Transcript Unit 3 Basics of Tissue Healing - Anoka

Basics of Tissue Injury
Sports Medicine Injuries Learning Targets
Unit 3 – Tissue Repair and Rehabilitation
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I can discuss what happens at the site of an injury during
Phase 1: The Acute Inflammatory Phase.
I can discuss what happens at the site of an injury during
Phase 2: The Proliferation Phase.
I can discuss what happens at the site of an injury during
Phase 3: The Remodelling Phase.
I can explain the factors that impede healing.
I can describe the importance of controlling swelling and the
PRICE principle.
I can explain the goals of rehabilitation for each Phase of
healing.
INTRODUCTION
WHEN AN
INJURY
OCCURS IT
MUST GO
THROUGH 3
STAGES OF
HEALING
Stage 1: Acute
Inflammatory
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Increase blood flow to the area that brings cells and
chemicals to begin the healing process.
 Phagocytes- Eat up dead cells.
 Leukocytes- Infection fighting white blood cells.
 Platelets-Carry blood clotting materials.
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Vascular changes
– Vasoconstriction – immediately; decreased blood flow
to area (approx. 5-10 mins.); platelet plug formed;
blood coagulation; produces local anemia
– Vasodilation – increased blood flow; increased
hydrostatic pressure in blood vessels ( capillary
permeability, plasma proteins leak out; proteins attract
H2O = edema)
THIS STAGE LASTS FOR ABOUT 2 DAYS
Phase I: Acute Inflammatory
Phase
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Goal
– Protect,
– Localize,
– Decrease injurious agents,
– Prepare for healing and repair
Cardinal Signs of Inflammation
Redness Heat
Swelling Pain
Caused by
dilation of
arterioles/
increased
blood flow
Caused by
accumulation
of blood &
damaged tissue
cells
Increased
chemical
activity &
increased
blood flow to
skin surface
Loss of
Function
Direct injury
Increased
of nerve
pain/ swelling
fibers,
pressure of
hematoma on n.
endings
Chemical
irritants –
bradykinin,
histamine,
prostaglandin
Phase 2: Proliferation/Repair
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The injured area has
been filled with the
blood, cells, and
chemicals needed to
rebuild the injury
– Fibroblasts begin
building fibers across
the injury and form the
scar.
THIS PROCESS LASTS
FROM 6 WEEKS TO 3
MONTHS.
Phase II: Proliferation Phase
“Repair/Regeneration” Phase
 Phase will extend from 48 hours to 3
months
 Phase removes debris & temporary repair
– SCAR FORMATION (fibroplasia)
Dependent on levels of: debris removal,
skin cell production, production of
fibroblasts
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Phase II: Proliferation Phase
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Repaired through 3 phases
– Resolution - dead cells & cellular debris are
removed (tissue left with original structure
& function in tact)
fibroblast (tissue cells) formation
 tissue remodeling
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Phase II: Proliferation Phase
– Regeneration – damaged tissue is
replaced by cells of the same type
(structure retains some or all of its
original structure & function)
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synthesis of collagen (fencing)
– Repair – original tissue is replaced with
scar tissue (original structure &
function is lost)
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tissue alignment
Phase II: Proliferation
Phase
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Phase II Goal
– Help new tissues start to align
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Wolff’s Law
Phase 3: Remodeling
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Goal
– Builds tissue strength in the
repaired/replaced tissue of the tendons,
ligaments or muscles in order to
withstand stress applied to the body.
THIS STAGE TAKES UP TO A YEAR OR
MORE.
