Week 2: Tissue Response to Injury Flashcards
Pain
-Complex phenomenon, very individualized (not everyone has same experience)
-Common to measure by rating on scale 1-10 (different for each person relative to their experience with pain)
-Can cause shock and fear/catastrophizing
-Essential role along with pain management is reassurance (making a plan)
Types of Skin Wounds (5)
- Lacerations
- Abrasions
- Punctures
- Contusions
- Blisters
Management of Lacerations (3 Steps)
Step 1- Control bleeding
Step 2- Clean the wound
Step 3- Steri-strips
Step 1: Controlling Bleeding
-Apply pressure (“all gauze sponges”, i.e. non-sterile loose gauze; add extra layers as needed *do not remove previous layer). Pressure on major artery for large lacerations
-Elevation (raise above heart to decrease blood flow)
-Wear personal protective equipment (e.g. gloves) to protect yourself and keep it clean
Step 2: Clean the Wound
-Use soap and water
-Cinder suds (foam soap) can be applied directly to wound, lifts dirt and debris
-Hydrogen peroxide not as good for tissues, can damage them
Step 3: Steri-Strips
-Dry area around laceration, adhesive spray via Q-tip (not directly on skin) which you rub on either side of laceration where strip will be applied
When do we Send for Stitches?
-Deep wounds affecting more than just skin
-Unable to stop the bleeding
-Wound is to the face or across a joint
*can only be done effectively within 24 hrs of injury (faster the better)
Minor Cuts and Abrasions Treatment
For RTP use non-stick gauze and cover roll to dry skin
Punctures
-Common in feet/hands
-Can penetrate multiple levels (skin, then fat, then muscle)
-With deep/large punctures, if the object is still in you should: leave it in (prevent further bleeding), pad around it with gauze rolls, send for medical attention
Contusions
-Definition: bleeding under the skin from blunt trauma
-Deep contusions need proper management (need to avoid myositis ossificans (bone growths);
-No deep tissue manage/do not massage (except effleurage)
-Use effleurage or lymph drainage to drain blood from area
-Ice
-Use protective padding (donut pad to prevent pressure right on contusion)
-Supervised in clinic (ultrasound- pulsed setting not continuous, interferential current- IFC)
Blisters
-Definition: fluid-filled bubble caused by friction
-Prevention- skin lube over areas of friction
-Treatment- if broken clean well, second-skin, cover roll
OVERALL: When do we seek medical attention? (6)
- Unable to control bleeding
- Wound is dirty and unable to be thoroughly cleaned
- Deep wound or puncture
- Object is still impaled (leave it in)
- Changes in sensation
- Wound is from a human or animal bite, or rusty object
Soft Tissue Healing
-Cartilage and Meniscus- limited capacity to heal (little or no direct blood supply), longer healing time
-Ligament- during repair phase, collagen or CT fibers lay down randomly, gradually a scar is formed, over following months collagen fibres align in response to joint stress/strain
-Skeletal muscle healing- regeneration of new myofibers is minimal, healing and repair follows same process of random collagen alignment and develops tensile strength in response to stress/strain
-Nerves- regeneration can take place very slowly (3-4mm/day), peripheral nerves regenerate better than CNS
Wound Healing Stages (4)
Stage 1: Hemostasis- process leading to cessation of bleeding (blood clotting)
Stage 2: Inflammation- essential vascular and cellular response for proper tissue healing (macrophages come in)
Stage 3: Repair and regeneration/proliferation- formation of granulation tissues (a type of new CT; fibroblasts come in and start healing)
Stage 4: Remodelling- strengthening of tissues along lines of tension
Phases of Wound Healing (Time-Frame)
- Inflammation (4-6 days)
-Aim to minimize, reduce pain, protect and educate - Proliferation (4-24 days)
-Reduce residual swelling/pain, increase ROM, strength, proprioception, fitness, prevent 2nd degree complications, educate - Remodelling (21 days-2 years)
-Increase circulation, ROM, strength, fitness (more sport specific), proprioception
*people can get impatient, important to have at-home programs for them to follow
Do you take Anti-Inflammatories Right After Injury?
