1. Tissue Response to Injury

2. Basic Signs of Inflammation
Pain
Redness
Immobility
Swelling
Heat

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

4. 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

5. 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

6. 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)

7. Phase III: Remodeling Phase
Usually 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)

8. 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.

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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. The Wheel of Functional Components

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

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

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

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

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

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

27. Proper Progression= OVERLAPPING involved

28. 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

29. 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