Understanding and Managing the Healing Process

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

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

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

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

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

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

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

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

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 Hemorrhage Poor vascular supply Separation of tissue Muscle spasm Corticosteriods Infection Health –age Nutrition

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 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-injury-rehabilitation-paradigm-rice-is-not-nice-do-meth-instead/

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.