NO- do not take anti-inflammatories (ibuprofen) for first 24 hours, take acetaminophen for pain control
*taking ibuprofen sequentially= anti-inflammatory
Phase 1: Inflammatory Response
-Vasodilation of blood vessels
-White blood cells (neutrophils and macrophages) fight infection, break down and clean up damaged tissue to start healing process
-Decreased collagen synthesis
-Signs and symptoms of inflammation:
-Redness
-Swelling
-Heat (good indicator)
-Pain
-Loss of function
Phase 2: Repair and Regeneration (Proliferation)
-Collagen laid down in disorganized matrix
-Revascularization brings O2 and nutrients
-Edges of wound draw closer
-Decreased number of inflammatory cells
Phase 3: Remodeling
-Collagen reorganizes along lines of stress (Wolff’s Law)
-Tissues increase in tensile strength
Bone Healing (5 Stages)
-Follows same 3 phases as soft tissue but more complex
-5 Stages (avg. 6-8 weeks but can be more/less depending on bone):
- Hematoma formation
- Cellular proliferation (cells grow and divide)
- Callus formation (soft callus- fibrous tissue and cartilage)
- Ossification (hard callus/bony callus)
- Remodelling
What Tools do Student Trainers Have (6)
- Heat and cold
- Massage
- Wound care
- Taping and wrapping
- Exercise
- Educate
Heat Indications- When to Use it?
- Healing phase and beyond
- Relaxation
- Promote flexibility
*not immediately after injury
Contraindications to Heat- When Not to Use it?
-Inflamed tissues/post-injury
-Bleeding disorders
-Blood clots (heat can move them)
-Impaired sensation
-Metal implants/therapeutic modalities (can heat the metal and cause problems)
-Infection (heat can increase)
-Open wounds
-Additional contras for whole body i.e. sauna or hot tub: pregnancy or trying to conceive, multiple sclerosis due to heat intolerance, illness
Cold Indications: When to Use it?
- Initial inflammatory phase
- Right after injury to reduce swelling and pain (instead of anti-inflammatories)
Contraindications to Cold- When Not to Use it?
- Raynaud’s Phenomenon- caused by decreased blood flow to fingers/toes due to vasospasm in those areas (ask do your fingers/toes ever turn white in cold?)
- Urticaria- hives/rash from cold
- Clotting disorders
- Over superficial nerves
- Altered skin sensation
- Complex Regional Pain Syndrome (body not responding in way that makes sense
Indications for Massage- When to Use it?
- Tight muscles (increase extensibility, decrease pain)
- Injured muscles- in inflammatory phase use for effleurage/lymph drainage only (decrease pain and swelling) and in healing phase can use deeper forms of massage to increase circulation to promote healing
Massage Protocols
-Educate on why you’re using massage
-Clear contraindications and get consent
-Expose area to be treated (be mindful of covering sensitive areas, use towel if needed)
-Be professional
Contraindications to Massage Therapy
-Acute inflammation (except effleurage)
-Contusions (except effleurage)
-Acute spasm around another injury
-Over open wounds or skin reactions
-Altered sensation
-Possible blood clot
-Bleeding disorders
-Over varicose veins
-Deep Vein Thrombosis (DVT)- symptoms: deep, burning calf pain
-Cancer
-Diabetes
Principles of Massage Therapy
- General- specific- general
- Superficial- deep- superficial
- Proximal- distal- proximal
- Peripheral- central- peripheral
Lymph Drainage/Effleurage
- Try to stim lymphatics and enhance drainage
- Open “terminus” in hollow above clavicles- gentle pumping “C” motions
3 Massage Techniques
- Petrissage- spread muscle belly across fibers
- Shaking/rocking- limbs loose and rock
- Vibration- hand over hand, vibrate to engage tissue
Soft Tissue Acute Management Acronyms
ICE: ice, compression, and elevation *oldest
RICE: rest, ice, compression, elevation
PRICE: protect, rest, ice, compression, elevation
POLICE: protection, optimal loading, ice, compression, elevation
PEACE & LOVE: protection, elevation, avoid anti-inflammatories, compress, educate & load, optimism, vascularisation, exercise *most current
