Download Tissue Response to Injury - Liberty Union High School District

Tissue Response to Injury
Basic Signs of Inflammation
 Pain
 Redness
 Immobility
 Swelling
 Heat
Three Phases of Healing
Phase I: Acute Inflammatory Phase
Phase II: Repair/Regeneration Phase
Phase III: Remodeling Phase
Phase I: Acute Inflammatory Phase
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Begins almost right away, lasts
approx. 2-4 days
Goal
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Protect,
Localize,
Decrease injurious agents,
Prepare for healing and repair
Phase II: Proliferation Phase
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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
Phase II: Proliferation Phase
a.
b.
c.
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)
Phase III: Remodeling Phase
 Usually begins @ week 3
 Purpose is to increase strength of
repaired/replaced tissues
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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)
Phase III: Remodeling Phase
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Take into consideration
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forces applied,
immobilization time frames relative to
tissue
healing time
Scaring
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Minor scars fade & eventually return to
near normal color
Deeper scars may not due to the irregular
collagen patterns.
Factors That Impede (Slow) Healing
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Tissue type
Extent of
injury
Swelling
Hemorrhage
Poor Vascular
Supply
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Muscle Spasm
Atrophy
Infection
Disorders
Health, Age,
and Nutrition
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
Types of Tissues and their Healing
Skeletal Muscle – (Fastest healer)
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Great capacity to heal
Direct blood supply
Initial bleeding followed by laying down a
ground substance
Nerves – (Slowest healer)
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Limited capacity to heal
Very complex to regenerate
No blood supply
Importance of Controlling Swelling
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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
principle
(P)RICE
Importance of Controlling Swelling

Protection
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Protect the injury
from further damage
Splint, wrap,
immobilize the
injured site
If the lower
extremity is involved,
crutches should be
supplied
Importance of Controlling Swelling
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Restricted Activity (Rest)
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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
Importance of Controlling Swelling

Ice
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Constricts blood
vessels which
pushes out
swelling
Numbs the area
to decrease pain
Should be used:
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When there is any swelling
Within the first 2-3 days of any acute
injury
Importance of Controlling Swelling
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Compression
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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
Importance of Controlling Swelling
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Elevation
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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
Managing the Healing Process
through Rehabilitation
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Pre-surgical Phase:
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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
Phases of Treatment
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I = initial inflammatory phase
M = mobility restoration
P = propioception phase
R = resistance training phase
E = endurance training phase
SS = sport – specific function phase
The Wheel of Functional
Components
Flexibility
Muscular
Strength
Mobility
Cardio/
Endurance
WHOLE
Person
Propioception
Muscular
Endurance
Sport specific
function
Initial Inflammatory Phase
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What are some considerations?
Pain / Spasm
Protection- Rested- Iced- CompressedElevated
Mobility Phase = Joint Movement
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Range of Motion (ROM)
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Alphabet
Seated Calf Raises
Flexibility
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Gastroc vs Soleus Stretch
Propioception Phase
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Knowing where your body is in space;
sensing the position of the limbs.
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Balance or coordination exercises
Resistance Training
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Muscles, bones, and surrounding tissues such
as ligaments and tendons will increase in
strength!
Endurance
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Must be able to maintain positions or
movements over TIME!
Muscular
Cardiovascular
Sport - Specific
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Can they perform the movements of their
sport safely and effectively?????
Needed for COMPLETION!!!!
Proper Progression=
OVERLAPPING involved
STRENGTH
ENDURANCE
POWER
Rehab Phases
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Phase 1 – Acute
Inflammatory Phase
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Phase 2 – Proliferation
Phase
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Phase 3 - Remodeling
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Inflammation
Mobility
Proprioception
Resistance
Endurance
Sport Specific
Pain Management
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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