[1.1] Soft Tissue Healing

Question 1

what are the tissue repair phases

Answer 1

bleeding + inflammation + proliferation + remodeling

Answer 2

it depends; variable with the nature of the injury & the tissue in question

Answer 3

• more vascular tissues (muscle) bleed longer and there is a greater escape of blood into tissues
• other tissues (ligament) will bleed less in terms of both duration and volume

Answer 4

acute inflammatory process & chronic persistent inflammatory process

Answer 5

rapid onset (a few hours at most) that swiftly increases in magnitude to its max (1-3 days) before gradually resolving (over the next couple weeks)

Answer 6

more vascular tissues have a swifter onset and resolution when compared to less vascular tissues

Answer 7

include neurogenic, mechanical irritation, repeated minor trauma, excessive heating and cooling plus others that may be less significant in therapy such as infection and a wide range of autoimmune disorders

Answer 8

generation of the repair material, which for the majority of MSK injuries it involves the production of scar material (collagen)

Answer 9

it is a rapid onset @ 24-48 hours

Answer 10

• rapid onset of 24-48 hours

- considerably longer peak of reactivity (2-3 weeks post injury)

Answer 11

shorter/less

Answer 12

the time phase during which the bulk of scar (collagen) material is formed

Answer 13

several months, typically around 4-6 months

Answer 14

to start stressing/loading your patients

• “oh can I put weight/pressure this much?” ABSOLUTELY!!!
• teach your patients, validate this idea

Answer 15

roughly the same time as the proliferative phase (2-3 weeks post injury)
- more recent evidence supports that the remodeling phase starts earlier than this, so it would be reasonable to consider the start point of the remodeling phase to be in that first week.

Answer 16

• with all the scar/collagen being produced, the remodeling phase is organizing the quality and fxn of the tissue produced.
• this phase is responsible for finding the best scar/collagen suitable in behaving as its parent tissue (that which it is repairing)

Question 17

considerations of soft tissue healing

Answer 17

• It would also be difficult to argue that there is any need to change the process of tissue repair.
• The mechanism through which therapy can be effective throughout the repair sequence is becoming better understood and these effects appear to be achieved by ‘stimulating’ rather than ‘changing’ the events.
• The more logical approach would be tofacilitateorpromotethe normality of tissue repair, and thereby enhance the sequence of events that take the tissues from their injured to their ‘normal’ state.

Question 18

tissue specific considerations

Answer 18

Skin
Tendon and Ligament
Cartilage
Bone
Muscles
Peripheral nerve
Vasculature
Lymphatic system (delicate nature)
Disc