chapter 2: using therapeutic modalities to affect the healing process jennifer doherty-restrepo, ms,...

Chapter 2: Using Therapeutic Modalities to Affect the Healing

Process

Chapter 2: Using Therapeutic Modalities to Affect the Healing

Process

Jennifer Doherty-Restrepo, MS, LAT, ATCJennifer Doherty-Restrepo, MS, LAT, ATC

FIU Entry-Level ATEPFIU Entry-Level ATEP

Therapeutic ModalitiesTherapeutic Modalities

Physiological Responses to InjuryPhysiological Responses to Injury

Therapeutic modalities should be selected Therapeutic modalities should be selected and applied based on the ________ and applied based on the ________ ________ of the tissues to injury and on ________ of the tissues to injury and on the understanding of how various tissues the understanding of how various tissues ________________

Phases of the Healing ProcessPhases of the Healing Process

Inflammatory - Response PhaseInflammatory - Response Phase Fibroblastic - Repair PhaseFibroblastic - Repair Phase Maturation - Remodeling PhaseMaturation - Remodeling Phase

The ATC must understand the healing process to The ATC must understand the healing process to make decisions on how and when therapeutic make decisions on how and when therapeutic modalities may best be used to facilitate the modalities may best be used to facilitate the healing processhealing process

Healing Process ContinuumHealing Process Continuum

Injury Day 4 Week 6 2-3 Years

Inflammatory-Response Phase



Inflammatory-Response PhaseFibroblastic-Repair Phase



Inflammatory-Response PhaseFibroblastic-Repair PhaseMaturation-Remodeling Phase

Inflammatory - Response PhaseInflammatory - Response Phase

S/SS/S RednessRedness ________________ PainPain ________________ TendernessTenderness ________________ Loss of FunctionLoss of Function

Vascular ReactionVascular ReactionInjury

Immediate ____________________________________ Of Vascular Walls

__________________________________________________ With Hyperemia

Stagnation and Stasis

Initial Effusion of Blood and Plasma Lasts 24-36 Hours

Immediate Vascular ReactionImmediate Vascular ReactionInjury

Vessels’ Endothelium is Disrupted

______________________________ Adhere To Exposed Collagen

Sticky Matrix For Platelets and Leukocytes

Formation of A ______________________

Obstructs Local Lymphatic Drainage

__________________________ Injury Response

Cellular ReactionChemical Mediators Released From Cell

Cellular ReactionChemical Mediators Released From Cell

Histamine Histamine ________________ Cell PermeabilityCell Permeability

Leucotaxin Leucotaxin ________ (Leukocytes Line Cell Wall)________ (Leukocytes Line Cell Wall)

Cell PermeabilityCell Permeability Forming ________Forming ________

Necrosin Necrosin Activates ________Activates ________

Clot Formation

Damaged Cell

Thromboplastin

Prothrombin

Thrombin

Fibrinogen

Fibrin ClotCompleted Within 48 Hours

Clot Formation

Damaged Cell

Thromboplastin

Prothrombin

Thrombin

Fibrinogen

Fibrin ClotCompleted Within 48 Hours

Inflammatory - Response PhaseInflammatory - Response Phase

Injured area is walled-offInjured area is walled-off Leukocytes phagocytize foreign debrisLeukocytes phagocytize foreign debris Sets stage for Sets stage for Fibroblastic-Repair PhaseFibroblastic-Repair Phase Lasts ________ after initial injuryLasts ________ after initial injury

Chronic InflammationChronic Inflammation

Occurs when _____ inflammatory-response Occurs when _____ inflammatory-response does not eliminate injuring agentdoes not eliminate injuring agent

Leukocytes replaced by _________, Leukocytes replaced by _________, ___________, and ________ ___________________, and ________ ________

Specific mechanism which causes conversion Specific mechanism which causes conversion to chronic inflammation is unknownto chronic inflammation is unknown ________or ________ with cumulative ________or ________ with cumulative

repetitive ____________ may be a causerepetitive ____________ may be a cause

Fibroblastic - Repair PhaseFibroblastic - Repair Phase

S/SS/S Signs and symptoms of inflammatory response Signs and symptoms of inflammatory response

subsidesubside Proliferative, regenerative activity which Proliferative, regenerative activity which

leads to a period of ________ ________ leads to a period of ________ ________ (fibroplasia) and repair of injured tissue(fibroplasia) and repair of injured tissue


FibroplasiaFibroplasia

Begins within the first few _____ following Begins within the first few _____ following injuryinjury

Signs of inflammation subsideSigns of inflammation subside Pain and tenderness to touchPain and tenderness to touch May last ________ weeksMay last ________ weeks

Vascular ReactionVascular Reaction

Growth of Endothelial Capillary Growth of Endothelial Capillary Buds (Stimulated By Lack of Buds (Stimulated By Lack of

Oxygen)Oxygen)

________Blood Flow________Blood Flow

Increased Delivery of Essential Increased Delivery of Essential ________ for Tissue Regeneration________ for Tissue Regeneration

Cellular ReactionCellular ReactionBreakdown of Fibrin ClotBreakdown of Fibrin Clot

Formation of ________ TissueFormation of ________ Tissue

(Fibroblasts, Collagen, Capillaries)(Fibroblasts, Collagen, Capillaries)

Fibroblasts Accumulate Along Capillary BedsFibroblasts Accumulate Along Capillary Beds

Synthesizes Extracellular MatrixSynthesizes Extracellular Matrix

(________, ________, ________)(________, ________, ________)

By Day 6 or 7By Day 6 or 7

Fibroblasts begin producing ______, which Fibroblasts begin producing ______, which is deposited randomly throughout the scaris deposited randomly throughout the scar

