Soft Tissue & Healing Flashcards
What are the 2 stages following tissue injury?
(hypothesised by Merrick (2002))
- Primary injury
- Secondary injury
What is the primary injury stage following tissue injury?
Direct mechanical damage to cells causing loss of homeostasis and cellular death
What can be damaged in tissue injury?
- Ligaments
- Tendons
- Muscle
- Nerve
- Connective tissues
How can tissue injury occur?
- Crush
- Strain force
- Contusion
- Disrupting cell membranes
What is the secondary injury stage following tissue injury?
Physiological response following primary injury, occurring at the periphery of the injury
What (2) ways can the secondary injury stage occur following tissue damage?
- Hypoxic or ischaemic (decreased blood flow)
- Enzymatic mechanisms (destroys lysosomes and cell membrane, causing cells to swell and subsequently die)
What are the 4 phases of tissue healing and repair, and how long do they last?
- Phase 1: Bleeding (0-10 hours)
- Phase 2: Inflammation (0-4 days)
- Phase 3: Tissue proliferation, fibrous repair (1-10+ days post-injury)
- Phase 4: Tissue remodelling (from day 2 - up to 2 years, dependent on injury severity)
0-72 hours post-injury, what are physio interventions in phases 1&2 of tissue healing and repair?
- Reduce pain
- Limit inflammatory exudates
- Reduce newly damaged tissue from further injury
- Protect newly damaged tissue from further injury
- Protect newly-forming tissue from disruption
- Promote new tissue growth and fibre realignment
- Maintain general levels of cardiovascular and musculoskeletal fitness and activity
What is the acute soft injury management principle?
P rotection
E levation
A void anti-inflammatories
C ompression
E ducation
&
L oad
O ptimism
V ascularisation
E xercise
What occurs during phase 3 of tissue healing and repair?
Tissue proliferation and fibrous repair
- ongoing phagocytosis
- angiogenesis (formation of new blood vessels)
- proliferation of fibroblasts
- production of collagen fibres (initially produced in an unordered and random fashion)
- absorption of inflammatory exudate
What are the general physiotherapy aims in the tissue proliferation stage in phase 3 of tissue healing and repair?
- Decrease swelling
- Decrease pain
- Decrease local temp
- Prevent further trauma
- Protecting new tissue
- Increasing range of movement
- Maintaining/increasing muscle strength, timing and control
- Preventing soft tissue adaptation in non-injured tissues
- Improving function
- Graded return to exercise and activity (avoid any high SIN - pain severity, irritability and nature)
What are the key processes of phase 4 (remodelling) of tissue healing and repair?
- Ongoing fibroblasts activity and collagen production
- Deposition of new fibrous tissue
- Scar tissue formation
- Type 3 collagen fibres being replaced by type 1 collagen fibres
What are the general physiotherapy aims in the remodelling stage in phase 4 of tissue healing and repair?
- Promoting collagen growth and fibre/tissue realignment
- Increasing the ROM - active, passive, accessory
- Increasing muscle strength, control and timing
- Preventing soft tissue adaptation in injured and non-injured tissues
- Maximising function
- Promote movement and mobility of the injured structures/tissues (3-10 days post-injury)
- Prevention of tissue contraction and adhesion formation (3rd week post-injury); therefore end-of-range stretching should commence on 3rd week
What are some factors that influence the clinical reasoning process for the management of a patient’s tissue healing and repair?
- Physiology
- Anatomy
- Environment
- Pathology
- Histology
- Biomechanics
- Sociology
- Kinesiology
- Psychology
- Therapeutic effects of treatment modalities
What are issues with management and healing of tendons?
- Limited vascularity and slow metabolic rate
- Tenocytes have a slow turnaround rate (50-100 days)
- If given inadequate time to repair tenocytes can undergo apoptosis
