Stages of Healing Flashcards
Electric stimulation, heat and cold therapy, mechanical energy, and light are all example of what kind of treatment category?
Electrophysical agents
Are electrophysical agents primarily used as a primary treatment or a complementary treatment?
Complementary
What is the difference between active and passive care?
Active = patient has to perform activity/exercise to achieve effect Passive = doctor applies intervention
What are the 4 stages of healing (Belanger)?
1 hemostasis
2 inflammatory
3 proliferation
4 remodeling/maturation
What is the duration for each stage of healing?
Hemostasis = seconds/minutes Inflammatory = hours/days/weeks Proliferation = weeks/months Remodeling/maturation = months/year
What are the 3 stages of healing (other model)?
1 inflammation
2 repair
3 remodeling
What is another name for the inflammatory phase?
Acute phase
What is the purpose of the inflammatory/acute phase?
1 defend against foreign intruders (infection)
2 remove damaged tissue and debris
3 immobilize area
What types of tissue don’t heal well?
Avascular or poorly vascularized tissue
What are the cardinal signs of inflammation derived from Celsus in A.D. 25?
Heat (calor)
Redness (rubor)
Swelling (tumor)
Pain (dolor)
Which cardinal sign of inflammation was derived from Virchow in 1902?
Loss of function (functio laesa)
What is the 6th sign of inflammation added by Belanger?
Muscle spasm
What vascular changes are present in the inflammatory phase of healing?
1 vasodilation
2 increased capillary permeability
What cells are responsible for the phagocytosis seen in the inflammation stage of healing?
Neutrophils and macrophages
The inflammation stage of healing is controlled and initiated by approximately how many chemicals?
Over 180
Bradykinin, prostaglandins, and serotonin are examples of chemicals that initiate what kind of sensation during the inflammatory phase of healing?
Nociception (pain)
What type of injury can occur following too much inflammation during the healing process?
Secondary enzymatic injury or secondary hypoxic injury
What occurs with secondary enzymatic injuries?
Lysosomal enzymes are released an attack healthy tissue
What occurs with secondary hypoxic injuries?
Decreased O2 and nutrients leading to damage of surrounded uninjured tissue
Hemorrhage, clotting, edema, spasm, and hematomas are all examples of what kind of injury following excessive inflammation?
Secondary hypoxic injury
What are the ultimate goals of the inflammatory phase?
Limit extent of inflammation (only small amount needed)
Preserve range of motion (ROM)
What is the acronym used for the inflammatory phase of healing?
PRICE:
Protect, rest, ice, compress, elevate
What are the lengths of the acute phase of healing for ankle sprains for each grade type?
Grade 1 = 1-3 days
Grade 2 = 2-4 days
Grade 3 = 3-7 days
What are the top areas of focus during the acute phase of an ankle sprain?
1 decrease swelling and pain
2 maintain motion and appropriate weight bearing
3 protect from re-injury
What is another name for the proliferative phase?
Repair phase
What is the term for the production of new capillaries during the proliferative phase of healing?
Angiogenesis
What types of cells are primarily at work during the proliferative phase?
Fibroblasts, chondroblasts, osteoblasts
What type of fibers and cells are found in the ECM during the proliferative phase?
Type III collagen & proteoglycans
Why are Type III collagen fibers not ideal?
Weak, disorganized
What term is the unconscious perception of movement and spatial orientation arising from stimuli within the body itself?
Proprioception
How long does the proliferation phase last for each grade type of an ankle sprain?
Grade 1 = 2-4 days
Grade 2 = 3-5 days
Grade 3 = 4-8 days
What are the goals of the proliferative phase of healing for an ankle sprain?
1 decrease swelling and pain 2 increase pain ROM 3 begin non-weight bearing proprioceptive training 4 encourage and increase proliferation 5 provide protective support as needed
What are examples of active care that can help in the proliferative stage of healing of an ankle sprain?
1 proprioceptive training 2 range of motion 3 strengthening (carefully)
What is another name for the remodeling phase?
Maturation phase
What physiologic changes are seen during the remodeling phase?
1 scar contraction
2 decrease of blood vessels
3 type III collagen switching to type I
What is the danger of scar contraction during the remodeling phase?
Can lead to joint adhesion and loss of motion
What are the benefits on collagen of increasing tension on the connective tissue during the remodeling phase?
1 increased collagen fibril diameter
2 increased cross-linking
3 increased number of collagen fibrils
4 increased collagen fibril packing density
5 collagen is organized and aligned in parallel fashion
6 optimal strength
How long is the remodeling phase of each grade type of an ankle sprain?
Grade 1 = one week
Grade 2 = two weeks
Grade 3 = three weeks
What are the goals of the remodeling phase in reference to an ankle sprain?
1 increase pain-free ROM 2 progress proprioceptive training 3 regain full strength 4 normal biomechanics 5 protect and strengthen any residual joint instability
Which ligament is most commonly involved in an ankle sprain?
Anterior talofibular ligament (could also be posterior talofibular and calcaneofibular ligaments)
Which muscles can be stretched following an ankle sprain to help with loss of dorsiflexion?
Gastrocnemius and soleus
What are good exercises of active care for an individual with an ankle sprain to increase strength?
Heel/toe raises, stair steps, quarter squats, eccentric/concentric with cuff weights/theraband
