Healing Stages

Question 1

The healing process has 3 stages… name them

Answer 1

1. Inflammation
2. Repair/proliferative
3. Remodelling/Maturation

Question 2

Inflammation can be referred to as “sounding the alarm”… what is the purpose of inflammation and when might we see it come up?

Answer 2

• let’s the immune system know there’s a tissue threat (generic response)
• usually overdramatic but can stop pretty soon as threat is resolved ( up to 3 days a acute)
• generic: get this with ankle sprains, seasonal allergies, infections from cuts etc.

Question 3

Acute Inflammation is driven by -

Answer 3

Biochemical mediators

Question 4

Name the 3 biochemical mediators and their origin

Answer 4

Histamine, prostaglandin, bradykinin
- released from mast cells in tissues and local blood vessels

Question 5

What effect do bio chemical mediators have at the blood vessel level?

Answer 5

• vasodilators
• increased vascular permeability, vessels leak more easily into tissues

Question 6

What effect do bio chemical mediators have at the nerves?

Answer 6

• make nerve endings more sensitive to threatening stimuli
  = injured area becomes more sensitive in general (acute hyperalgesia)

Question 7

Name the components of SHARP symptoms

Answer 7

Swelling, heat, altered function, redness, pain

Question 8

What’s the difference between swelling and inflammation?

Answer 8

Swelling = Collection of fluid
- Can happen for other reasons (ie. medication side effects, pregnancy, vascular disease)

Inflammation = process

Question 9

We use different names for different fluids in different locations. Define edema

Answer 9

• fluid leaks from the vessels into the tissues (could be localized or more widespread)

Question 10

We use different names for different fluids in different locations. Define hematoma

Answer 10

• Collection of blood that has escaped the vessels and often, but not always, presents as a bruise (depending on closeness to skin surface)

Question 11

We use different names for different fluids in different locations. Define hemarthrosis

Answer 11

Bleeding into a joint cavity
- Can happen when you tear your ACL/PCL/bleed into knee joint

Question 12

We use different names for different fluids in different locations. Define joint effusion

Answer 12

The synovial membrane inside of a joint creates an excessive amount of synovial fluid
- Swelling can remain present even after inflammation process is done, particularly if the person has been immobile/kept trunk level for a long time

Question 13

What’s the biological reason for swelling?

Answer 13

• Chemical mediators change the vascular permeability, more fluid is moving from vessels to tissues

Question 14

What’s the biological reason for heat in an injured area? How can the location you see this differ?

Answer 14

• Heat and redness is related to vaso dilation, result of chemical mediators
• Heat, redness in our ability to detect changes are ultimately related to how close to the surface the injury and inflammation is
• a DEEPER STRUCTURE: MIGHT NOT BE ABLE TO SEE THE REDNESS OR HEAT
• a SURFACE STRUCTURE: Would make redness or heat easier to see

Question 15

Define altered function

Answer 15

• negative impact on your ability to walk, support your own body weight or play a sport
• can be related to paint a lack of stability within a joint and altered motor patterns (ex. Protective muscle spasm)

Question 16

Briefly describe the origin of pain

Answer 16

• product of chemicals: stimulating the nociceptors, which then tip off and start the process of creating a pain experience for the person who’s got the injury
• Make nociceptors more sensitive

Question 17

Describe the two main goals of the repair/proliferative healing stage

Answer 17

• clean up any debris such as dead tissue left over from the injury
• Build a foundation that will temporally closed the gap between injured ends of the muscle ligament or bone (can be a lot of work, depending on extent of tissue damage, and other factors)

Question 18

How long can the repair/proliferative stage last?

Answer 18

• up to three weeks post injury

Question 19

Each healing stage overlaps with the other: at what point during the inflammatory stage does the repair/proliferative states start?

Answer 19

• starts around two days post injury, while the inflammatory stage is slowing down

Question 20

Describe the first step of repair biologically

Answer 20

• call on the macrophages (big eaters that will clean up injury area through phagocytosis)

Question 21

Describe the second step of repair biologically

Answer 21

Purpose: build new, temporary foundation

• Use fibroblasts which create and lay down new collagen
• This tissue tends to be a weaker and less organized form that you need in the end (Quick but messy)
• Gives injury site some structural integrity, but not a lot

Question 22

Describe the last stage of repair biologically

Answer 22

• building fragile new blood vessels
• scabs happen in repair phase (if you were impatient and peeled it off to Early you got fragile, collagen, and blood vessels underneath called granulation tissue)
• Granulation tissue is the weak and isn’t meant for a big load, risks, breaking apart, and bleeding again

Question 23

How does the repairs stage present clinically?

Answer 23

• People tend to feel much better in this stage
• pain swelling an altered function may still actually be present, but are improving and they should go away with time
• Heat and redness from vasodilation will be more/less over but bruising can still linger
• Person will improve a lot overall, but this can make the stage tricky (can feel fully healed up with the underlying structure is weak, and will easily fail again, tissue not fully competent yet)

Question 24

Name the primary goal of the remodeling/maturation stage and describe the timeline

Answer 24

• primary goal is to develop end product, healed tissue
• want to progressively challenge the tissues so they build into shape and strength you need
• Starts close to three weeks post injury and can last up to two years

Question 25

What happens with collagen and blood vessels in the remodeling/maturation stage?

Answer 25

• physiologically we reach a point with no net gain in collagen content. Instead, we find balance between synthesis of new high-quality, well, organized, collagen, and simultaneous breakdown of the original foundation.
• The blood vessels are becoming more stable, but new growth comes to a stop.

Question 26

What are some clinical considerations for the remodeling/maturation stage?

Answer 26

• can progressively introduce more challenging in sport specific skills as required musculature become stronger and develops more endurance
• 2 YEARS?? Doesn’t mean a person can’t participate in a sport for two years because that depends on the number of factors (how much does your needs repairing? How well did the process go? What kind of tissue was injured?)

*** bone and muscle tend to heal more quickly than tendons and ligaments

WANT TO DO OBJECTIVE EVALUATION OF THE ATHLETES, FUNCTIONAL SKILLS AND PSYCHOLOGICAL READINESS

• THIS STAGE MARKS THE END OF THE HEALING PROCESS - YAY!