1. Understanding and Managing the Healing Process

2. Healing Process PHASES OF HEALING: Inflammatory Phase
2-4 days
Fibroblastic-Repair Phase
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

3. Primary Injury
Almost always described as being either chronic or acute
Macrotrauma or Microtrauma

4. Secondary Injury
Is essentially the inflammatory or hypoxia response that occurs with the primary injury

5. Inflammatory response
Once tissue injured the healing process begins immediately
Destruction of tissue produces direct injury to cells of various soft tissues
Cellular injury results in altered metabolism and the liberation of materials that initiate the inflammatory response

6. Inflammatory response
Response is characterized by swelling , redness , tenderness and increased temperature
The initial inflammatory response is critical to the entire healing process, if it does not occur normal healing will not occur

7. Vascular Reaction Vascular spasm Formation of a platelet plug
Blood coagulation
Growth of fibrous tissue
Immediate response is vasoconstriction of vascular walls for 5 to 10 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

8. Chemical Mediators
Chemical mediators are important in limiting the amount of exudate and thus swelling after an injury

9. Formation of a Clot
Platelets do not normally adhere to the vascular wall
However after an injury platelets will adhere to the exposed collagen fibers
These eventually form a plug which obstruct local lymphatic drainage and thus localize the injury

10. 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.

11. 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

12. Factors that Impede Healing
Extent of injury
Edema
Hemorrhage
Poor vascular supply
Separation of tissue
Muscle spasm
Corticosteriods
Infection
Health –age
Nutrition

13. 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

14. 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?????

15. PIER & METH P- Pressure I- Ice E-Elevation R- Rest M- Movement
T – Traction
H- Heat

16. METH Movement “Garbage in Garbage out”
Muscle contraction to move lymph
Elevation - drainage
Traction – realignment
Heat- blood flow – healing – nutrients

17. 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.