1. Tissue Response to injury

2. Injury Acute injury Overuse injury – microtrauma  macrotrauma
Macrotrauma - force that overwhelms the body with high force in a short time
Microtrauma – repeated low-intensity forces
Overuse injury – microtrauma  macrotrauma
Chronic injury – failure of systems to continue healing process – “stuck”

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The Healing Process
Essential for athletic trainer to possess in depth knowledge of healing process
Understand phases
Time frames physiological changes associated with each phase
Must create a conducive environment for healing
Healing is a continuum
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4. Phases of the Inflammatory Response
(3 separate phases)
1. Inflammatory response phase
2. Fibroblastic repair phase
3. Maturation and remodeling phase
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Figure 10-1
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6. Phase I: Inflammatory Response Phase
Healing begins immediately
Injury results in altered metabolism and liberation of various materials
Initial reaction by leukocytes and phagocytic cells
Goal
Protect
Localize
Decrease injurious agents
Prepare for healing and repair
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7. Cardinal Signs of Inflammation
Rubor (redness)
Tumor (swelling)
Color (heat)
Dolor (pain)
Functio laesa (loss of function)
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Vascular Response
Vasoconstriction and coagulation occur to seal blood vessels and chemical mediators are released
Presses endothelial lining together to produce local anemia
Followed by vasodilation of blood vessel 5-10 minutes later
Initially increases blood flow
Initial effusion of blood and plasma lasts hours
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Figure 10-3
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Clot Formation
Platelets adhere to exposed collagen leading to formation of plug (clot)
Clots obstruct lymphatic fluid drainage and aid in localizing injury
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Chronic Inflammation
Occurs when acute inflammatory response does not eliminate injuring agent
Tissue not restored to normal physiologic state
Cause for shift from acute to chronic is unknown
Typically associated with overuse, overload, cumulative microtrauma
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12. Phase II: Fibroblastic Repair Phase
Scar formation through 3 phases
Resolution (little tissue damage and normal restoration)
Restoration (if resolution is delayed)
Regeneration (replacement of tissue by same tissue)
Referred to as fibroplasia
Complaints of pain and tenderness end
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13. Phase III: Maturation & Remodeling
Long-term process
Realignment of collagen relative to applied tensile forces
Continued breakdown and synthesis of collagen = increased strength
Tissue will gradually assume normal appearance
May require several years to complete
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14. Factors That Impede Healing
Extent of injury
Edema
Hemorrhage
Poor Vascular Supply
Separation of Tissue
Muscle Spasm
Atrophy
Corticosteroids
Keloids and Hypertrophic Scars
Infection
Humidity, Climate, Oxygen Tension
Health, Age, and Nutrition
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Soft Tissue Healing
Cell structure/function
All organisms composed of cells
Properties of soft tissue derived from structure and function of cells
Cells consist of nucleus surrounded by cytoplasm and encapsulated by phospholipid cell membrane
Nucleus contains chromosomes (DNA)
Functional elements of cells (organelles) include mitochondria, ribosomes, endoplasmic reticulum, Golgi apparatus & centrioles
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Tissues of the Body
Bone - not classified as soft tissue
4 types of soft tissue
Epithelial tissue
Skin, vessel & organ linings
Connective tissue
Tendons, ligaments, cartilage, fat, blood, and bone
Muscle tissue
Skeletal, smooth, cardiac muscle
Nerve tissue
Brain, spinal cord & nerves
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17. Soft Tissue Adaptations
Atrophy- a decrease in the size of tissue due to cell death and re-absorption or decreased cell proliferation
Hypertrophy - an increase in the size of tissue without necessarily changing the number of cells
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Cartilage Healing
Limited capacity to heal
Little or no direct blood supply
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Ligament Healing
Follows similar healing course as other vascular tissues
Proper care will result in acute, repair, and remodeling phases in same time required by other vascular tissues
Repair phase will involve random laying down of collagen which, as scar forms, will mature and realign in reaction to joint stresses and strain
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20. Skeletal Muscle Healing
Initial bleeding followed by proliferation of ground substance and fibroblast
Myoblastic cells form = regeneration of new myofibrils
Collagen will mature and orient along lines of tension
Healing could last 6-8 weeks depending on muscle injured
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Tendon Healing
Requires dense fibrous union of separated ends
Abundance of collagen is required for good tensile strength
Too much = fibrosis – may interfere with gliding
Initially injured tendon will adhere to surrounding tissues (week 2)
Week 3 – tendon will gradually separate
Tissue not strong enough until weeks 4-5
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Bone Healing
Less complex process
Acute fractures have 5 stages
Hematoma formation
Cellular proliferation
Callus formation
Ossification
Remodeling
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23. Healing of Stress Fractures
Result of cyclic forces, axial compression or tension from muscle pulling
Electrical potential of bone changes relative to stress (compression, tension, or torsional)
Constant stress axially or through muscle activity can impact bone resorption, leading to microfracture
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24. Key Time Frames

25. Key Time Frames

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Pain
Major indicator of injury
Pain is individual and subjective
Factors involved in pain
Anatomical structures
Physiological reactions
Psychological, social, cultural and cognitive factors
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Pain Categories
Pain sources
Fast versus slow pain
Acute versus chronic
Projected or referred pain
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Pain sources
Cutaneous, deep somatic, visceral and psychogenic
Cutaneous pain is sharp, bright and burning with fast and slow onset
Deep somatic pain originates in tendons, muscles, joints, periosteum and blood vessels
Visceral pain begins in organs and is diffused at first and may become localized
Psychogenic pain is felt by the individual but is emotional rather than physical
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Referred Pain
Pain which occurs away from actual site of injury/irritation
Unique to each individual and case
May elicit motor and/or sensory response
A-alpha fibers are sensitive to pressure and can produce paresthesia
Three types of referred pain include: myofascial, sclerotomic, and dermatomic
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Pain assessment
Self report is the best reflection of pain and discomfort
Utilize multi- and uni-dimensional questionnaires
Assessment techniques include:
Visual analog scales (0-10, marked no pain to severe pain)
Pain charts
McGill Pain questionnaire
Activity pain indicator profiles
Numeric rating scale
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