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Tissue Repair & Electrotherapeutic Agents. Causes of Inflammation. Soft tissue trauma Fractures Autoimmune diseases Microbial agents Chemical agents Thermal agents Irradiation Foreign bodies. Inflammation & Repair consists of 4 phases:. Initial injury phase (bleeding, clot,…)
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Causes of Inflammation • Soft tissue trauma • Fractures • Autoimmune diseases • Microbial agents • Chemical agents • Thermal agents • Irradiation • Foreign bodies
Inflammation & Repair consists of 4 phases: • Initial injury phase (bleeding, clot,…) • Inflammatory response phase (prepares wound for healing) • Fibroblastic repair phase, proliferation (rebuilds damaged structures & strengthen the wound) • Maturation phase, remodeling (modifies the scar tissue into its nature form)
Initial Injury Phase • Destruction of tissue (injury of cells) • bleeding Inflammatory Phase • Signs of inflammation
Fibroblastic – Repair (proliferative) Phase • First few hours after injury 4 to 6 weeks • Reconstruct (fibroblasts- endothelial cells – macrophages) • Resurfacing • Strength of wound
Processes Occur in The Proliferative Phase • Epithelization • Collagen production fibroblasts • Wound contracture myofibroblasts. Contract pulling the ends of wound (scar) • Neovascularization
Maturation (Remodeling) Phase • Takes months or years • Change in size, form & strength of scar tissue • Fibroblasts, macrophages, myofibroblasts, capillaries and water content of tissue • The goal is restoration of prior function of injured tissue
Factors Affecting Rate of Maturation & Scar Characteristics are: • Fiber orientation • Balance of collagen synthesis and lysis
Factors That Impede Healing • Extent of injury • Edema • Hemorrhage • Bad vascular supply • Separation of tissue • Muscle spasm • Atrophy
Factors That Impede Healing • Corticosteroids • Keloids & hypertrophic scar • Infection • Humidity climate & oxygen tension • Health, age & nutrition
Injury Management • Cryotherapy • RICE (rest, ice, compression & elevation)
The Role of Progressive Controlled Mobility in The Maturation Phase • Wolff’s Law: states that both bone & soft tissue will respond to the physical demands placed on them, causing them to remodel along the line of tensile force.
Immobilization • Control mobilization, revascularization, muscle regeneration & reorientation of muscle fibers • Active strengthening exercises in the remodeling phase
Modality not combined with anti-inflammatory medication during initial acute & inflammatory phases
Applied Electrical Charges The effect on the body depend on: • Intensity • Nature of resulting current • Chemical changes (direct current) • Stimulation of excitable tissues ( stimulating current) • High currents significant heating (diathermy)
Therapeutic modalities can restore normal cell membrane potential and leads to decreasing inflammation, decreasing edema and increasing healing.