Concepts of Healing Flashcards
Name each of the 3 phases of healing?
- Inflammation phase
- Repair phase/proliferation/fibroplastic
- Maturation phase/ remodeling
Primary events occurring in each of these 3 phases:
Inflammation phase, what is it & what is the clinician’s goal during this phase?
Body’s response to injury, defensive maneuvers to stabilize site & protect itself.
Create an optimal healing environment (RICES often 1st step)
Primary events occurring in each of these 3 phases:
Inflammation process
2-3 days possibly 7-10.
- immediate local vasoconstriction in small vessels
- followed quickly by vasodilation
- chemical mediators arrive & signal that damage has occured
- platelets stimulate clotting mechanism
- body attempts to remove cellular debris
What are the 5 cardinal signs of inflammation?
- pain
- swelling
- heat
- redness
- loss of function
EXERCISE IS CONTRAINDICATED
Primary events occurring in each of these 3 phases:
Repair/proliferation/fibroplastic phase, what is it?
The phase where new blood vessels & granulation tissue is deposited at injury site.
How do we know that a pt has progressed to the repair phase?
- The wound/scare appears red/”beefy”(increased # of capillaries.
- continued but decreased swelling.
- still painful to the touch (pressure sensitive nerve endings).
Primary events occurring in each of these 3 phases:
Repair process
2-4 weeks possibly 5-21 days.
- Extension of leukocyte migration & phagocytosis of inflammation response.
- macrophages scavenge cellular debrise & circulatory & lymphatic system drains away remains.
- New vascular framework deposited
- Increased fibroblasts
- Wound contraction
* **PASSIVE EXERCISE DURING THIS PHASE
What is Type III Collagen’s role in the repair phase?
This is the collagen of granulation tissue & it is produced quickly by young fibroblasts before the tougher Type I collagen is synthesized.
Primary events occurring in each of these 3 phases:
Maturation/remodeling phase, what is it?
Maturing of wound’s collagen structures & arrangement.
Primary events occurring in each of these 3 phases:
Maturation process
6-18 months
- Myofibroblasts cause wound contraction to minimize scar
- Collagen transition: Type 1 Collagen replaces Type III Collagen
- Tensile strength increases
- Capillaries diminish in #
How do we know when a patient has progressed to the maturation phase?
- decreased redness from reduction of capillaries
- decreased edema from decreased extracellular matrix substances
- decreased pain from lessened nerve sensitivity & reduced edema
Factors that influence Healing
Therapeutic Modalities
- Cryotherapy - Prevent formation of edema
- Estim - 1st week may enhance protein synthesis, reduce M. spasm, facilitate lymphatic system (pumping), facilitate M. contraction (retard atrophy)
- Thermotherapy - decrease general sorness, increases collagen extensibility
- US/SWD - deep heating, collagen extensibility
* **Match your modalities c/ treatment goals
Factors that influence Healing
Other factors that effect it
- Wound size - larger, longer for area to connect & scare tissue to form
- Swelling - puts pressure on sensitive nerve endings, causes M. reflex inhibition, decrease nutrient exchange at injury site and function, increase pain, slow healing
- Muscle spasm - decreased blood flow (ischemia), M. self-immobilization
- Age, drugs, and nutrition (lack of protein, vit. A/C, copper, zinc)
What is the pain & progressive resistance exercise (PRE) principles?
Keep in mind these 2 principles:
1) Pain durin activity tells you that pt is exercising to vigorously (pain next day, exercise to vigorous)
2) Use progressive resistance exercise (PRE)
- Start slow, simple ROM exercise.
- Progressively increase demand at a pace the pt is comfortable with.
Exercise appropriate for each phase of healing
Inflammation
Modalities, no exercise, maintain CV fitness, exercise uninjured body parts
Exercise appropriate for each phase of healing
Repair
Begin ROM to influence arrangement (PROM, AAROM, SOME AROM), Mild isometrics
Exercise appropriate for each phase of healing
Maturation
- Full AROM-RROM
- Balance & agility exercises
- Functional, sport specific drills
- increased aggressiveness as tissue strength improves.
Exercises that are appropriate for each phase of healing: Primary objective
prevent deconditioning and return pt efficiently, yet safely to full participation.
