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
