1. The Basics of Healing - Understanding the Inflammation Process

2. Bell Work
1.When you hear the word inflammation, what do you think of? 2. What is the difference between acute versus chronic injury?

3. Standard 12
Describe the physiological and pathological processes of trauma, wound healing, and tissue repair, and evaluate their implications on the development, progression, and implementation of a therapeutic exercise regimen. For example, examine a post- operative cardiac patient undergoing cardiac rehabilitation.

4. Introduction Injury is a part of athletic participation
Athletes have to learn how to cope with
Injuries
Temporarily interference with performance
Extended time away from their sport
Sports Medicine professionals understand
How the body heals
Help the athlete have a full recovery

5. Acute Injuries Injuries Generally result from Characterized by
Sudden onset
Definite time of occurrence
Generally result from
Large force
Overcomes tissue being acted upon
Characterized by
Sudden onset of symptoms
Traced to a specific event

6. Examples of Acute Injuries
Sprained ankle
Torn ACL
Hamstring Strain

7. Chronic Injuries Injuries Generally Occur from prolonged over-use
Onset not traced to one specific event
Generally
Small force repeated over and over
Extended period of time

8. Chronic Injuries Usually caused by biomechanical issues:
Improper form or technique
Unaccustomed to a new sport or activity
Genetic components
Hyperpronation
Scoliosis
Muscle imbalances, etc.

9. Examples of Chronic Injuries
Achilles tendinitis
Jumpers knee (patellar tendonitis)
Shin Splints (Medial Tibial Stress Syndrome)
Osgood Schlatters

10. Inflammation The body’s normal response to injury
Series of events that attempts to
Minimize further tissue damage
Localize trauma
Create environment for healing to occur

11. Inflammation The inflammatory response may
Resolve injury
Repair damaged tissue
Persist as chronic inflammation
While the word usually has a bad connotation, it should be noted that
Process is normal
Necessary for healing to occur

12. Inflammation Not all tissues respond the same
Many of the inflammatory processes can cause secondary issues
Sports medicine attempts
Limit adverse affects
Encourage the advantageous affects

13. The Healing Process
It is practical to have a sense of the healing process - this will give you insight into why some injuries take longer than others to recover
In an ideal world, we would let the process take over and allow the athlete to heal properly
In athletics, we do not have the luxury in many cases to allow this to happen

14. The Healing Process Consists of 3 phases:
Inflammatory response phase
Fibroblastic repair phase
Maturation - remodeling phase
Anything done when treating a patient that interferes with this process will likely slow the return to full activity

15. Injury Classification 1st Degree (Grade 1)
Tissues have been overly stretched
Tweaked
“Micro-tears” in the tissue develop
Symptoms include:
Pain
Minor swelling
Loss of function that may or may not limit activity
Integrity of the fibers is generally maintained

16. 2nd Degree (Grade 2) Tissue is partially torn Symptoms include:
Rolled or sprained
Symptoms include:
Moderate pain
Moderate Swelling
Loss of function
Usually limits activity
May result in ecchymosis
Integrity of the fibers is affected with joint laxity or decreased strength

17. 3rd Degree (Grade 3) A complete rupture of the tissue
Pop
Symptoms include:
Severe Pain
Moderate to severe swelling
Probable ecchymosis
Complete loss of integrity of the joint
Complete loss of function

18. The Healing Process
There is little that can be done to speed up physiology
But we can provide the optimal environment for healing or do the opposite and impair the process
Understand these phases, although discussed separately, do overlap and sometimes are tough to distinguish

19. The Healing Process Inflammatory Response Phase
The initial inflammatory response is critical to the entire healing process. If this response does not accomplish what it is supposed to do, normal healing cannot take place
The body often overreacts in this phase
This is an individual process - each of us are different

20. The Healing Process The inflammatory response phase
Signs we are in this phase:
5 signs of inflammation:
Redness
Swelling
Tenderness
Increased temperature
Loss of function
How long does this phase last?
Typically 72 hrs if treated correctly

21. The Healing Process Inflammatory Response Phase
How do we treat this correctly and allow it to do its thing?
R.I.C.E.
Rest = Do not use the part (crutches, slings, splints, etc)
Ice = Used for pain and vasoconstriction (slow down the body’s overreaction)
20 min on and 1 hr off
Hunting response - a slight temperature increase during cooling
A reaction against tissue damage from too cold exposure. This is important to educate athletes on how long they should leave ice on
Compression = elastic wrap will help control edema and reduce space for fluids to develop
Elevation = help the lymphatic system by using gravity to return the damaged cells to the core for removal

22. The Healing Process Fibroblastic Repair Phase How do I know?
Generally, signs and symptoms of inflammatory period subside
Tenderness and pain with function remain
How long does it last?
Starts few hours after injury and can last as long as four to six weeks depending on tissue and trauma done

23. The Healing Process Maturation - Remodeling Phase
Tensile strength begins to increase
Wolff’s Law states that bone and soft tissue will respond to the physical demands placed on them to remodel or realign along the lines of the tensile force
This is why most patients are now treated with controlled mobilization rather than complete immobilization

24. The Healing Process How do I know?
Clinical signs and symptoms will now begin to disappear
As healing progresses to remodeling, controlled activity is warranted with a gradual return to normal flexibility and strength
Usually, this is the time to tape, wrap and brace to allow activity while supporting the structure

25. The Healing Process Factors that impede healing:
Extent of injury or separation of tissue
Amount of edema - increased pressure impedes healing process
Hemorrhage
Poor blood supply
Muscle spasm
Infection
Health, age and nutrition
Allowing activity too early may allow these things to happen!

26. The Healing Process Methods used to modify healing:
Drugs: Non-steroidal anti-inflammatory drugs (NSAIDs): ibuprofen, advil, motrin, etc.- combat out of control inflammation
Thermal agents - cold first 72 hrs, usually a combo thereafter
Modalities - Electrical Stimulation = helps with pain and inflammation, Ultrasound = aids in blood flow and healing in later stages
Exercise - trend now is early range of motion (ROM) to aid in maturation-remodeling and avoid adverse biochemical changes

27. The Healing Process So how do we apply all this knowledge? In general:
Sprains and Strains:
RICE for first 72 hrs
“R” may include brief period of immobilization
After 72 hrs, introduce heat (hot packs, ultrasound, whirlpool) and range of motion (ROM) exercises
When symptoms begin to subside and ROM returns - begin strengthening and return to functional
If we handle properly, expected length of recovery:
1st degree = 3-6 wks
2nd degree = months
3rd degree = months to years

28. The Healing Process In general: Fractures “itis” -
Immobilize 6-8 wks depending on severity
Then we begin the process
Expected length of recovery:
2-4 months
“itis” -
Begin healing modalities, stretching and massage right away in combo with ice and electrical stimulation
Stimulate blood flow
Monitor stages and modify as needed
Generally, we are not going to heal this, we want to keep athlete in functional stages