Transcript Lecture 4 understanding Healing 2016

Understanding and
Managing the Healing
Process
Primary and Secondary Healing
 Primary – direct ( acute)
 Secondary – inflammatory (chronic)
 When an injury occurs the healing process that follows
depends on the extent of the injury , the
approximation of the wound site
 Small separation – a bridge will bind the ends together
– this is called primary intention
 More severe wound when there is not close tissue
approximation – the space is filled from the bottom
and sides of the wound – secondary intention
 This take longer and more of a scar is formed
Healing Process
PHASES OF HEALING:
 Inflammatory Phase
 2-4 days
 Fibroblastic-Repair Phase ( proliferation)
 First few hours post-injury to 4-6 weeks
 Maturation-Remodeling
 3 weeks to several years
 Must be understood that the healing process is a
continuum , phase may and do over lap and
have no definite beginnings or end
Inflammatory response
 Injury occurs body recognizes the problem and begins
a series of defensive maneuvers to stabilize the wound
site and protect it
 Extremely complex process 2-3 days up to a week or
more to complete
 Inflammation often considered negative but it is an
important and necessary step
 With out inflammation body would not be able to
complete the healing process
 However inflammation becomes detrimental when
prolonged
 Goal is to allow inflammation to happen but to
minimize it and encourage healing to continue along
its normal path
Inflammatory response
 Signs of inflammation
 Response is characterized by redness , swelling, pain
tenderness , loss of normal function and increased
temperature
The initial inflammatory
response is critical to the
entire healing process, if it
does not occur normal
healing will not occur
Vascular Reaction
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
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Vascular spasm
Formation of a platelet plug
Blood coagulation
Growth of fibrous tissue
 Immediate response is vasoconstriction of
vascular walls form seconds to minutes
 Then an increase in blood flow which is
transitory and gives way to a slowing of the
flow in dilated vessels
 This initial effusion of blood and plasma may
last for 24 to 36 hours
Chemical Mediators
 Chemical mediators are important in limiting the
amount of exudate and thus swelling after an injury
 Complex chemical reaction
Fibroblastic Repair Phase
 During this phase activity leads to scar
formation and repair of injured tissue
 At this time s/s associated with the
inflammatory response subside.
 Tenderness and pain with some certain
movements may still occur but should
decrease as the scar formation
progresses
 As we progress to repair the tensile
strength increases and there is minimal
scar tissue.
Maturation -Remodeling
Phase
 This phase is a long term process
 Features realignment or remodeling of the
collagen fibers that make the scar tissue,
according to the tensile forces to which they
are subjected.
 Tissue gradually assumes normal
appearance and function , although a scar
is rarely as strong as the normal tissue
Factors that Impede Healing
 Extent of injury
 Edema / swelling
 Hemorrhage
 Poor vascular supply
 Separation of tissue
 Muscle spasm
 Corticosteriods
 Infection
 Health – disease
 age
 Nutrition
 Surgical repairs
Drugs
 Therapist should have a basic
understanding of drugs
 Not going to know them all or different
names
 Always remember drugs should be taken
by individual as prescribed by physician
and if undesirable effect should occur
they should contact physician
immediately
Drugs
 Duration of action – length o f time the drug is in the
blood above the level needed for action
 Half life – the amount of time it takes for level of drug
in blood stream to be diminished by half
 The frequency of the drug is administered based on
the drugs half life . Shorter half life the more frequent
the drug is administered
 Thus goal is a steady state – 4- 5 half lives of the drug
 Eg -Naproxen – half life 14 hours – dosage 2twice a
day – ibuprofen half life , administered 2 hours – 3 – 4
times a day
 More is not better – higher concentrations may have a
toxic effect
Drugs
 Taking medication
 Orally – absorbed in small intestine – should be taken
with a glass of water – not just a swallow – liquid helps
dissolve the medication thus increasing the speed
which the drug moves from stomach to small intestine
 If taken with food it is absorbed at a slower rate –
however that is required of some medications
 Medication will not be absorbed as quickly if taken
prior to exercise as blood is taken from small intestine
to working muscles , so not a good idea to take antiinflammatories just before exercise
NSAIDs
 NSAIDs and athletic injuries , research supports use in
early days but no significant data to support long term
use
 Used to decrease pain and inflammation , hopefully
by doing this the therapist can work ROM and other
therapeutic exercises and promote healing
 Important to remember lots of choices and some may
find one works better than the other – work with
physician if patient having difficulty – most commonly
stomach upset - Naproxen
Swelling
 The one common problem to almost all
injuries is swelling
 Swelling can be caused by a number of
factors, bleeding , production of synovial
fluid, accumulation of inflammatory by
products, edema or a combination of
factors .
 No matter the process, swelling
produces increased pressure, and thus
increased pain, as well can cause
neuromuscular inhibition , which results in
weakness of the muscle
 Once swelling has occurred the healing
process significantly slowed
Swelling
 The injured area cannot return to normal until the
swelling is all gone.
 “therefore everything that is done in first aid
management should be directed toward controlling
the swelling”
 How do we do this?????
PIER & METH
P- Pressure
I- Ice
E-Elevation
R- Rest
M- Movement
E-Elevation
T – Traction
H- Heat
METH
 Movement “Garbage in Garbage out”
 Muscle contraction to move lymph
 Elevation - drainage
 Traction – realignment
 Heat- blood flow – healing – nutrients
 http://theelitetrainer.com/wp/the-new-injuryrehabilitation-paradigm-rice-is-not-nice-do-methinstead/
Chronic Inflammation
 Occurs when the acute inflammatory response does
not eliminate the injuring agent and restore tissue to its
normal physiological state.
 Chronic inflammation does appear to be resistant to
both physical and pharmacological treatments.