Tissue Healing Sports Medicine 1/2

Inflammatory Response Phase Begins immediately following injury – critically important Without the inflammatory phase the other phases will not occur Phagocytosis occurs to clean the injured area Phagocytosis is when cells come in and ingest/ digest all bacteria in the injured area Chemical mediators are released to facilitate healing Histamines, serotonin and Bradykinin Symptomatically presents with the following Redness, swelling, warmth, tenderness and loss of function If bleeding occurs( slow due to vasoconstriction then increased blood flow due to mediators release vasodilation). Stage lasts about 72 hours

Fibroblastic Repair Phase Proliferative and regenerative activity occurs resulting in scar formation (fibroplasia) Occurs within initial hours of injury and continues up to 4-6 weeks Inflammatory phase and repair phase overlap S&S of inflammatory phase subside Athlete will still experience some tenderness and pain with motion With increasing development of the scar, complaints of pain and tenderness will decrease

Maturation-Remodeling Phase Long-term process Phase overlaps with the repair phase May last up to over a year Re-alignment of scar tissue according to tensile forces acting on tissue Re-align to position of maximum efficiency (parallel to lines of tension) Tissue gradually resumes normal appearance and function After 3 weeks Firm, strong, contracted, nonvascular scar exists Adhesions

Acute Traumatic Injuries

Chronic Overuse Injuries Importance of Inflammation in Healing Essential part of healing process Must occur following tissue damage to initiate healing Signs and Symptoms Pain, redness, swelling, loss of function, and warmth If source of irritation is not removed then inflammatory process becomes chronic

Tendinitis Most common overuse problem in sports Gradual onset, with diffuse tenderness due to repeated microtrauma and degenerative changes Obvious signs of swelling and pain May also experience crepitus (due to chemical products of inflammation) Key for treatment is rest and removal of causal factors Work to maintain fitness but avoid activities that aggravate condition

Tenosynovitis Inflammation of synovial sheath In acute case - rapid onset, crepitus, and diffuse swelling Chronic cases result in thickening of tendon with pain and crepitus Often develops in long flexor tendons of fingers Treatment is similar to that of tendinitis NSAID’s may also be of some assistance

Bursitis Bursa Fluid filled sac that develops in area of friction Sudden irritation can cause acute bursitis, while overuse and constant external compression can cause chronic bursitis Results in increased fluid production, causing increases in pressure due to limited space around anatomical structures Signs and symptoms include swelling, pain, and some loss of function Three most commonly irritated bursae Subacromial, olecranon, and prepatellar bursa

Osteoarthritis Wearing away of hyaline cartilage as a result of normal use Changes in joint mechanics lead joint degeneration (the result of repeated trauma to tissue involved) May be the result of direct blow, pressure of carrying and lifting heavy loads, or repeated trauma from an activity such as running or cycling Commonly affects weight-bearing joints but can also impact shoulders and cervical spine

Symptoms include pain (as the result of friction), stiffness, prominent upon rising in the morning, localized tenderness, creaking, grating, and often localized to one side of the joint or generalized joint pain