1.  Primary Response: tissue destruction directly associated with traumatic force; can’t change amount of initial damage  Secondary Response: occurs from cell death caused by a blockage of O 2 supply; can assist to keep minimum damage to other tissues Injury Response Cycle = pain-spasm-pain cycle (Chemicals stimulate free n. endings & cause pain which causes m. spasm & triggers body’s protective mechanism.)

2. Phase I: Acute Inflammatory Phase Phase II: Proliferation/Fibroblastic/ Repair/Regeneration Phase Phase III: Remodeling/ Maturation Phase

3. RednessHeatSwellingPainLoss of Function Caused by dilation of arterioles/ increased blood flow Increased chemical activity & increased blood flow to skin surface Caused by accumulation of blood & damaged tissue cells Direct injury of nerve fibers, pressure of hematoma on n. endings Chemical irritants – bradykinin, histamine, prostaglandin Increased pain/ swelling

4.  “Substrate Phase”  Begins almost right away, lasts approx. 2-4 days  Goal  Protect,  Localize,  Decrease injurious agents,  Prepare for healing and repair  Critical to the healing processes - If this phase does not accomplish what it is supposed to or if it does not subside, normal healing cannot take place.  Lasts until damaged tissue has been removed & new capillary network has been formed

5.  “Repair/Regeneration or Fibroblastic phase”  Phase will extend from 48 hours to 3-6 weeks  Phase removes debris & temporary repair – SCAR FORMATION (fibroplasia)  Adenosine triphosphate (ATP) is a critical factor that regulates the rate & quality of healing - cell’s primary source of energy - provides metabolism needed to restore cell’s membrane properties by moving Na 2+ & K + into & out of cell, to build new proteins & synthesize proteins

6.  4 processes of soft tissue repair - fibroblast formation - tissue remodeling - synthesis of collagen - tissue alignment Dependent on levels of: debris removal, endothelial production, production of fibroblasts  Repaired through 3 phases  Resolution - dead cells & cellular debris are removed by phagocytosis (tissue left with original structure & function in tact)  Regeneration – damaged tissue is replaced by cells of the same type (structure retains some or all of its original structure & function)  Repair – original tissue is replaced with scar tissue (original structure & function is lost)

7.  Usually begins @ week 3  Purpose is to increase strength of repaired/replaced tissues  First 3-6 weeks involves laying down of collagen and strengthening of fibers  3 months to 2 years allowed for enhanced scar tissue strength  Balance must be maintained between synthesis & lysis  # of fibroblasts, myofibroblasts, & macrophages reduced to pre- injury state  # of capillaries decrease, H 2 O content decreases  Take into consideration forces applied, immobilization time frames relative to tissue and healing time  Scars fade & eventually return to near normal color  Type I collagen continues to replace Type III collagen

8.  Varying issues exist for all soft tissues relative to healing (cartilage, muscle, nerves)  Blood supply and nutrients is necessary for all healing

9.  Extent of injury  Edema  Hemorrhage  Poor Vascular Supply  Separation of Tissue  Muscle Spasm  Atrophy  Corticosteroids  Keloids and Hypertrophic Scars  Infection  Humidity, Climate, Oxygen Tension  Health, Age, and Nutrition

10.  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 RICE principle

11.  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

12.  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

13.  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

14.  Phase I: Acute Inflammatory Phase  Initial swelling management & pain control are crucial  PRICE  If you are too aggressive in the 1 st 48 hours the inflammatory process may not have time to accomplish what it needs to

15.  Phase II: Fibroblastic Phase:  As inflammatory phase begins to subside & pain decreases

16.  Phase III: Remodeling Phase:  Longest phase with the ultimate goal of returning to activity  Continued collagen realignment  Pain continues to decrease