Tissue Response to Injury

Basic Signs of Inflammation Pain Redness Immobility Swelling Heat

Three Phases of Healing Phase I: Acute Inflammatory Phase Phase II: Repair/Regeneration Phase Phase III: Remodeling Phase

Phase I: Acute Inflammatory Phase Begins almost right away, lasts approx. 2-4 days Goal Protect, Localize, Decrease injurious agents, Prepare for healing and repair

Phase II: Proliferation Phase Phase will extend from 48 hours to 3-6 weeks Phase removes debris & temporary repair – SCAB FORMATION (fibroplasia) Dependent on levels of: debris removal, skin cell production, production of fibroblasts

Phase II: Proliferation Phase Repaired through 3 phases Resolution - dead cells & cellular debris are removed Regeneration – damaged tissue is replaced by cells of the same type Repair – original tissue is replaced with scab tissue (original structure & function is lost)

Phase III: Remodeling Phase Usually begins @ week 3 Purpose is to increase strength of repaired/replaced tissues First 3-6 weeks involves laying down of collagen (doesn’t lay down “straight” and strengthening of fibers 3 months to 2 years allowed for enhanced scar tissue strength Build up (synthesis) and break down (lysis)

Phase III: Remodeling Phase Take into consideration forces applied, immobilization time frames relative to tissue healing time Scaring Minor scars fade & eventually return to near normal color Deeper scars may not due to the irregular collagen patterns.

Factors That Impede (Slow) Healing Tissue type Extent of injury Swelling Hemorrhage Poor Vascular Supply Muscle Spasm Atrophy Infection Disorders Health, Age, and Nutrition

Types of Tissues and their Healing Cartilage – (Slow healer) Limited capacity to heal Little or no direct blood supply Articular cartilage that fails to clot heals very slowly Ligaments/ Tendons (Faster healer) Long full healing process (12 months) Decent blood supply Requires a lot of collagen being laid down

Types of Tissues and their Healing Skeletal Muscle – (Fastest healer) Great capacity to heal Direct blood supply Initial bleeding followed by laying down a ground substance Nerves – (Slowest healer) Limited capacity to heal Very complex to regenerate No blood supply

Importance of Controlling Swelling Initial injury management an swelling control is critical Swelling can result in increased pressure to the injured area, causing pain and altered neuromuscular function Swelling slows the healing process and normal function is not regained until swelling is eliminated To limit swelling use the (P)RICE principle

Importance of Controlling Swelling Protection Protect the injury from further damage Splint, wrap, immobilize the injured site If the lower extremity is involved, crutches should be supplied

Importance of Controlling Swelling Restricted Activity (Rest) Healing immediately begins after injury Without rest, external stresses are still placed on the injured area, interfering with the healing process- prolonging recovery Controlled mobility is superior to immobilization 24-48 hours of rest should be applied prior to active rehabilitation – depends on severity Rest applies to the injured body part – cardiovascular fitness, strengthening and flexibility should be maintained

Importance of Controlling Swelling Ice Constricts blood vessels which pushes out swelling Numbs the area to decrease pain Should be used: When there is any swelling Within the first 2-3 days of any acute injury

Importance of Controlling Swelling Compression Single most important factor in swelling control Mechanically reduces space available for swelling accumulation Using an elastic wrap, firm, evenly applied pressure can be achieved Compression should be maintained continuously for 72 hours – depends on severity With chronic inflammatory conditions compression should be applied until the swelling is almost entirely gone

Importance of Controlling Swelling Elevation Used to eliminate the effects of gravity on blood pooling Assists venous and lymphatic drainage of blood and other fluids from the injured area Elevation should occur as often as possible during the first 72 hours of the acute injury – depends on severity

Managing the Healing Process through Rehabilitation Pre-surgical Phase: If surgery can be delayed, exercise may help to improve outcome Maintaining or improving ROM, strength, cardiovascular fitness, neuromuscular control may enhance the athlete’s ability to perform rehab after surgery

Phases of Treatment I = initial inflammatory phase M = mobility restoration P = propioception phase R = resistance training phase E = endurance training phase SS = sport – specific function phase

The Wheel of Functional Components

Initial Inflammatory Phase What are some considerations? Pain / Spasm Protection- Rested- Iced- Compressed- Elevated

Mobility Phase = Joint Movement Range of Motion (ROM) Alphabet Seated Calf Raises Flexibility Gastroc vs Soleus Stretch

Propioception Phase Knowing where your body is in space; sensing the position of the limbs. Balance or coordination exercises

Resistance Training Muscles, bones, and surrounding tissues such as ligaments and tendons will increase in strength!

Endurance Must be able to maintain positions or movements over TIME! Muscular Cardiovascular

Sport - Specific Can they perform the movements of their sport safely and effectively????? Needed for COMPLETION!!!!

Proper Progression= OVERLAPPING involved

Rehab Phases Inflammation Mobility Proprioception Resistance Endurance Phase 1 – Acute Inflammatory Phase Phase 2 – Proliferation Phase Phase 3 - Remodeling Inflammation Mobility Proprioception Resistance Endurance Sport Specific

Pain Management Reduce pain! Control acute pain! Protect the patient from further injury while encouraging progressive exercise Minimize further tissue damage Encourage psychological interaction (positive thinking, etc.) Medications Communication with athlete Use of modalities to reduce pain