proliferation, remodelling and management

Question 1

when does proliferation occur?

Answer 1

• 1 to 10 days

Question 2

what is attracted to injured area and when ?

Answer 2

• fibroblasts attracted to area 24 hours post exercise

Question 3

what do fibroblasts do?

Answer 3

• fibroblasts degrade fibrin and replaces it with extracellular matrix

Question 4

what two processes does extracellular matrix signal?

Answer 4

• angiogenesis
• granulation

Question 5

what does proliferation produce?

Answer 5

• collagen
• glycoproteins
• hyaluronic acid

Question 6

what are the nine influencing factors on proliferation?

Answer 6

• severity of trauma
• early management
• tissue vascularity
• age
• nutrition
• medication
• temperature
• biochemical factors
• appropriate loading

Question 7

what capacity does muscles have? - describe

Answer 7

• regenerative capacity
• MuSC - myoblast- myocyte - myotube - myofiber

Question 8

when does remodelling process occur?

Answer 8

• 10 days + post injury

Question 9

what does remodelling involve?

Answer 9

• ongoing fibroblast activity and collagen production

Question 10

when does remodelling peak?

Answer 10

• peaks at 2-3 weeks following injury

Question 11

what does remodelling absorb and deposit?

Answer 11

• absorption of older fibrous tissue
• deposition of new fibrous tissue

Question 12

what contracts in the remodelling phase?

Answer 12

• scar tissue contraction

Question 13

what are type III collagen fibres replaced with?

Answer 13

• replaced with type I collagen fibres

Question 14

how do physios manage healing tissues?

Answer 14

• make sure there are no contrary influences
• all possible favourable conditions are encouraged

Question 15

do all injuries recover in the same amount of time?

Answer 15

• different injuries take different periods of time to recover
• muscles recover quicker than ligaments and tendons due to higher blood supply and content of cells that repair

Question 16

what are the two management processes used in the inflammatory phase?

Answer 16

• PEACE
• LOVE

Question 17

what does PEACE stand for?

Answer 17

Protection
Elevation
Avoid anti- inflammatory
Compression
Education

Question 18

how do you protect?

Answer 18

• avoid activities and movements that increase pain during first few days

Question 19

describe elevation

Answer 19

• elevate injured limb higher than heart as often as possible

Question 20

why should you avoid anti- inflammatory medicine?

Answer 20

• as they reduce tissue healing
• no icing

Question 21

what do you use for compression?

Answer 21

• use elastic bandage or taping
• reduces swelling

Question 22

what is the importance of education ?

Answer 22

• avoid unnecessary passive treatments as body knows best

Question 23

what does LOVE stand for?

Answer 23

Load
Optimism
Vascularisation
Exercise

Question 24

describe load

Answer 24

• let pain guide your gradual return

Question 25

what does optimism mean?

Answer 25

- condition your brain for optimal recovery by being confident and positive

Question 26

what is vascularisation?

Answer 26

- choose pain- free cardiovascular activities ^ blood to repairing tissues

Question 27

what does exercise restore?

Answer 27

- restores mobility, strength and proprioception by adapting an active approach

Question 28

what does large amount of inflammatory exudate contain? what does this do?

Answer 28

- contains lots of fibrins - coats structures and becomes organised into scar tissue in unwanted places

Question 29

what does large amounts of inflammatory exudate in joints cause?

Answer 29

- thickened, contracted joint capsule or adhesion formation

Question 30

what is not used in the inflammatory process?

Answer 30

- ice

Question 31

what should you keep an eye on in inflammation stage?

Answer 31

- check joints, swelling, amount of pain and functional loss - ensures inflammation hasn't got worse

Question 32

what treatment do you use in the proliferation phase?

Answer 32

- protection and optimal loading

Question 33

what treatment do you use in the remodelling phase?

Answer 33

- optimal load

Question 34

what does chronic inflammation cause? what could occur?

Answer 34

- causes continuous pain, swelling and lack of function - could occur with no preceding acute inflammation

Question 35

what does chronic inflammation involve?

Answer 35

- adhesions and fibrosis - pathological remodelling

Question 36

what is gradually causes chronic inflammation?

Answer 36

- gradual avascularisation of fibrous tissue - becomes scar tissue - shrinkages as ages - leads to contractures