Chapter 2: Using Therapeutic Modalities to Affect the Healing Process

1. Chapter 2: Using Therapeutic Modalities to Affect the Healing Process Jennifer Doherty-Restrepo, MS, LAT, ATC FIU Entry-Level ATEP Therapeutic Modalities

2. Therapeutic modalities should be selected and applied based on the ________ ________ of the tissues to injury and on the understanding of how various tissues ________ Physiological Responses to Injury

4. Inflammatory - Response Phase Fibroblastic - Repair Phase Maturation - Remodeling Phase The ATC must understand the healing process to make decisions on how and when therapeutic modalities may best be used to facilitate the healing process Phases of the Healing Process

5. Inflammatory-Response Phase Healing Process Continuum Injury Day 4 Week 6 2-3 Years

6. Inflammatory-Response Phase Fibroblastic-Repair Phase Healing Process Continuum Injury Day 4 Week 6 2-3 Years

7. Inflammatory-Response Phase Fibroblastic-Repair Phase Maturation-Remodeling Phase Healing Process Continuum Injury Day 4 Week 6 2-3 Years

8. S/S Redness ________ Pain ________ Tenderness ________ Loss of Function Inflammatory - Response Phase

9. Injury Immediate __________________ Of Vascular Walls _________________________ With Hyperemia Stagnation and Stasis Initial Effusion of Blood and Plasma Lasts 24-36 Hours Vascular Reaction

10. Injury Vessels’ Endothelium is Disrupted _______________ Adhere To Exposed Collagen Sticky Matrix For Platelets and Leukocytes Formation of A ___________ Obstructs Local Lymphatic Drainage _____________ Injury Response Immediate Vascular Reaction

11. Histamine ________  Cell Permeability Leucotaxin ________ (Leukocytes Line Cell Wall)  Cell Permeability Forming ________ Necrosin Activates ________ Cellular ReactionChemical Mediators Released From Cell

12. Clot FormationDamaged Cell Thromboplastin Prothrombin Thrombin Fibrinogen Fibrin ClotCompleted Within 48 Hours

13. Injured area is walled-off Leukocytes phagocytize foreign debris Sets stage for Fibroblastic-Repair Phase Lasts ________ after initial injury Inflammatory - Response Phase

14. Occurs when _____ inflammatory-response does not eliminate injuring agent Leukocytes replaced by _________, ___________, and ________ ________ Specific mechanism which causes conversion to chronic inflammation is unknown ________or ________ with cumulative repetitive ____________ may be a cause Chronic Inflammation

15. Fibroblastic - Repair Phase

16. Inflammatory-Response Phase Fibroblastic-Repair Phase Maturation-Remodeling Phase Healing Process Continuum Injury Day 4 Week 6 2-3 Years

17. S/S Signs and symptoms of inflammatory response subside Proliferative, regenerative activity which leads to a period of ________ ________ (fibroplasia) and repair of injured tissue Fibroblastic - Repair Phase

18. Begins within the first few _____ following injury Signs of inflammation subside Pain and tenderness to touch May last ________ weeks Fibroplasia

19. Vascular Reaction Growth of Endothelial Capillary Buds (Stimulated By Lack of Oxygen) ________Blood Flow Increased Delivery of Essential ________ for Tissue Regeneration

20. Cellular Reaction Breakdown of Fibrin Clot Formation of ________ Tissue (Fibroblasts, Collagen, Capillaries) Fibroblasts Accumulate Along Capillary Beds Synthesizes Extracellular Matrix (________, ________, ________)

21. Fibroblasts begin producing ______, which is deposited randomly throughout the scar ________ _______ increases proportionally to collagen synthesis By Day 6 or 7

22. Formation of minimal ________ Increase in tensile strength and a decrease in the number of fibroblasts signals the beginning of the __________________ ________ Normal Sequence

23. Persistent Inflammatory Response Phase causes extended ___________ and _____________ Abnormal Response

24. Maturation - Remodeling Phase

25. Inflammatory-Response Phase Fibroblastic-Repair Phase Maturation-Remodeling Phase Healing Process Continuum Injury Day 4 Week 6 2-3 Years

26. Long-term process Realignment of collagen fibers along lines of ________ ________ Ongoing _________________ of collagen Increase in tensile strength of scar matrix At 3-weeks a contracted, non-vascular scar exists May require several years to complete Maturation - Remodeling Phase

27. The Role of Controlled Mobility in the Maturation – Remodeling Phase _________________ Bone and soft tissue will respond to the physical demands placed on them, causing them to remodel along lines of ________ ________ Injured structures must be exposed to __________ loads during the Maturation -Remodeling Phase

28. Controlled mobility… ________ scar formation ________ revascularization ________ muscle regeneration ________ muscle and ligament fibers Immobilization; however, during the Inflammatory - Response Phase will facilitate ________ by controlling inflammation Controlled Mobility is Superior To Immobilization

29. Extent of Injury Edema Hemorrhage _________________ Separation of Tissue ________ ________ Atrophy Corticosteroids Keloids and Hypertrophic Scars ________ Humidity, Climate Age, Health, Nutrition Factors That Impede Healing

30. Using Specific Modalities During Different Phases of Healing

31. Immediate first aid management of injury Minimize the early effects of excessive inflammation by: ________ ________ ________ ________ ________ ________ Initial goal should be to limit ________ Limiting the amount of ________ will reduce the time required for rehabilitation Inflammatory – Response Phase

32. Protection Restricted Activity Ice Compression Elevation Controlling Edema: Immediate First Aid Management

33. Protection from additional injury by applying appropriate splints, braces, or other immobilization devices Restricted activity to allow the Inflammatory - Response Phase to elicit its effects Rest does not mean ________ Ice for __ _______ to decrease metabolism and elicit analgesic effects Compression for ___ _______ to reduce space for swelling to accumulate Elevation to reduce blood pooling in the extremities and facilitate ________ and ________ drainage

34. ________ and/or ________ ____________ Currents are typically used for analgesia Low-Power LASER may also be used for pain modulation Modulating Pain

35. Low intensity _________ may be effective in facilitating the healing process _________ may be used safely immediately following injury Facilitating Healing

36. 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 Phase

37. ____________ ____________ 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 Fibroblastic - Repair Phase

38. ___________ 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 ________ Maturation - Remodeling Phase

39. Assist the natural healing process while doing no harm Goal For Using Therapeutic Modalities