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Therapeutic Rehab > Healing Process > Flashcards

Healing Process Flashcards

1
Q

What happens to the blood vessels when a injury initially occurs?

A

vasoconstriction followed by vasodilation

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2
Q

What is the purpose of the vasodilation follow injury?

A

influx of nutrients (blood, platelets, clotting factors)

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3
Q

What are the three phases of the healing process?

A
  • Inflammatory response phase (recruit cells and nutrients)
  • Fibroblastic repair phase (scab)\
  • Maturation & remodeling phase (hardens/skin)
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4
Q

What is important to remember about the phases although they are separate phases?

A

they are a continuum (overlaps)

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5
Q

What are the two types of healing?

A

primary and secondary

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6
Q

What other phase is included in the healing process?

A

Hemostasis

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7
Q

Primary Injury

A

In sports setting typically described as being either chronic or acute

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8
Q

Primary injuries occur from what?

A

Microtraumatic or Macrotraumatic

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9
Q

Macrotraumatic

A

result of acute trauma and produce immediate pain and disability

  • Fractures, dislocations, subluxations, sprains, strains, contusions
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10
Q

Microtraumatic

A

Overuse injuries
- Repetitive overloading or incorrect mechanics

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11
Q

Secondary Injury

A

The inflammatory or hypoxia response that occurs with the primary injury

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12
Q

Hypoxia

A

An absence of enough oxygen in the tissues to sustain bodily functions.

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13
Q

Chronic and acute injuries both cause what reaction?

A

reduced function

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14
Q

Reduced function for a chronic injury looks like what?

A
  • inappropriate neural feedback
  • increased tissue stress
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15
Q

Reduced function for a acute injury looks like what?

A
  • scar tissue adhesions
  • atrophy
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16
Q

The effects of reduced function caused by an acute and chronic injury both cause what?

A

dysfunctional movement with neural changes

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17
Q

What are the 3 R’s of rehabilitation?

A
  • relieve symptoms
  • restore deficiencies
  • return to function
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18
Q

Relieve symptoms: Acute

A

modalities; no exercise

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19
Q

Relieve symptoms: Chronic

A

identify causes

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20
Q

Restore deficiencies

A
  • manual therapy
  • ROM exercises
  • strength-endurance exercises
  • balance-coordination exercises
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21
Q

Return to function

A
  • functional exercises
  • acticity-specific exercises
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22
Q

Define hemostasis

A

Process of stopping blood flow through the locally damaged vessels and into the injury
site

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23
Q

What is the shortest stage of healing?

A

hemostasis

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24
Q

Why is the hemostasis phase so important?

A

none of the other healing
phases can begin until hemostasis occur

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25
Q

What is proliferation (organization)?

A

Phase begins with the transition from debridement to angiogenesis and formation of
granulation

26
Q

Define debridement

A

the removal of damaged tissue or foreign objects from a wound.

27
Q

Define angiogenesis

A

is the formation of new blood vessels.

28
Q

Define granulation

A

is the primary type of tissue that will fill in a wound that is healing by secondary intention.

29
Q

How long is the proliferation phase typically?

A

5 days following injury
to around day 21

30
Q

Remolding phase

A
  • Much yet to be understood about this phase
  • Wound tissue converts to scar tissue
  • Collagen transition
  • Wound sensitivity lessens
31
Q

Growth factors

A
  • Roles not fully understood
  • Function in healing
  • Types of growth factors
  • Chronic inflammation
32
Q

What occurs during the Inflammatory Response Phase?

A
  • Process of healing begins immediately
  • Redness, swelling, tenderness, increased temperature
  • Response is critical to the rest of the healing process
33
Q

Vascular Reaction

A
  • Involves:
    • vascular spasm
    • formation of platelet plug
    • blood coagulation
    • growth of fibrous tissue
  • Immediate response of tissue damage is vasoCONSTRICTION then replaced by rapid hyperemia
34
Q

How long does the vascular reaction/initial effusion of blood and plasma last?

A

24-36 hours

35
Q

Define hyperemia

A

an excess of blood in the vessels supplying an organ or other part of the body.

36
Q

The vascular reaction is what kind of response?

A

inflammation response

37
Q

What are the three important chemical mediators?

A
  • histamine
  • leukotaxin
  • necrosin
38
Q

Histamine function

A

Responsible for vasodilation and increased cell permeability

39
Q

Leukotaxin function

A

Responsible for margination in which leukocytes line up
along the cell walls

40
Q

Necrosin function

A

Responsible for phagocytic activity

41
Q

What are the effects of a histamine?

