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Fundamentals of MSK > Healing Phases > Flashcards

Healing Phases Flashcards

1
Q

What are the characteristics of direct trauma?

A

Obvious trauma, rapid onset of symptoms

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2
Q

What are the characteristics of overuse syndrome?

A

No trauma, sudden changes in parameters of activity, subsequent onset of symptoms

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3
Q

What are the characteristics of repetitive strain syndrome?

A

No trauma, gradual onset without change in parameters of activity, typically a local biomechanical limitations or a degenerative disease such as OA

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4
Q

What are the characteristics of regional interdependance?

A

Gradual onset without change in activity parameters, symptoms usually distant from a “silent and real culprit”; often abnormal spinal motion/stability due to past and subtle trauma and/or persistent poor posturing; Possible increased pain response

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5
Q

What are the 4 general phases of tissue healing?

A
  1. hemostasis
  2. inflammation
  3. proliferation or repair
  4. remodeling
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6
Q

Are the phases of tissue healing mutually exclusive?

A

not mutually exclusive; overlap chronologically

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7
Q

Can healing occur without inflammation?

A

No

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8
Q

Can inflammation occur without healing?

A

yes

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9
Q

What is acute inflammation like?

A

sharp and severe

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10
Q

How long does acute inflammation last?

A

24 hours to 2 weeks

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11
Q

What are cardinal S&S of acute inflammation?

A

Red
swollen
hot
pain

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12
Q

What are the purposes of acute inflammation?

A

Protection and preparation for next phases

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13
Q

What are the vascular reactions to hemostasis?

A
  • systemic vasoconstriction
  • local vasodilation and vascular permeability
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14
Q

What are the cellular reactions to hemostasis?

A
  • Serotonin released
  • platelets aggregate, release growth factors for inflammation and repair
  • histamines/prostaglandins/proteins/NO released for local dilation
  • WBCs
    -RBCs, cellular debris and fibronectin (glue)
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15
Q

What is local stasis? What does it do?

A

Edema
- increased viscosity
- increased chemicals and acidity

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16
Q

What does local stasis lead to?

A

Protection / tenderness and muscle guarding

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17
Q

What does local vasodilation and vascular permeability do?

A
  • brings cells to kill and clean
  • brings cells to form a fragile clot/matrix to support the area
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18
Q

What does systemic vaso-constriction do?

A
  • shunt blood to injured site, stars clotting, and slows bleeding
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19
Q

What is the P in POLICED?

A

Protection with possible…
- activity modification
- immobilization
- assistive device

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20
Q

What is the OL in POLICED?

A

Optimal Loading through activity and MET for pain and inflammation

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21
Q

What does optimal loading promote?

A
  • Tissue repair and remodeling to prevent random fiber alignment
  • muscle activation to combat inhibition
  • confidence for motion
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22
Q

What is the ICED in POLICED?

A

Ice
Compression
Elevation
Drugs

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23
Q

What do we use modalities/MT to control?

A

pain
inflammation
muscle guarding

24
Q

When does the repair/proliferation phase?

A

begins within 24 hours to ~10 weeks

25
What are the purposes of the repair phase?
Collagen production by respective tissue cells & angiogenesis
26
What is angiogenesis?
formation of new blood vessels
27
What is the repair phase general rx?
- Greater address of ROM restrictions and involved tissues with manual therapy and MET - progress MET for optimal stresses with dose response
28
What does dose response with MET help with?
Protecting forming collagen and achieve neuromuscular benefits
29
FORM FOLLOWS ...
Function
30
What does the patient need to know about the repair phase?
Their body can adapt heal and needs optimal stresses
31
Little to no stress is almost as bad as ...
too much
32
When does collagen repair and remodel best?
With early and optimal healthy stress
33
What do we need to modify in the line of stress regarding articular cartilage/ inner annulus of vertebral discs/ and nucleus of disc and menisci?
Compression/ decompression/ glidingW
34
What do we need to modify about bone in the line of stress?
Compression/ decompression
35
What do we need to modify for muscles/tendons/ligaments/capsules/etc. in the line of stress?
Tension
36
When is the remodeling phase?
Highest rate from 2 weeks out to 1 year but may continue up to 3 years
37
What is the purpose of the remodeling phase?
Collagen conversion and organization
38
What happens to the collagen in the remodeling phase?
Initial and different type of immature collagen changes to its mature original type and alignment
39
How long for full cellular turnover?
Well over a year
40
What is the remodeling phase rx?
- address symptoms prn - restore full ROM with MT/MET - progress to higher MET purposes
41
What is sub-acute inflammation?
mild prolonging of inflammatory response
42
What does chronic or persistent inflammation NOT have?
redness or head
43
What does chronic inflammation have?
pitting edema and hardness with resistant absorption
44
What happens with more prostaglandins?
More pain and may lead to nociplastic pain
45
What happens with homunculus reorganization with more prostaglandins?
Increased nociceptive response
46
What does having more prostaglandins prolong?
Local vasodilation and permeability
47
What is persistent inflammation releasing more of?
Inflammatory products such as prostaglandins
48
What happens with excess oxygen from increased cellular metabolism?
Damages cell structure
49
What happens when we have more macrophages?
they release fibronectin and lead to extra matrices to accept more collagen
50
Is scar tissue a natural part of the healing process?
yes
51
What is remodeled tissue?
Combination of original and secondary types of collagen (aka scar tissue)
52
When is scar tissue a problem?
If excessive and disorganized = abnormal
53
What does abnormal scar tissue doi?
-limits tissue extensibility and elasticity - crimps off veins so limits circulation - impairs healing - C-fibers tolerate pressure and are left behind
54
What do C-fibers do?
tolerate compression and generate pain under tension
55
What do we have to manage while promoting optimal loading?
Pain and inflammation

Fundamentals of MSK (2 decks)

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