1. Tissue’s Response to Injury Unit 4 Evaluation and Assessment of Athletic Injuries

2. Introduction  The starting running back has sprained his ankle 2 days before the 1 st playoff game.  The coach, parents, and athlete want to know what can be done to make him well more quickly.  Question: What does the athletic trainer need to know to answer their question?

3. Objective  By the end of the lesson:  Define the 3 Phases of Healing  Identify factors that impede healing

4. Three Phases of healing  There are 3 phases that an injury will go through in order to heal. 1.Inflammatory Response Phase 2.Fibroblastic Repair Phase 3.Maturation-Remodeling Phase

5. Time Span  Interpret this graph. What does it mean? Injury Day 4 6 Wks 2-3 Yrs 1 2 3 1: Inflammatory Phase 2: Fibroblastic Phase 3: Maturation-Remodeling Phase

6. Inflammatory Response Phase  Once tissue is injured, the healing process begins immediately  This phase is characterized by:  Redness  Swelling  Tenderness/Pain  Increased Temperature of tissue  Loss of function  This phase of healing is CRITICAL to the entire process of healing. If this response does not accomplish what it is supposed to do, normal healing cannot take place.

7. Inflammation process  White blood cells are delivered to the site of injured tissue – begin the clean up!  Vasoconstriction lasts for 5-10 minutes  Chemical mediators then produce dilation – causing swelling  Formation of a clot begins – scab/scar  This phase lasts 2-4 days after initial injury

8. Fibroblastic Repair Phase  Fibers are created, causing a scab/scar in the tissue  Signs and symptoms of inflammation decrease  Increased blood flow during this phase brings nutrients to the injury site – essential for growth  This stage can begin 2hrs after injury and last up to 4 wks

9. Maturation-Remodeling Phase  Remodeling of the fibers creates scar tissue – according to the force it was subjected to  What does this mean?  If fibers were laid down properly during Phase 1 and 2, the scar tissue will be strong and return close to normal.  If fibroblast stage was too long or too short, the tissue may not return to normal.  With increased stress & strain (Rehab); fibers realign in maximum position = parallel to the lines of tension  Tissue assumes normal appearance, but not as strong as normal tissue.  By the end of 3 wks a firm scar is formed  This phase can last up to 3 years

10. Take note  On the 6 th -7 th day collagen fibers are deposited in a random formation which creates a scar  As more fibers are laid down, the stronger the scar is – which begins the maturation phase  What would happen if the inflammatory response and fibroblast phases are prolonged? What do you think would happen to the scar?

11. Question  What could make the healing process slow down?  What factors could impede healing?

12. Answer  Extent of injury  If severe, each phase could be prolonged  Prolonged swelling  Prevented by good first aid management  Infection  Not caring for an open wound can cause a delay in healing  Age, health, nutrition  The older we get, the greater the change in wound healing

13. Exit Cards  A wrestler receives a sudden twist to his right shoulder, causing a grade 2 muscle tear. What happens in the first hour of this injury?  What is the timeline for an injury? How long is each phase?