Stages of Healing Ch.1 Flashcards
What are the 4 stages of healing?
- ) Hemostasis
- ) Inflammatory
- ) Proliferation (repair)
- ) Remodeling/maturation
Hemostasis involves what and lasts how long?
Initial blood clotting to stop bleeding. Lasts seconds -> minutes.
What is another name for the inflammatory stage, and how long does it last?
The acute phase.
Hours -> days -> weeks
How long is the proliferation phase?
Weeks -> months
How long is the maturation phase?
Months -> year
Does the cause of injury change the stages of the healing process? Are there any exceptions?
No. Time can vary
Are the stages of healing clearly demarcated and occur separately?
No, there is much overlap.
What is the purpose of the Inflammation (acute) phase?
To defend against foreign intruders (infection), Remove damaged tissue and debris, Immobilize area.
How well will avascular or poorly vascularized tissue heal?
Not well
What are the signs of Inflammation?
Rubor - redness Calor - heat Dolor - pain Tumor - swelling Functio laesa - loss of function
What characterizes the inflammation stage at the site of injury?
Vasodilation, Increased capillary permeability, Phagocytosis by neutrophils and macrophages.
Which inflammatory chemicals cause pain?
Bradykinin, prostaglandins, serotonin
Inflammation can cause secondary injury. What are the 2 types of secondary injury?
Secondary enzymatic injury, secondary hypoxic injury.
What characterizes secondary enzymatic injury?
Lysosomal enzymes released
Not specific
Healthy tissue is damaged
What characterizes secondary hypoxic injury?
Hemorrhage, edema, clotting, spasm, hematoma.
These lead to decreased O2 and nutrients.
Damage to surrounding uninjured tissue.
What are the doctor’s goals and intervention in the acute phase?
Goals: limit extent of inflammation, preserve ROM
Intervention: PRICE (protect, rest, ice, compress, elevate).
What is the time frame for the acute phase of an ankle sprain with each grade?
Grade 1: 1-3 days
Grade 2: 2-4 days
Grade 3: 3-7 days
What is the Doctor’s focus during the acute phase of an ankle sprain?
Decrease swelling
Decrease pain
Protect from re-injury
Maintain appropriate weight bearing
What are the protective measures needed for the acute phase of an ankle sprain?
Taping Functional bracing Remove cast or walking boot Rest Crutches
What are the interventions needed for the acute phase of an ankle sprain?
Ice (to decrease pain and swelling)
Compression
Elevation (above heart, add in ankle pumps - dorsi/plantar flexion)
What characterizes the proliferative (repair) stage at the site of injury?
Angiogenesis (new capillaries)
Fibroblasts, chondroblasts, Osteoblasts
Extracellular matrix (type III collagen, Proteoglycans)
Proprioception
What is the timing of the proliferation phase by grade?
Grade 1: 2-4 days
Grade 2: 3-5 days
Grade 3: 4-8 days
What are the doctor’s goals for the proliferation phase?
Decrease pain Decrease swelling (if still present) Encourage and increase proliferation Increase pain free range of motion Begin non-weight bearing proprioceptive training Provide protective support as needed.
What kind of passive care interventions are appropriate for the proliferation phase?
Decrease pain and swelling: IFC, PreMod, Hi-Volt, Ice, Contrast baths, Massage (gentle)
Soft orthotics
Administer EPA’s to increase proliferation: Thermotherapy, ultrasound, low level laser therapy, microcurrent.
What are the active care interventions appropriate for the proliferation phase?
Increase weight bearing (as pain permits). Partial to full weight bearing progression).
Active range of motion: (can be performed in water). Plantar/dorsiflexion, foot circles, alphabet.
Proprioceptive training, progressing to unstable surface: Seated (less of a challenge), standing (more challenge/risk), wobble boards, dynadiscs.
Strength exercises (to limit atrophy): isometrics in a pain free range. toe curls with towel, pick up objects with toes.
Stretching: Passive ROM (dorsi/plantarflexion as pain allows), achilles stretching, joint mobilization.
What characterizes the remodeling/maturation phase?
Scar contraction (can lead to joint adhesion, loss of motion). Decrease of blood vessels. Type III collagen replaced by type I (collagen aligns across stress lines). Cross linking continues.
Tension on connective tissue causes:
Increased collagen fibril diameter
Increased cross linking
Increased number of collagen fibrils
Increased collagen fibril packing density
What is beneficial about collagen fibers aligned in an organized, parallel fashion?
Forms the greatest number of cross links. Possesses optimal strength.
What is the timing associated with the remodeling phase of an ankle sprain by grade?
Grade 1: 1 week
Grade 2: 2 weeks
Grade 3: 3 weeks
What are the goals of the remodeling phase of an ankle sprain?
Increase pain-free ROM Progress proprioceptive training Regain full strength Normal biomechanics Protect and strengthen any residual joint instability
What are the active care interventions for the remodeling phase of an ankle sprain?
Stretching: (gastroc/soleus) Joint mobilization.
Strengthening: heel toe raises (controlled), stair steps, quarter squats, eccentric/concentric with weight cuffs.
Proprioceptive training: progress to single leg exercises.
What are some task specific skills appropriate for active care in the remodeling phase?
Running, alternating jogging to sprinting in a straight line, agility training, proprioception (e.g. multi-directional lunges)
Power: plyometrics, box jumps, etc.
Properly applied external forces enhance what?
Collagen organization (arrangement).
