Lecture 5 - Phases of healing Flashcards
What is a strain
Strain: Term used to describe physical damage to “active” soft tissues (muscle, tendon, myofascia).
What’s a sprain?
Sprain: Term used to describe physical damage to “passive” soft tissues (esp. ligament and joint capsule).
T/F The description of a 1st, 2nd and 3rd degree of a sprain differ slightly from a strain because of the difference in tissue damage.
If T: describe what are those differences?
F: it’s the exact same thing
For ligaments that are closely anatomically related to surrounding structure (s/a joint capsule), the completeness of the rupture may be less simple to determine.
How do we grade in those cases?
For ligaments that are closely anatomically related to surrounding structure (s/a joint capsule), the completeness of the rupture may be less simple to determine (e.g. the MCL of the knee).
For the latter, the grade of 3 may be assigned based on the severity of the damage, rather than a clear anatomical distinction.
What are the 3 phases of soft tissue healing?
When do they occur?
Lasts until when?
- Inflammatory – first 48-72 hours (up to 10 days)
- Proliferative – from ~day 3 (lasts 3 - 6 wks)
- Remodeling – from ~day 9 (lasts 6 wks to 12 mths)
What are the 5 cardinal signs of inflammation?
Redness, heat, edema, pain, decreased function
What are the 4 different responses in the inflammatory phase?
–Hemostatic response
–Vascular response
–Cellular response
–Immune response
How is the inflammatory phase begin and end
It begins with disruption of normal tissue physiology
–Caused by injury, disease, etc. (duh)
It ends with complete removal of the wound debris
During inflammatory phase, is there a vasoconstriction or a vasodilation?
BOTH
Initial Vasoconstriction – with the role of limiting blood loss
Followed by vasodilation
What are the treatment in the inflammatory phase of healing?
POLICE
T/F
In the “protection” of the POLICE acronym: short period of unloading are not recommended in the first 24h but may be necessary after 24-36h
F
Short periods of unloading may be necessary
(I made up the rest)
T/F
The proliferative phase may be named “chronic phase” in clinical terminology
F
Proliferative : subacute phase
Remodeling phase: chronic phase
What are the different names for proliferative phase?
Physiological: Proliferative, granulation, fibroblastic or repair phase
Clinical: Subacute phase
Management: Controlled motion phase
What are the different names for remodeling phase?
Physiological: Remodeling phase
Clinical: Chronic phase
Management: Return-to-Function phase
When does the proliferative phase ends?
•It ends when
–Fibroblasts activity / collagen production returns to baseline levels
–Fibroblast-rich granulation tissue is replaced by scar tissue
When does the remodeling phase ends?
–The ends point for this phase is unclear as the rate of tissue remodeling may return to baseline before biomechanical properties are recovered.
What are the general long term goals of rehab concerning the healing phases (3)?
Strong and mobile scar at the lesion site
Complete and painless restoration of function
Complete remodelling of scar at lesion site
Inflammatory phase: what controlled mobilization improves (4)?
Scar formation
Revascularization
Muscle regeneration
Tissue remodeling
Inflammatory phase: what early mobilization prevents (3)?
Loss of muscle, ligament and bone strength
Formation of adhesions
Loss of proprioception
LETS MIX IT ALL:
In which phase (inflam-prolif-remod) can we have these clinical signs:
1.Beginning of tissue resistance during ROM assessment
- Pain at end of tissue resistance
- 1 Pain appears before completion of ROM
- 3 Pain with overstressed tissue
- 4 Painful mvt
- Active effusion but no local redness
- Resumption of normal ADL
1.Beginning of tissue resistance during ROM assessment - Prolif
- Pain at end of tissue resistance - Remod
- 1 Pain appears before completion of ROM - Inflam
- 3 Pain with overstressed tissue - prolif
- 4 Painful mvt - inflam
- Active effusion but no local redness - prolif
- Resumption of normal ADL - prolif
In which phase (inflam-prolif-remod) can we have these goals:
- Protection
- Start of recovery of proprioception
- Improve strength
- Establish normal ROM
- Reduce pain
- Education
- Protection - inflam
- Start of recovery of proprioception - prolif
- Improve strength - remod
- Establish normal ROM - prolif
- Reduce pain - inflam
- Education - inflam
In which phase (inflam-prolif-remod) can we have these treatments ?
- Modalities:
- Education
- Str, proprioception exs
- Conditionning safely and pain free
- Conditionning: swimming
- Pain free ROM
- Flexibility
- Modalities: all 3
- Education: all 3
- Str, proprioception exs: prolif, remod
- Conditionning safely and pain free - inflam
- Conditionning: swimming - prolif
- Pain free ROM: inflam, prolif
- Flexibility: prolif, remod