A
  • histamine causes capillary permeability and vasodilation
  • capillary permeability causes edema, edema causes pain and altered function
  • ## vasodilation causes blood flow, blood flow causes redness and heat
42
Q

Formation of a Clot Process

A
  • Injury exposes collagen in vascular wall where
    platelets can adhere to create a sticky matrix
  • Plug obstruct local lymphatic fluid drainage and localizes injury response
  • Clot formation begins around 12 hours after injury and is completed around 48 hours
  • Initial inflammatory phase lasts up to 2-4 days after initial injury
43
Q

Chronic Inflammation cause and process

A
  • Occurs when the acute inflammatory phase does not eliminate the injuring agent and
    restore tissue to its normal physiological state
  • Leukocytes are replaced with macrophages, lymphocytes and plasma cells
  • Exact mechanism is still unknown, seem to be
    associated with overuse and overload with cumulative microtrauma
44
Q

What is a NSAID’s?

A

Nonsteroidal anti-inflammatory drugs

45
Q

What medicine is not a NSAID’s?

A

Tylenol

46
Q

Firbroblastic Repair Phase

A
  • Proliferative and regenerative activity leading to scar formation and repair of the injured tissue follows the vascular and exudative
    phenomena of inflammation
  • Period of scar formation is referred to as fibroplasia
  • Endothelial capillary growth into the wound stimulated by lack of oxygen
    - Wound starts to heal aerobically
  • Increased oxygen delivery will increase blood flow which delivers more nutrients
  • Formation of granulation tissue
  • On about day 6-7 fibroblasts begin producing collagen fiber that are deposited in a random
    fashion
  • As collagen proliferates, tensile strength of the wound rapidly increases
47
Q

When does the Fibroblastic Repair Phase begin?

A

few hours after injury and can last 4-6 weeks

48
Q

What marks the beginning of the maturation phase?

A

As tensile strength increases, fibroblasts diminish

49
Q

Maturation- Remodeling Phase

A
  • Phase features a realignment or remodeling of the collagen fibers that make up scar tissue
    according to the tensile forces to which the scar is subjected
  • With increased stress and strain, the collagen fibers realign in a position of maximum efficiency parallel to the lines of tension
  • Typically by the end of 3 weeks a firm, strong, nonvascular scar exists
50
Q

What is Wolff’s law?

A

bone and soft tissue will respond to the physical demands placed on them

51
Q

Role of Progressive Controlled Mobility During the Healing Process

A
  • Critical that injured structures be exposed to progressively increasing loads throughout
    rehabilitation process
  • As remodeling phase begins, aggressive active range of motion and strengthening exercises should be incorporated to facilitate tissue
    remodeling and realignment
52
Q

What factors impede healing?

A
  • Extent of Injury
  • Edema
  • Hemorrhage
  • Poor vascular supply
  • Separation of tissue
  • Muscle spasm
  • Atrophy
  • Corticosteroids
  • Keloids and hypertonic scars
  • Infection
  • Humidity, climate & oxygen
    tension
  • Health, age and nutrition
53
Q

What is the primary function of a ligament?

A
  • Provide stability to a joint

– Provide control of the position of one articulating bone to another during normal joint motion

– Provide proprioceptive input or a sense of joint position through the function of free nerve endings or mechanoreceptors

54
Q

Sprain _____________, strain ___________.

A

ligaments, muscles

55
Q

Grade 1 Sprain

A
  • mild stretching
  • mild (or no)joint instability
  • mild pain
  • mild swelling
  • mild joint stiffness
56
Q

Grade 2 Sprain

A
  • Moderate tearing or stretching
  • moderate instability
  • moderate (or severe) pain
  • moderate swelling
  • moderate joint stiffness
57
Q

Grade 3 Sprain

A
  • complete rupture
  • severe joint instability
  • severe pain
  • severe swelling
  • severe joint stiffness
    - will probably require some type of immobilization
58
Q

Ligament Healing

A

Healing process in the sprained ligament follows the same course of repair as with other
vascular tissues
- If sprain occurs outside of joint capsule (extraarticular ligament) bleeding occurs in
subcutaneous space

   - If sprain occurs inside of joint capsule (intraarticular ligament) bleeding occurs inside joint capsule
59
Q

Why is it essential that torn ends of ligament be reconnected?

A

Failure to produce enough scar and failure to reconnect the ligament are two reasons why
ligament will fail

60
Q

How long does the maturation of a scar (ligament healing) take?

A

12 months

61
Q

How does level of activity affect ligament healing?

A
  • Actively exercised
    ligaments are stronger than those that are immobilized
  • Ligaments immobilized for several weeks after injury tend to decrease in tensile strength as well as a weakening at the insertion of the bone
62
Q

What other factor affects ligament healing?

A

Other structures surround the joint (muscles) must be strengthened

Therapeutic Rehab (4 decks)

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