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The Basics of Healing - Understanding the Inflammation Process

The Basics of Healing - Understanding the Inflammation Process. The Healing Process. It is practical to have a sense of the healing process - this will give you insight into why some injuries take longer than others to recover

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The Basics of Healing - Understanding the Inflammation Process

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  1. The Basics of Healing - Understanding the Inflammation Process

  2. The Healing Process • It is practical to have a sense of the healing process - this will give you insight into why some injuries take longer than others to recover • In an ideal world, we would let the process take over and allow the athlete to heal properly • In athletics, we do not have the luxury in many cases to allow this to happen

  3. The Healing Process • Consists of 3 phases: • Inflammatory response phase • Fibroblastic repair phase • Maturation - remodeling phase • Anything done when treating an athlete that interferes with this process will likely slow the return to full activity

  4. The Healing Process • There is little that can be done to speed up physiology • But we can provide the optimal environment for healing or do the opposite and impair the process • Understand these phases, although discussed separately, do overlap and sometimes are tough to distinguish

  5. The Healing Process • Inflammatory Response Phase • The initial inflammatory response is critical to the entire healing process. If this response does not accomplish what it is supposed to do, normal healing cannot take place • The body often overreacts in this phase • This is an individual process - each of us are different

  6. The Healing Process • The inflammatory response phase • Signs we are in this phase: • 5 signs of inflammation: • Redness • Swelling • Tenderness • Increased temperature • Loss of function • How long does this phase last? • Typically 72 hrs if treated correctly

  7. The Healing Process • Inflammatory Response Phase • How do we treat this correctly and allow it to do its thing? • R.I.C.E. • Rest = Do not use the part (crutches, slings, splints, etc) • Ice= Used for pain and vasoconstriction (slow down the body’s overreaction) • 20 min on and 1 hr off • Hunting response - a slight temperature increase during cooling • A reaction against tissue damage from too cold exposure. This is important to educate athletes on how long they should leave ice on • Compression = elastic wrap will help control edema and reduce space for fluids to develop • Elevation = help the lymphatic system by using gravity to return the damaged cells to the core for removal

  8. The Healing Process • Fibroblastic Repair Phase • How do I know? • Generally, signs and symptoms of inflammatory period subside • Tenderness and pain with function remain • How long does it last? • Starts few hours after injury and can last as long as four to six weeks depending on tissue and trauma done

  9. The Healing Process • Maturation - Remodeling Phase • Tensile strength begins to increase • Wolff’s Law states that bone and soft tissue will respond to the physical demands placed on them to remodel or realign along the lines of the tensile force • This is why most patients are now treated with controlled mobilization rather than complete immobilization

  10. The Healing Process • How do I know? • Clinical signs and symptoms will now begin to disappear • As healing progresses to remodeling, controlled activity is warranted with a gradual return to normal flexibility and strength • Usually, this is the time to tape, wrap and brace to allow activity while supporting the structure

  11. The Healing Process • Factors that impede healing: • Extent of injury or separation of tissue • Amount of edema - increased pressure impedes healing process • Hemorrhage • Poor blood supply • Muscle spasm • Infection • Health, age and nutrition Allowing activity too early may allow these things to happen!

  12. The Healing Process • Methods used to modify healing: • Drugs: Non-steroidal anti-inflammatory drugs (NSAIDs): ibuprofen, advil, motrin, etc.- combat out of control inflammation • Thermal agents - cold first 72 hrs, usually a combo thereafter • Modalities - Electrical Stimulation = helps with pain and inflammation, Ultrasound = aids in blood flow and healing in later stages • Exercise - trend now is early range of motion (ROM) to aid in maturation-remodeling and avoid adverse biochemical changes

  13. The Healing Process • So how do we apply all this knowledge? • In general: • Sprains and Strains: • RICE for first 72 hrs • “R” may include brief period of immobilization • After 72 hrs, introduce heat (hot packs, ultrasound, whirlpool) and range of motion (ROM) exercises • When symptoms begin to subside and ROM returns - begin strengthening and return to functional • If we handle properly, expected length of recovery: • 1st degree = 3-6 wks • 2nd degree = months • 3rd degree = months to years

  14. The Healing Process • In general: • Fractures • Immobilize 6-8 wks depending on severity • Then we begin the process • Expected length of recovery: • 2-4 months • “itis” - • Begin healing modalities, stretching and massage right away in combo with ice and electrical stimulation • Stimulate blood flow • Monitor stages and modify as needed • Generally, we are not going to heal this, we want to keep athlete in functional stages

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