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Primary Response: tissue destruction directly associated with traumatic force; can’t change amount of initial damage
Secondary Response: occurs from cell death caused by a blockage of O2 supply; can assist to keep minimum damage to other tissues
Injury Response Cycle = pain-spasm-pain cycle(Chemicals stimulate free n. endings & cause pain
which causes m. spasm & triggers body’s protective mechanism.)
Phase I: Acute Inflammatory Phase
Phase II: Proliferation/Fibroblastic/ Repair/Regeneration Phase
Phase III: Remodeling/ Maturation Phase
Redness
Heat Swelling
Pain Loss of Function
Caused by dilation of arterioles/increased blood flow
Increased chemical activity & increased blood flow to skin surface
Caused by accumulation of blood & damaged tissue cells
Direct injury of nerve fibers, pressure of hematoma on n. endingsChemical irritants – bradykinin, histamine, prostaglandin
Increased pain/ swelling
“Substrate Phase” Begins almost right away, lasts approx. 2-4 days Goal
Protect, Localize, Decrease injurious agents, Prepare for healing and repair
Critical to the healing processes - If this phase does not accomplish what it is supposed to or if it does not subside, normal healing cannot take place.
Lasts until damaged tissue has been removed & new capillary network has been formed
“Repair/Regeneration or Fibroblastic phase”
Phase will extend from 48 hours to 3-6 weeks
Phase removes debris & temporary repair – SCAR FORMATION (fibroplasia)
Adenosine triphosphate (ATP) is a critical factor that regulates the rate & quality of healing- cell’s primary source of energy- provides metabolism needed to restore cell’s membrane properties by moving Na2+ & K+ into & out of cell, to build new proteins & synthesize proteins
4 processes of soft tissue repair- fibroblast formation - tissue remodeling- synthesis of collagen - tissue alignment
Dependent on levels of: debris removal, endothelial production, production of fibroblasts
Repaired through 3 phases Resolution - dead cells & cellular debris are removed by
phagocytosis (tissue left with original structure & function in tact)
Regeneration – damaged tissue is replaced by cells of the same type (structure retains some or all of its original structure & function)
Repair – original tissue is replaced with scar tissue (original structure & function is lost)
Usually begins @ week 3 Purpose is to increase strength of repaired/replaced
tissues First 3-6 weeks involves laying down of collagen and strengthening
of fibers 3 months to 2 years allowed for enhanced scar tissue strength
Balance must be maintained between synthesis & lysis # of fibroblasts, myofibroblasts, & macrophages reduced to pre-
injury state # of capillaries decrease, H2O content decreases
Take into consideration forces applied, immobilization time frames relative to tissue and healing time
Scars fade & eventually return to near normal color Type I collagen continues to replace Type III collagen
Varying issues exist for all soft tissues relative to healing (cartilage, muscle, nerves)
Blood supply and nutrients is necessary for all 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
Initial injury management an swelling control is critical
Swelling can result in increased pressure to the injured area, causing pain and altered neuromuscular function
Swelling slows the healing process and normal function is not regained until swelling is eliminated
To limit swelling use the RICE principle
Restricted Activity (Rest) Healing immediately begins after injury Without rest, external stresses are still
placed on the injured area, interfering with the healing process- prolonging recovery
Compression Single most important factor in swelling control Mechanically reduces space available for
swelling accumulation Using an elastic wrap, firm, evenly applied
pressure can be achieved Compression should be maintained
continuously for 72 hours – depends on severity
With chronic inflammatory conditions compression should be applied until the swelling is almost entirely gone
Elevation Used to eliminate the effects of gravity on
blood pooling Assists venous and lymphatic drainage of blood
and other fluids from the injured area Elevation should occur as often as possible
during the first 72 hours of the acute injury – depends on severity
Phase I: Acute Inflammatory Phase Initial swelling management & pain control are
crucial PRICE If you are too aggressive in the 1st 48 hours the
inflammatory process may not have time to accomplish what it needs to
Phase II: Fibroblastic Phase: As inflammatory phase begins to subside
& pain decreases
Phase III: Remodeling Phase: Longest phase with the ultimate goal of
returning to activity Continued collagen realignment Pain continues to decrease