1. Injury/ Trauma
Injury occurs when local stress or strain exceeds the ultimate strength of bones and/ or soft tissues.
The rate of injury or tissue deformation also contributes to the degree of injury

2. Trauma/ Injury
An injury includes mechanical failure and destruction of the cells and tissues.

3. The Phases of Healing There are 3 phases of healing:
Acute Inflammatory Response
The Proliferation Phase
The Maturation Phase

4. Acute Inflammatory Response
Mechanical trauma, such as a sprain, strain, disc injury, amputation or burn, results in damaged cells;
Damaged cells initiate the inflammatory response;
The sudden and extended release of inflammatory mediators is necessary to initiate the healing response.

5. The Inflammatory Response
Attracts precursors for cell growth, and
Encourages repair mechanisms.
The buildup of fluids causes chemical irritation and mechanical pressure on the nerve receptors.
Chemical irritation and mechanical pressure stimulates pain receptors, which serve a protective purpose, causing patients to limit motion around the damaged tissue.

6. The Inflammatory Response
Other effects of the inflammatory response include:
Clogging of the vasculature which results in further cell death due to cell oxygen deprivation;
Muscle spasm occurs due to the pain and lack of oxygen, and
The patient moves less due to pain and muscle spasm.

7. Inflammation Necessary part of the healing process
However, if the inflammatory response is prolonged or particularly intense, it may lead to chronic inflammation which can be debilitating
Through use of therapeutic modalities, we can influence the inflammatory response promote healing

8. Cardinal Signs of Inflammation
Heat
Redness
Swelling
Pain
Loss of Function

9. Measuring Inflammation
Measure the amount of swelling compared to the opp0site side
Point tenderness on palpation
Joint range of motion as compared to the opposite side

10. Typical Presentation in Acute Inflammatory Response Phase
Swelling
Loss of Range of Motion
Muscle guarding
Splinting postures

11. Duration of the Acute Inflammatory Response
Begins immediately following injury
Persists until the stimulus is removed/ mediators dissipated
May last a few seconds or a few months

12. Proliferation Phase
The number and size of fibroblasts increase allowing for the collection of ground substance and collagen to collect in preparation for tissue repair.
Growth of new tissue
Development of new blood vessels
Development of fibrous tissue
Wound contraction
Formation of collagen matrix

13. Proliferation Phase
Removal of debris and temporary repair tissue formed by the inflammatory response phase
Development of new, permanent replacement tissues
Development of new vascular framework to supply repairing tissues with oxygen and nutrients and cells needed to restore the area

14. Proliferation Phase
Thought to begin approximately 72 hours after injury
May last 3 weeks

15. Maturation Phase
Collagen and Fibroblasts attempt to align themselves in the original tissue orientation, although this does not always occur.
Main focus is:
Deposition of permanent tissues
Return to normal function

16. Return to normal function
The Injury Response
Trauma
Ischemia
Cell Death
Secondary Trauma
Inflammation
Phagocytosis
Contain Injury
Clogging of Blood Flow
Bleeding
Swelling
Blood Clotting
Revascularization
Pain, spasm, atrophy
Wound Contraction
Loss of Function
Tissue Repair
Wound Remodeling
Return to normal function