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Understanding Healing CH3 - Coggle Diagram
Understanding Healing CH3
Understand etiology & pathology of each condition
Physiologic response of tissues to injuries- Predictable sequence
Programs must be based on healing process framework
Healing process phases:
1) Inflammatory Response
Macroscopic characteristics- (Swelling, pain/tenderness, redness, ↑ temperature (loss of function)
Initial response is critical in healing process!
Inflammation: When leukocytes, phagocytic cells and exudate (plasma fluid) are delivered to injured tissue
Chronic inflammation
Acute inflammation insufficient
Leukocytes are replaced with macrophages, lymphocytes, fibroblasts and plasma cells
Chronic low-grade inflammation
No specific time frame in which acute becomes chronic inflammation
2) Fibroblastic-repair
Active scar formation & repair of injured tissue
4-6 weeks
↓ Signs and symptoms
Endothelial capillary buds develop
↑ blood flow for nutrient delivery
Granulation tissue develops
Scar development: 6-7 days
Stretching NB!!
3) Maturation-remodeling
Long-term process – may take several years
Factors that Impede Healing
Extent of injury
Oedema
Hemorrhage
Poor vascular supply
Separation of tissue
Muscle spasm
Atrophy
Corticosteroids
Keloids & hypertrophic scars
Infection
Humidity & climate
Health
Age
Nutrition
Ligaments sprains
Inelastic band of tissue
Connects bone to bone
Primary function: joint stability, bone position during joint motion, and provides proprioceptive input
Scar maturation: 12 months
Ligaments sprain
Grade 2- some tearing and seperation of ligament fibres
Grade 3- Total rapture of ligament
Grade 1- Over stretching
Cartilage Damage
Tough but flexible, provides strong rigidity (firmness) to the structures it supports
No nerve fibers or blood supply
Types:
Hyaline
Fibrocartilage
Elastic cartilage
Osteoarthritis
Arthritis
Arthrosis
Chondromalacia
Sport type, external force application, altered joint mechanics (laxity or trauma related) can serve as predisposing factors
Injuries conducive to osteoarthritic changes:
Dislocations and subluxations
Recurrent synovial effusion and hemarthrosis
Ligament damage = instability
Cartilage Healing ± 2months
Injuries to bone
Epiphysis
Diaphysis
Epiphyseal/growth plate
Periosteum
Fractures
Acute: open vs closed.
Chronic: stress fracture
Transverse
Oblique
Spiral
Comminuted
Avulsion
Impacted
Fissure
Greenstick
Angulated
Displaced
Stress fractures: no specific cause but with a number of possible causes
Signs and symptoms:
Focal tenderness and pain
Pain with activity
Pain becomes constant and more intense
Does not show up on X-ray until osteoblastic activity begins callus formation
Treatment:
Removal from activity for at least 14 days
Does not usually require casting unless normal fracture occurs
Musculotendinous Injuries
Skeletal muscle exhibits 4 traits:
Elasticity
Extensibility
Irritability/excitability
Contractility
Lengthy recovery: 6-8 weeks
Muscle strains
Grade 2- Some fibres torn
Grade 3- Complete rapture
Grad 1- Fibres stretched
Nerve tissue injury
NB for communication between CNS & muscles, sensory organs, various systems & periphery
Severe injury: disability, paralysis
Peripheral nerves can regenerate if injury does not impact cell body
Rehabilitation Management
Phase 1
Phase 1: acute injury phase
First 4 days
Primary treatment: PRICE
Day 4: mobility exercises
NSAIDs
Phase 2
Phase 2: repair phase
Scar tissue forms
Several weeks long
Cryotherapy & electrical stimulation
Increase cardiorespiratory fitness
Restore full ROM
Restore or increase strength
Re-establish neuromuscular control
Phase 3
Phase 3: remodeling phase
Longest phase – several years
Heating modalities
Manual therapy
Regain sport-specific skills
Functional testing
