This article was reviewed by University of Minnesota doctoral physical therapy student Angela Pitar, 2014. 
 
The link to the full text from Dignity-Danish Institute Against Torture is below.
 
Background: Many movement impairments are found in torture survivors, since they were placed in fixed positions for prolonged periods of time.  This article discusses the effects of tissue stress/strain, the phases of injury, and different management approaches for the different phases. 
 
 
Background -
  • when tendons are loaded, all the fibers straighten out because of their parallel alignment.
  • when ligaments are loaded, the fibers not being aligned so much, only the fibers in the direction of the principal load are straighten out completely and sustain tension.
  • in the skin only few fibers are oriented in the direction of loading.
  • when constant force is applied to a collagenous structure for a prolonged period of time, further movement (or creep) is detected in the tissue, which often happens in torture victims.
  • when the structure is then unloaded from a loaded position, it regains another shape that is different than the original tissue, which is called hysteresis.
3 phases of muscle, tendon, and ligament injuries -
  • acute inflammatory phase (up to 72 hrs):  vascular rupture and cellular infiltration
    • management:  RICE (rest, ice, compression, and elevation)
  • repair phase (72 hrs to 4-6 wks):  collagen deposition
    • management:  muscle injury-pain free restoration of strength, ligament injury-pain free ligament with return to pre-trauma tensile strength
  • remodeling phase (3-6 wks to 3-6 mos):  collagen and muscle remodeling
    • management:  after 3 days-passive/active stretching, after a week-active exer and load-bearing
Conclusion - Many movement impairments are found in torture survivors, since they were placed in fixed positions for prolonged periods of time.  This article discusses the effects of tissue stress/strain, the phases of injury, and different management approaches for the different phases. 
 

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