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Download Lecture 4 understanding Healing 2016
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Understanding and Managing the Healing Process Primary and Secondary Healing Primary – direct ( acute) Secondary – inflammatory (chronic) When an injury occurs the healing process that follows depends on the extent of the injury , the approximation of the wound site Small separation – a bridge will bind the ends together – this is called primary intention More severe wound when there is not close tissue approximation – the space is filled from the bottom and sides of the wound – secondary intention This take longer and more of a scar is formed Healing Process PHASES OF HEALING: Inflammatory Phase 2-4 days Fibroblastic-Repair Phase ( proliferation) First few hours post-injury to 4-6 weeks Maturation-Remodeling 3 weeks to several years Must be understood that the healing process is a continuum , phase may and do over lap and have no definite beginnings or end Inflammatory response Injury occurs body recognizes the problem and begins a series of defensive maneuvers to stabilize the wound site and protect it Extremely complex process 2-3 days up to a week or more to complete Inflammation often considered negative but it is an important and necessary step With out inflammation body would not be able to complete the healing process However inflammation becomes detrimental when prolonged Goal is to allow inflammation to happen but to minimize it and encourage healing to continue along its normal path Inflammatory response Signs of inflammation Response is characterized by redness , swelling, pain tenderness , loss of normal function and increased temperature The initial inflammatory response is critical to the entire healing process, if it does not occur normal healing will not occur Vascular Reaction Vascular spasm Formation of a platelet plug Blood coagulation Growth of fibrous tissue Immediate response is vasoconstriction of vascular walls form seconds to minutes Then an increase in blood flow which is transitory and gives way to a slowing of the flow in dilated vessels This initial effusion of blood and plasma may last for 24 to 36 hours Chemical Mediators Chemical mediators are important in limiting the amount of exudate and thus swelling after an injury Complex chemical reaction Fibroblastic Repair Phase During this phase activity leads to scar formation and repair of injured tissue At this time s/s associated with the inflammatory response subside. Tenderness and pain with some certain movements may still occur but should decrease as the scar formation progresses As we progress to repair the tensile strength increases and there is minimal scar tissue. Maturation -Remodeling Phase This phase is a long term process Features realignment or remodeling of the collagen fibers that make the scar tissue, according to the tensile forces to which they are subjected. Tissue gradually assumes normal appearance and function , although a scar is rarely as strong as the normal tissue Factors that Impede Healing Extent of injury Edema / swelling Hemorrhage Poor vascular supply Separation of tissue Muscle spasm Corticosteriods Infection Health – disease age Nutrition Surgical repairs Drugs Therapist should have a basic understanding of drugs Not going to know them all or different names Always remember drugs should be taken by individual as prescribed by physician and if undesirable effect should occur they should contact physician immediately Drugs Duration of action – length o f time the drug is in the blood above the level needed for action Half life – the amount of time it takes for level of drug in blood stream to be diminished by half The frequency of the drug is administered based on the drugs half life . Shorter half life the more frequent the drug is administered Thus goal is a steady state – 4- 5 half lives of the drug Eg -Naproxen – half life 14 hours – dosage 2twice a day – ibuprofen half life , administered 2 hours – 3 – 4 times a day More is not better – higher concentrations may have a toxic effect Drugs Taking medication Orally – absorbed in small intestine – should be taken with a glass of water – not just a swallow – liquid helps dissolve the medication thus increasing the speed which the drug moves from stomach to small intestine If taken with food it is absorbed at a slower rate – however that is required of some medications Medication will not be absorbed as quickly if taken prior to exercise as blood is taken from small intestine to working muscles , so not a good idea to take antiinflammatories just before exercise NSAIDs NSAIDs and athletic injuries , research supports use in early days but no significant data to support long term use Used to decrease pain and inflammation , hopefully by doing this the therapist can work ROM and other therapeutic exercises and promote healing Important to remember lots of choices and some may find one works better than the other – work with physician if patient having difficulty – most commonly stomach upset - Naproxen Swelling The one common problem to almost all injuries is swelling Swelling can be caused by a number of factors, bleeding , production of synovial fluid, accumulation of inflammatory by products, edema or a combination of factors . No matter the process, swelling produces increased pressure, and thus increased pain, as well can cause neuromuscular inhibition , which results in weakness of the muscle Once swelling has occurred the healing process significantly slowed Swelling The injured area cannot return to normal until the swelling is all gone. “therefore everything that is done in first aid management should be directed toward controlling the swelling” How do we do this????? PIER & METH P- Pressure I- Ice E-Elevation R- Rest M- Movement E-Elevation T – Traction H- Heat METH Movement “Garbage in Garbage out” Muscle contraction to move lymph Elevation - drainage Traction – realignment Heat- blood flow – healing – nutrients http://theelitetrainer.com/wp/the-new-injuryrehabilitation-paradigm-rice-is-not-nice-do-methinstead/ Chronic Inflammation Occurs when the acute inflammatory response does not eliminate the injuring agent and restore tissue to its normal physiological state. Chronic inflammation does appear to be resistant to both physical and pharmacological treatments.
