1. Chapter 2: Using Therapeutic Modalities to Affect the Healing Process Jennifer Doherty-Restrepo, MS, LAT, ATC FIU Entry-Level ATEP Therapeutic Modalities

2. Physiological Responses to Injury n Therapeutic modalities should be selected and applied based on the ________ ________ of the tissues to injury and on the understanding of how various tissues ________

4. Phases of the Healing Process n Inflammatory - Response Phase n Fibroblastic - Repair Phase n Maturation - Remodeling Phase The ATC must understand the healing process to make decisions on how and when therapeutic modalities may best be used to facilitate the healing process

5. Healing Process Continuum Injury Day 4 Week 6 2-3 Years Inflammatory-Response Phase

6. Healing Process Continuum Injury Day 4 Week 6 2-3 Years Inflammatory-Response Phase Fibroblastic-Repair Phase

7. Healing Process Continuum Injury Day 4 Week 6 2-3 Years Inflammatory-Response Phase Fibroblastic-Repair Phase Maturation-Remodeling Phase

8. Inflammatory - Response Phase n S/S u Redness u ________ u Pain u ________ u Tenderness u ________ u Loss of Function

9. Vascular Reaction Injury __________________ Immediate __________________ Of Vascular Walls _________________________ _________________________ With Hyperemia Stagnation and Stasis Initial Effusion of Blood and Plasma Lasts 24-36 Hours

10. Immediate Vascular Reaction Injury Vessels’ Endothelium is Disrupted _______________ _______________ Adhere To Exposed Collagen Sticky Matrix For Platelets and Leukocytes ___________ Formation of A ___________ Obstructs Local Lymphatic Drainage _____________ _____________ Injury Response

11. Cellular Reaction Chemical Mediators Released From Cell n Histamine u ________ u  Cell Permeability n Leucotaxin u ________ (Leukocytes Line Cell Wall) u  Cell Permeability u Forming ________ n Necrosin u Activates ________

12. Clot Formation Damaged Cell Thromboplastin Prothrombin Thrombin Fibrinogen Fibrin Clot Completed Within 48 Hours

13. Inflammatory - Response Phase n Injured area is walled-off n Leukocytes phagocytize foreign debris n Sets stage for Fibroblastic-Repair Phase n Lasts ________ after initial injury

14. Chronic Inflammation n Occurs when _____ inflammatory-response does not eliminate injuring agent n Leukocytes replaced by _________, ___________, and ________ ________ n Specific mechanism which causes conversion to chronic inflammation is unknown u ________or ________ with cumulative repetitive ____________ may be a cause

15. Fibroblastic - Repair Phase

16. Healing Process Continuum Injury Day 4 Week 6 2-3 Years Inflammatory-Response Phase Fibroblastic-Repair Phase Maturation-Remodeling Phase

17. n S/S u Signs and symptoms of inflammatory response subside n Proliferative, regenerative activity which leads to a period of ________ ________ (fibroplasia) and repair of injured tissue Fibroblastic - Repair Phase

18. Fibroplasia n Begins within the first few _____ following injury n Signs of inflammation subside n Pain and tenderness to touch n May last ________ weeks

19. Vascular Reaction Growth of Endothelial Capillary Buds (Stimulated By Lack of Oxygen) ________Blood Flow Increased Delivery of Essential ________ for Tissue Regeneration

20. Cellular Reaction Breakdown of Fibrin Clot Formation of ________ Tissue (Fibroblasts, Collagen, Capillaries) Fibroblasts Accumulate Along Capillary Beds Synthesizes Extracellular Matrix (________, ________, ________)

21. By Day 6 or 7 n Fibroblasts begin producing ______, which is deposited randomly throughout the scar n ________ _______ increases proportionally to collagen synthesis

22. Normal Sequence n Formation of minimal ________ n Increase in tensile strength and a decrease in the number of fibroblasts signals the beginning of the __________________ ________

23. Abnormal Response n Persistent Inflammatory Response Phase causes extended ___________ and _____________

24. Maturation - Remodeling Phase

25. Healing Process Continuum Injury Day 4 Week 6 2-3 Years Inflammatory-Response Phase Fibroblastic-Repair Phase Maturation-Remodeling Phase

26. n Long-term process n Realignment of collagen fibers along lines of ________ ________ n Ongoing _________________ of collagen n Increase in tensile strength of scar matrix n At 3-weeks a contracted, non-vascular scar exists n May require several years to complete

27. The Role of Controlled Mobility in the Maturation – Remodeling Phase n _________________ u Bone and soft tissue will respond to the physical demands placed on them, causing them to remodel along lines of ________ ________ n Injured structures must be exposed to __________ loads during the Maturation - Remodeling Phase

28. Controlled Mobility is Superior To Immobilization n Controlled mobility… u ________ scar formation u ________ revascularization u ________ muscle regeneration u ________ muscle and ligament fibers n Immobilization; however, during the Inflammatory - Response Phase will facilitate ________ by controlling inflammation

29. Factors That Impede Healing n Extent of Injury n Edema n Hemorrhage n _________________ n Separation of Tissue n ________ ________ n Atrophy n Corticosteroids n Keloids and Hypertrophic Scars n ________ n Humidity, Climate n Age, Health, Nutrition

30. Using Specific Modalities During Different Phases of Healing

31. Inflammatory – Response Phase n Immediate first aid management of injury n Minimize the early effects of excessive inflammation by: u ________ ________ n Initial goal should be to limit ________ u Limiting the amount of ________ will reduce the time required for rehabilitation

32. Controlling Edema: Immediate First Aid Management n P rotection n R estricted Activity n I ce n C ompression n E levation

33. n Protection from additional injury by applying appropriate splints, braces, or other immobilization devices n Restricted activity to allow the Inflammatory - Response Phase to elicit its effects u Rest does not mean ________ n Ice for __ _______ to decrease metabolism and elicit analgesic effects n Compression for ___ _______ to reduce space for swelling to accumulate n Elevation to reduce blood pooling in the extremities and facilitate ________ and ________ drainage

34. Modulating Pain n ________ and/or ________ ____________ Currents are typically used for analgesia n Low-Power LASER may also be used for pain modulation

35. Facilitating Healing n Low intensity _________ may be effective in facilitating the healing process n _________ may be used safely immediately following injury

36. Fibroblastic - Repair Phase n n Treatments may change from cryotherapy to thermotherpy n ________ n Thermotherapy techniques are used to ________ circulation to the injured area to promote healing n ________ n Heat modalities may also produce some degree of ________

37. Fibroblastic - Repair Phase n ____________ ____________ n ____________ ____________ may be used to facilitate removal of injury by-products n _________________ n ________ _________ currents may be used… u _______ _______ u To elicit muscle contractions (_______ _______) to reduce swelling u ________ u For modulation of ________ n n Low-powered LASER may be used for modulation of pain

38. Maturation - Remodeling Phase n ___________ n ___________ modalities are beneficial to the healing process during this phase u _________ u _________, shortwave and microwave diathermy may be used to increase circulation to deeper tissues n ________ ________ ________ ________ n Electrical stimulating currents may be used for ________ ________ and to stimulate muscle contractions for increasing both ________ and ________

39. Goal For Using Therapeutic Modalities n Assist the natural healing process while doing no harm