________ _______ increases proportionally ________ _______ increases proportionally to collagen synthesisto collagen synthesis

Normal SequenceNormal Sequence

Formation of minimal ________Formation of minimal ________ Increase in tensile strength and a decrease Increase in tensile strength and a decrease

in the number of fibroblasts signals the in the number of fibroblasts signals the beginning of the __________________ beginning of the __________________ ________________

Abnormal ResponseAbnormal Response

Persistent Persistent Inflammatory Response PhaseInflammatory Response Phase causes extended ___________ and causes extended ___________ and __________________________

Maturation - Remodeling PhaseMaturation - Remodeling Phase

Maturation - Remodeling PhaseMaturation - Remodeling Phase Long-term processLong-term process Realignment of collagen fibers along lines Realignment of collagen fibers along lines

of ________ ________of ________ ________ Ongoing _________________ of collagenOngoing _________________ of collagen Increase in tensile strength of scar matrixIncrease in tensile strength of scar matrix At 3-weeks a contracted, non-vascular scar At 3-weeks a contracted, non-vascular scar

existsexists May require several years to completeMay require several years to complete

The Role of Controlled Mobility in the Maturation – Remodeling PhaseThe Role of Controlled Mobility in the Maturation – Remodeling Phase

__________________________________ Bone and soft tissue will respond to the physical Bone and soft tissue will respond to the physical

demands placed on them, causing them to remodel demands placed on them, causing them to remodel along lines of ________ ________along lines of ________ ________

Injured structures must be exposed to Injured structures must be exposed to __________ loads during the __________ loads during the Maturation -Maturation -Remodeling PhaseRemodeling Phase

Controlled Mobility is Superior To Immobilization

Controlled Mobility is Superior To Immobilization

Controlled mobility…Controlled mobility… ________ scar formation________ scar formation ________ revascularization________ revascularization ________ muscle regeneration________ muscle regeneration ________ muscle and ligament fibers________ muscle and ligament fibers

Immobilization; however, during the Immobilization; however, during the Inflammatory - Response PhaseInflammatory - Response Phase will facilitate will facilitate ________ by controlling inflammation ________ by controlling inflammation

Factors That Impede HealingFactors That Impede Healing

Extent of InjuryExtent of Injury EdemaEdema HemorrhageHemorrhage __________________________________ Separation of TissueSeparation of Tissue ________ ________________ ________

Atrophy Atrophy CorticosteroidsCorticosteroids Keloids and Keloids and

Hypertrophic ScarsHypertrophic Scars ________________ Humidity, ClimateHumidity, Climate Age, Health, NutritionAge, Health, Nutrition

Using Specific Modalities During Different Phases of

Healing

Using Specific Modalities During Different Phases of

Healing

Inflammatory – Response PhaseInflammatory – Response Phase

Immediate first aid management of injury Immediate first aid management of injury Minimize the early effects of excessive Minimize the early effects of excessive

inflammation by:inflammation by: ________ ________________ ________ ________ ________________ ________ ________ ________________ ________

Initial goal should be to limit ________Initial goal should be to limit ________ Limiting the amount of ________ will reduce the Limiting the amount of ________ will reduce the

time required for rehabilitationtime required for rehabilitation

Controlling Edema: Immediate First Aid Management

Controlling Edema: Immediate First Aid Management

PProtectionrotection

RRestricted Activityestricted Activity

IIce ce

CCompressionompression

EElevationlevation

PProtection from additional injury by applying rotection from additional injury by applying appropriate splints, braces, or other immobilization appropriate splints, braces, or other immobilization devicesdevices

RRestricted activity to allow the estricted activity to allow the Inflammatory - Inflammatory - Response PhaseResponse Phase to elicit its effects to elicit its effects Rest does not mean Rest does not mean ________________

IIce for __ _______ to decrease metabolism and ce for __ _______ to decrease metabolism and elicit analgesic effectselicit analgesic effects

CCompression for ___ _______ to reduce space for ompression for ___ _______ to reduce space for swelling to accumulateswelling to accumulate

EElevation to reduce blood pooling in the extremities levation to reduce blood pooling in the extremities and facilitate ________ and ________ drainageand facilitate ________ and ________ drainage

Modulating PainModulating Pain

________ and/or ________ ____________ ________ and/or ________ ____________ Currents are typically used for analgesiaCurrents are typically used for analgesia

Low-Power LASER may also be used for Low-Power LASER may also be used for pain modulationpain modulation

Facilitating HealingFacilitating Healing

Low intensity _________ may be effective Low intensity _________ may be effective in facilitating the healing process in facilitating the healing process

_________ may be used safely immediately _________ may be used safely immediately following injuryfollowing injury


Treatments may change from cryotherapy to thermotherpy

Thermotherapy techniques are used to ________________ circulation to the injured area to promote healing

Heat modalities may also produce some degree of ________________

Fibroblastic - Repair PhaseFibroblastic - Repair Phase ____________ ________________________ ____________ may be used to

facilitate removal of injury by-products ________________ __________________ currents may be used…

To elicit muscle contractions (_______ ______________ _______) to reduce swelling

For modulation of ________________ Low-powered LASER may be used for

modulation of pain

Maturation - Remodeling PhaseMaturation - Remodeling Phase ______________________ modalities are beneficial to the

healing process during this phase __________________, shortwave and microwave diathermy

may be used to increase circulation to deeper tissues Electrical stimulating currents may be used for

________ ________________ ________ and to stimulate muscle contractions for increasing both ________________ and ________________

Goal For Using Therapeutic Modalities

Goal For Using Therapeutic Modalities

Assist the natural healing process while Assist the natural healing process while doing no harmdoing no harm

chapter 2: using therapeutic modalities to affect the healing process jennifer doherty-restrepo, ms,...

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