Stages of Tissue Healing and Interventions - Class 6 Flashcards
stages of tissue healing
acute stage
subacute phase
chronic stage
acute stage
inflammatory response
subacute phase
proliferation
repair
healing
chronic stage
maturation and remodeling
acute stage consists of
vascular changes
exudation of cells and chemicals
clot formation
phagocytosis/neutralization of irritants
early fibroblastic activity
what is present during the acute pahse
signs of inflammation
signs of inflammation
swelling
redness
heat
pain at rest
loss of fxn
acute phase –> ROM
painful w/ guarding before the completion of the range
what is pain d/t in the acute phase
altered chemical state irritating nerve endings
increased tissue tension
guarding
why is there pain in the acute phase
body’s way of protecting the injury
how long does the acute phase last
4-6 days
goals and interventions of acute stage
protection phase
control effects of inflammation
manage pain
prevent negative effects of rest
education
general movement
pain…
prevent negative effects of rest
nondestructive movement
PROM
massage
muscle setting
education
on expected duration
what they can do
what to expect
general movement is
beneficial
pain
during movement in this phase is generally ill advised
but at low levels may be ok
subacute phase involves
removal of noxious stimuli
growth of capillary beds into area
collagen formation
granulation tissue resulting in very tenuous, easily injured tissue
when does inflammation decrease
2-4 days after injury
colt begins to resolve
repair begins
how long is the subacute phase
14-21 days after injury
but can last 6 weeks
defining characteristic of the subacute phase
synthesis and deposition of collagen
what is there a significant increase in –> subacute phase
presence and activity of fibroblasts
myofibroblastic activity begins around day 5 –> resulting in scar shrinkage
connective tissue –> subacute
immature
thin and unorganized
extremely fragile
tensile loading –> subacute
appropriate tensile loading can stimulate growth and alignment
subacute phase goals and interventions
controlled motion phase
develop a mobile scar
promote healing
continue to educate
asses response and sxs
gradually transition into active strengthening and endurance exercise
can implement stretching
be on the lookout for signs of excessive stretch
develop a mobile scar –> subacute
selective stretching/mobilization
promote healing –> subacute
nondestructive active, resistive, open and closed chain stabilization exercise
muscular endurance
cardiopulmonary exercise to increase circulation
continue to educate –> subacute
about expectation
encourage return to normal activities that do not exacerbate sxs
begin more involved HEP
assess response and sxs –> subacute
generally slow progression
gradually transition into active strengthening and endurance exercise –> subacute
submax isometrics
AROM
building endurance w/ repetition/low intensity exercise
protected weight bearing exercise
what should we avoid in the subacute phase
heavy eccentrics
high resistance exercises that may overstress the area
can implement stretching –> subacute
to minimize decreased flexibility
help with alignment of developing scar
signs of excessive stretch (1)–> subacute phase
soreness that persists longer than 24 hrs after exercise
increased intensity and earlier onset of pain
progressively increased feelings of stiffness/decrease ROM over several sessions
signs of excessive stretch (2)–> subacute phase
swelling, redness, warmth in affected tissue
progressive weakness over several sessions
decreased fxnal use of involved body part
chronic stage involves
maturation of connective tissue
contracture of scar tissue
remolding of scar
collagen aligns to physical stress
when is scar retraction typically complete
after 21 days
scar stops decreasing in size
when does the process of maturation begin
late subacute phase
persists for several months
what happens to the collagen fibers in the maturation phase
thicken and reorient
based on physical stress placed through connective tissue
what is remodeling time influenced by
factors that affect the density and activity of fibroblasts
factors that affect the density and activity of fibroblasts –> chronic stage
time of immobilization
location of the lesion
stress placed on tissue
vascular supply
healing time depends on
size of injured structure
degree of injury/pathology
healing with increasing tensile quality
healing may occur for
12-18 months
what happens to immature collagen fibers –> chronic
adhere to surrounding tissue
can be easily remodeled through physical stress for 10 weeks after the injury
what happens if the area isnt properly stressed –> chronic
collagen will begin to adhere to surrounding tissue
forming a restricting scar
what happens at 14 weeks –> chronic
scar is unresponsive to remodeling
required adaptive lengthening of the surrounding tissue or surgical release
chronic stage goals and intervention
return to fxn phase
increase tensile quality of scar
develop fxnal independence
educate the pt
lean into progressive resistance exercises
may need to isolate certain muscle/muscle groups
transition into high demand activities that stimulate specific tasks
increase tensile quality of the scar –> chronic
through progressive strengthening and endurance exercise
develop fnxal independence –> chronic
through fxnal exercise and specificity drills
educate the pt
safe progression of resistance exercises and how to monitor for signs of excessive stretch
est clear guidelines/criteria on return to affected activities
recommend progressions or modifications of exercises
recommend modifications to activities as necessary
isolate certain muscle/muscle groups –> chronic
b/c of inhibition or learned disuse
