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