1. Unit 6 Healing and Inflammation

2.  What seems to happen at the injury site?  What happens to the brain?

3.  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

4.  Injuries  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

5.  Sprained ankle  Torn ACL  Hamstring Strain

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

7.  Usually caused by biomechanical issues:  Improper form or technique  Unaccustomed to a new sport or activity  Genetic components  Hyperpronation  Scoliosis  Muscle imbalances, etc.

8.  Achilles tendinitis  Jumpers knee (patellar tendonitis)  Shin Splints (Medial Tibial Stress Syndrome)  Osgood Schlatters

9.  What is inflammation?  What occurs during the process of inflammation?

10.  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.  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.  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.  This phase is marked by initial damage (primary cell death) to the affected tissues  Blood vessels bring oxygen and nutrients to the tissues  Blood vessels are not intact  Normal blood flow to cells is disrupted  Tissue death occurs (secondary cell death)

14.  Cell death  Hypoxia  Results from lack of oxygen to tissue  General increase in  Blood flow which brings  Blood cells  Chemicals  Clean up cellular debris and initiate healing  Inflammation begins and is seen

15.  Pain comes from 2 mechanisms  Pain receptors triggered by initial trauma  Chemicals that are released into the area

16.  Sources tell the body that  Damage has occurred  Encourages decreased activity  Healing can take place  Decreased activity is important for proper healing  Pain medication can actually hinder this process

17.  Write about the worst injury that you have had.  Tell how it happened  How long it took to heal  What you had to do to get it to heal

18.  Swelling occurs due to 4 mechanisms 1. Initial trauma  Blood vessels rupture  Blood leaks out of blood vessels into the extracellular compartment 2. Damaged cells fail to retain intracellular fluid  Fluid is lost to the extracellular compartment

19. 3. Cellular debris  Increased proteins in the extracellular fluid  Hypertonic solution  Draws fluid out of cells 4. Blood vessels vasodilate  Small vessels become porous  Fluid loss from blood vessels

20.  Swelling  Increase secondary cell death due to hypoxia  Compression wrap  Decrease mechanisms  Limit swelling  Controlled motion  Limits swelling  Encourages  extracellular drainage  Venous return through the skeletal muscle pump

21.  Blood vessels stimulated to dilate  This vasodilatation causes  Increase in circulation  Brings white blood cells to engulf cellular debris  Macrophages and neutrophils  Prepare the area for healing to begin  Redness because of the heat

22.  Loss of function results because  Damage to supportive structures  Due to pain  Not always complete loss  The acute phase usually last from onset to 48 to 72 hours

23.  Regeneration mechanisms  Work with damaged tissue  Cellular debris has been removed  Next step is to regain adequate blood flow  Form capillary buds to connect existing vessels

24.  Blood flow normalized  Regeneration of damaged tissues begins  Body’s ability to regenerate various tissues is limited  Most damaged body tissue repaired with “scar tissue”  Scar tissue is composed of a protein called collagen

25.  Specialized cells migrate into the area  Begin the process of regeneration  Fibroblasts  Responsible for collagen production

26.  Collagen  Extremely strong  Elastic properties  Not the same as the existing tissues  Effective in regaining normal abilities of the tissue  As long as the damage is not overly extensive  Occurs for all damaged tissue in the body  Except bone which heals with actual bone tissue  This phase usually lasts 3 to 4 weeks

27.  What is rehabilitation?  What usually occurs during a session?

28.  Overlaps the Subacute phase  May continue for up to 1 year  Fibroblasts are decreased  Collagen fibers  Strengthen and attempt to align with existing fibers  “Controlled motion” can assist in this process  This type of rehabilitation  Prevents the formation of adhesions  Can form as collagen fibers contract in an effort to strengthen

29.  Adhesions  Areas of overgrowth of scar tissue  Become excessively tight  Reduces ROM  An area that is completely immobilized during this phase may be healed  Poorly adapted functionally  Collagen fibers are deposited randomly  Should form in line with existing fibers

30.  “ Wolff’s Law ”  “Tissues grow according to the stresses placed upon them”  Proper development  Must be “stimulus” for adaptation to occur  If stimulus is removed atrophy occurs  Explains why an arm that has been casted is smaller when the immobilization is removed

31.  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

32.  Tissue is partially torn  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

33. AA complete rupture of the tissue PPop SSymptoms include: SSevere Pain MModerate to severe swelling PProbable ecchymosis CComplete loss of integrity of the joint CComplete loss of function