1. Healing Process Chapter 3

2. Acute Injuries Tissues are torn, capillaries are damaged & cells die, due to interference of blood & oxygen supply Specialized cells limit damage to injury & begin healing process Initiate blood clotting Body reacts by pain, swelling, redness, heat, loss of function All fluids & dead cells have to be removed from injury by circulatory & lymphatic systems Oxygen & nutrient supplying capillaries and cells are formed to assist repair.

3. 3 Phases of Healing 1. Inflammation process a. 2-4 days 2. Tissue repair a. 2 wks-1 month 3. Regeneration a. up to 1yr.

4. Inflammation Process A component of the healing process, the body begins to repair itself. Functions to localize & destroy pathogenic agents or foreign materal. Body’s 1 st line of defense against pathogens (bacteria/infections) Creates a favorable environment for tissue repair. 2 Responses by the body: Vascular: swelling Cellular: White blood cells

5. Tissue Repair Fibrous scar tissue formation occurs through 5 vascular and cellular responses. 1 st : Proliferation of Fibroblasts; lots of cells of come together to form the scar tissue( ie.collagen) 2 nd : Collagen Fiber Formation; these fibers are what give scar tissue its strength. 3 rd: Formation of Granulation Tissue; the initial type of tissue that develops, structurally weak. When we see this tissue we know that healing is proceeding! Good Sign 4 th : Wound Contraction; where we see the size of the initial wound/ injury decreased. 5 th : Dense Fibrous Scar Formation Transition of cells from granulation tissue to actual scar tissue New scar tissue NEVER duplicates structural & biomechanical properties of original tissue

6. Regeneration Ultimate structure, strength, & biomechanical properties of the scar tissue are gradually determined This can continue for months, a year, possibly longer. Overall tensile strength of the scar tissue maybe up to 30% less than that of the original, uninjured tissues. Over time scar tissue increases in strength with proper remodeling of the tissue.

10. Treatment ICEHEAT 1 st 48 – 72 hours As long as pain, swelling,& redness are present Physiological changes that occur: Reduced swelling & inflammation Reduced blood flow to injury site Reduced pain @ injury site Post 72 hours Physiological changes that occur: Increased blood flow Reduced muscle stiffness Muscular relaxtion

11. Ice vs. Heat CryotherapyHeat therapy Ice/ Cold packs: 20min Ice massage: 5-10min Cold whirlpool: 5-15min Cold spray: 10secs Hot packs: 10-15min Hot whirlpool: 10-15min Contrast Bath: Combines hot and cold water immersion Great for injuries with increased swelling due to pumping action

12. Counter Irritants Are substances that when applied to the skin cause a reaction Produce a sensation that is stronger than the sensation of minor pain Irritate the skin to provide a perception of warmth Goal is to relax the muscles

13. Counter Irritants Analgesic Pack: analgesic balm with a plastic-backed compress roll Some provide a cooling sensation rather than warmth.

14. Therapeutic Modalities Consists of heat, cold, light, air, water, massage, & electricity Used to decrease pain, swelling, & muscle spasm. Examples: Ultrasound (US) Electrical Stimulation (e-stem) Diathermy UV therapy (ultraviolet) Laser

15. Exercise The movement of the body by the muscles increases circulation@ a deeper level than the modalities. Used to maintain or increase strength, regain lost ROM (range of motion)

16. Massage Considered heat treatment; due to the friction massage creates thereby increasing local circulation. Follow up for musculoskeletal injuries & scar tissue breakdown.

17. Joint Mobilization Improves joint mobility by restoring accessory movement to allow non-restricted, pain free range of motion.

18. Injury Management AcuteChronic Quick onset Short duration Use “Prices” Longer duration Repetitive Overuse Continued use of “Prices” with exercise, therapeutic modalities, heat, & contrast bath

19. Rehabilitation GoalBenefits To return the injured athlete to pre-injury level of strength, power, endurance, flexibility, & confidence as quickly and safely possible. Athlete stays in habit of working out Results are tangible Athlete feels better about themselves

20. Rehabilitation 5 Phases4 Basic Components 1. Post surgical/acute injury 2. Early exercise 3. Intermediate exercise 4. Advanced exercise 5. Initial sports re-entry 1. Therapeutic exercise 2. Therapeutic modalities 3. Athlete education 4. Goal Setting

21. Range of Motion Ankle Dorsiflexion: 20 degrees Plantar flexion: 45 degrees Inversion: 40 degrees Eversion: 20 degrees Knee Flexion: 140 degrees Extension: 0 degrees Hip Flexion: 125 degrees Extension: 10 degrees Adduction: 40 degrees Abduction: 45 degrees

22. Range of Motion Shoulder Flexion: 180 degrees Extension: 45 degrees Adduction: 40 degrees Abduction: 180 degrees Internal Rotation: 90 degrees External Rotation: 90 degrees

23. Range of Motion Elbow Flexion: 140 degrees Extension: 0 degrees Forearm Pronation: 80 degrees Supination: 80 degrees Wrist Flexion: 80 degrees Extension: 70 degrees Adduction: 45 degrees Abduction: 20 degrees