DO NOW What is inflammation?? What might be some of the signs or symptoms of inflammation??

Sports Medicine & Performance I The Injury Process Sports Medicine & Performance I

The Inflammatory Process As a result of injury, the body reacts with a predictable sequence. The body’s initial response to trauma is inflammation. (swelling) This begins immediately (within minutes) following an injury.

Normal Signs/Symptoms of Inflammation Redness Swelling Pain ↑ temperature of the area Loss of function

Signs of Inflammation Redness Caused by blood vessel dilation Chemical mediators promote vessel dilation Histamines, bradykinins, etc.

Signs of Inflammation Swelling- accumulation of excess fluid Edema fluid varies with the stage of inflammation Initially the fluid is clear and liquidy, consisting mainly of water and electrolytes. Fluid then turns thicker and cloudy as plasma proteins escape from the blood vessels.

Causes of Edema/Swelling Bleeding from torn vessels Cell death causes fluid leakage Chemicals (like histamines) draw fluid in Gravity may increase swelling

How to Get Rid of Edema/Swelling To cease swelling/edema you must reverse the condition pressure gradient (i.e. Ace wrap, more pressure distal, and wrapping distal to proximal) Promote vessel repair This is what we try to do as therapists through modality use

Signs of Inflammation Pain Results from irritation of nerve ending by physical or chemical factors Physical trauma may irritate pain receptors

Inflammatory Process 3 specific phases Acute/Inflammatory Phase Tissue Formation/Proliferation Phase Remodeling Phase Each phase has a specific purpose and is essential to repair of the structures involved.

Phases of the Inflammatory Process Phase I: Acute/Inflammatory Phase inflammatory response: lasts 2-4 days but is complete in 2 weeks Phase 2: Tissue Formation (Proliferation) Subacute phase, Tissue rebuilding approximately 2-3 weeks This does not include chronic inflammation Phase 3: Remodeling Phase Adapt to original tissue Continues for up to 1 year post injury

Acute/Inflammatory Phase When tissues are damaged millions of cells are destroyed including blood vessels. In the first 10 minutes there is vasoconstriction to try and cut off blood flow to the area. This then reverses. Result = increase in blood flow to the area causing a formation of a hematoma.

Acute/Inflammatory Phase Chemicals are released and sent to injured area. Phase usually lasts 2-4 days unless there is further irritation or trauma. At this time, tissue repair will begin to occur.

Proliferation Phase (Tissue Formation) Connective tissues of the body heal themselves by forming scar tissue. This begins to form as early as 3 to 4 days post injury. Fibroblasts (immature fiber-producing cells of connective tissue) begin migrating into the area.

Proliferation Phase (Tissue Formation) Occurs within 12 hours of injury to 6 weeks (average 3 weeks).

Remodeling Phase The replacement of destroyed cells by reproducing healthy cells next to the wound/injury. Damaged capillaries begins to repair itself in a process known as angiogenesis. Angiogenesis: the formation of new capillaries New tissue is able to begin to mature with a vascular supply.

Remodeling Phase Can last over a year depending on the injury.

Scar Tissue Scar tissue may be 95% as strong as original tissue & formation may take up to 4 months Appropriate rehabilitative exercises are critical to this process. Bone tissue does not heal itself as scar tissue but as a callus which matures into fully functional bone (uses specialized cells, osteoblasts & osteoclasts)

Inflammation which continues past 1 month Chronic Inflammation Inflammation which continues past 1 month loss of function

Pain Is an athletes friend!!! It serves as a mechanism to reduce activity level until adequate healing has occurred. Pain results from sensory input received through the nervous system and indicates location of tissue damage.

Pain Everyone copes with pain differently. Pain is not a useful indicator of injury severity!!! Pain is as much psychological as physiological. High pain tolerance vs. Low pain tolerance

Do Now: What are the 3 phases of the inflammatory process? How long does each one last??

Modalities Are physical agents that help create an optimal healing environment. Cryotherapy Thermotherapy Anti-inflammatories Analgesics Electric Stimulation Ultrasound

THE BIG QUESTIONS! When do we use cold? When do we use heat? When do we use medications? When do we use Electrical modalities?

Cryotherapy Direct application of cold may reduce vasodilation in the first few minutes after injury. Cold application has analgesic effect and reduces muscle spasm. Application of cold can decrease recovery time. Courtesy of Ron Pfeiffer

Cryotherapy Crushed ice in a plastic bag is an inexpensive modality. In extremities, elevation and compression are also helpful in treatment. Elastic wrap secures the ice bag to the body. Risk of frostbite is minimal with crushed ice.

Cryotherapy What are some other forms of cryotherapy you can think of other than an ice bag?

Thermotherapy Thermotherapeutic agents Should NEVER be applied to an acute injury while redness and heat are present. Increase vasodilation, available oxygen and permeability. Are useful in the final phases of injury repair.

Pharmacologic Agents Steroidal Anti-Inflammatory Manufactured to resemble natural chemicals in the body. Cortisone the most common. Problems steroids can decrease the overall strength of connective tissue.

Pharmacologic Agents Non-steroidal Anti-Inflammatory Drugs (NSAID) Block specific reactions in the inflammatory process. Most commonly known as aspirin. Aspirin has anti-inflammatory, analgesic, and antipyretic effects.

RICE Best approach to the care of soft tissue injury is RICE along with prescribed pharmacologic agents and supervised rehabilitative exercise. R = Rest R= Rest I = Ice I= Immobilize C = Compression C= Cold E = Elevation E= Elevate

The Role of Exercise Rehabilitation Properly supervised physical activity is very effective for many injuries. Early mobilization of the joint or muscle will assist in the healing process.

Therapeutic Exercise Rehabilitation Treatment Plan should include: MD Release- approval of a doctor Pain free ROM Do not cause further damage Keep person motivated Keep realistic goals Know the mechanism of injury

Factors influencing healing What factors can you think of that might influence how someone heals?