Phase III: Remodeling Phase
 Usually begins @ week 3
 Purpose is to increase strength of
repaired/replaced tissues
– First 3-6 weeks involves laying down of
collagen and strengthening of fibers
– 3 months to 2 years allowed for enhanced
scar tissue strength
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Balance must be maintained between
synthesis & lysis
– Build up (synthesis) and break down (lysis)
Phase III: Remodeling Phase
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Take into consideration
– forces applied,
– immobilization time frames relative to
tissue
– healing time
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Scars fade & eventually return to
near normal color
Modifying Soft-Tissue Healing
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Varying issues exist for all soft tissues
relative to healing (cartilage, muscle,
nerves)
Blood supply and nutrients is necessary for
all healing
Healing in older athletes or those with poor
diets may take longer
Certain organic disorders (blood
conditions) may slow or inhibit the healing
process
Factors That Impede Healing
 Extent
of
injury
 Edema
 Hemorrhage
 Poor Vascular
Supply
 Muscle Spasm
 Atrophy
 Infection
 Health,
Age,
and Nutrition
Types of Tissues and their
Healing
Cartilage
 Limited capacity to heal
 Little or no direct blood supply
 Articular cartilage that fails to clot heals
very slowly
Ligaments/ Tendons
 Long full healing process (12 months)
 Decent blood supply
 Requires a lot of collagen being laid down
Types of Tissues and their
Healing
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Bone
– Severity of injury
 Soft tissue damage
 Amount of necrotic tissue
 Disruption of blood supply
 Displacement of fragments
– Open fractures disrupts blood supply, severe soft tissue damage
– Union v Displaced/malunion fractures
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Skeletal Muscle
– Initial bleeding followed by laying down a ground
substance
– Healing could last 6-8 weeks depending on muscle
injured
Importance of Controlling Swelling
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Initial injury management an swelling control
is critical
Swelling can result in increased pressure to
the injured area, causing pain and altered
neuromuscular function
Swelling slows the healing process and normal
function is not regained until swelling is
eliminated
To limit swelling use the PRICE principle
Importance of Controlling
Swelling
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Protection & Ice
– Protect the injury
from further damage
– Splint, wrap,
immobilize the injured
site
– If the lower
extremity is involved,
crutches should be
supplied
– Ice causes
vasoconstriction and
slows down swelling
Importance of Controlling
Swelling
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Restricted Activity (Rest)
– Healing immediately begins after injury
– Without rest, external stresses are still placed
on the injured area, interfering with the healing
process- prolonging recovery
– Controlled mobility is superior to immobilization
– 24-48 hours of rest should be applied prior to
active rehabilitation – depends on severity
– Rest applies to the injured body part –
cardiovascular fitness, strengthening and
flexibility should be maintained
Importance of Controlling
Swelling
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Compression
– Single most important factor in swelling control
– Mechanically reduces space available for swelling
accumulation
– Using an elastic wrap, firm, evenly applied pressure
can be achieved
– Compression should be maintained continuously for
72 hours – depends on severity
– With chronic inflammatory conditions compression
should be applied until the swelling is almost
entirely gone
Importance of Controlling
Swelling
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Elevation
– Used to eliminate the effects of gravity on
blood pooling
– Assists venous and lymphatic drainage of
blood and other fluids from the injured area
– Elevation should occur as often as possible
during the first 72 hours of the acute injury –
depends on severity
Grades of Sprains/Strains
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Grade I – some pain, minimal loss of
function, no abnormal function, &
mild point tenderness
Grade II – pain, moderate loss of
function, swelling & instability
Grade III – extremely painful,
inevitable loss of function, swelling
Managing the Healing Process
through Rehabilitation
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Pre-surgical Phase:
– If surgery can be delayed, exercise
may help to improve outcome
– Maintaining or improving ROM,
strength, cardiovascular fitness,
neuromuscular control may enhance the
athlete’s ability to perform rehab after
surgery
Rehab Phases
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Phase 1 – Acute
Inflammatory Phase
Phase 2 –
Proliferation Phase
Phase 3 Remodeling
Inflammation
 Mobility
 Proprioception
 Resistance
 Endurance
 Sport Specific
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Managing the Healing Process
through Rehabilitation
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Phase I: Acute Inflammatory Phase
– Initial swelling management & pain control are
crucial
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PRICE
If you are too aggressive in the 1st 48 hours the
inflammatory process may not have time to
accomplish what it needs to
By days 3-4 some mobility exercises
should be performed along with gradual
increase of weight bearing status
Use of NSAIDs
Managing the Healing Process
through Rehabilitation
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Phase II: Fibroblastic Phase:
As inflammatory phase begins to subside &
pain decreases with PROM, add
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Cardiorespiratory fitness
Restore full ROM
Restore or increase strength
Re-establish neuromuscular control
Continued use of modalities for pain control
Managing the Healing Process
through Rehabilitation
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Phase III: Remodeling Phase:
Longest phase with the ultimate goal of
returning to activity
– Continued collagen realignment
– Pain continues to decrease
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Regain sports-specific skills
– Dynamic functional activities
– Sports-directed strengthening activities
– Plyometric strengthening
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Functional testing
– Determine specific skill weakness
Pain Management
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Reduce pain!
Control acute pain!
Protect the patient from further injury
while encouraging progressive exercise
Minimize further tissue damage
Encourage psychological interaction
(positive thinking, etc.)
Medications
Communication with athlete
Use of modalities to reduce pain
CONCLUSION
Soft tissue healing requires the tissue to
go through 3 stages:
Acute Inflammatory
Repair
Remodeling