The Healing Process and
Guidelines for Using Therapeutic
Modalities
Why do Athletic Trainers use
modalities???
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As an Adjunct to
Therapeutic Exercises
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Facilitate Healing Process
Chapter II
Phases of Healing
™ Inflammatory
™ Fibroblastic
™ Maturation
– Response Phase
– Repair Phase
– Remodeling Phase
Inflammation
™ Contribution
to the
healing process
™ Defends
body against
alien substances
™ Disposes of dead and
dying tissues
™ Promotes regeneration
of normal tissue
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Detrimental effects
Edema
™ Decreased oxygen
™ Chemical spillage
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Irritant to surrounding tissues
™ Results in inflammation in
surrounding tissues
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Inflammatory – Response Phase
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When damage occurs down to the cellular level a change
in metabolism and a release of materials start this phase.
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It occurs immediately.
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Defensive mechanism by which the body attempts to
control the side effects of injury and return the tissue to its
normal state. (Starkey, 1993)
Cardinal Signs of Inflammation
™ Increased
Temperature
™ Redness
™ Swelling
™ Pain
™ Loss
of Function *
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Cellular Response to Inflammation
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Phagocyte: “Eating” Cell
Leukocytes, Phagocytes,
and Exudate migrate from
the blood to the injured
area to:
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Protect injured area
Dispose of Bi-products
through Phagocytosis
Vascular Response to Inflammation
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Vascular Spasm causes
Immediate
Vasoconstriction
Lasts Five to Ten minutes
™ Allows local anemia
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Platelet plug
™ Coagulation
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Chemical Mediators
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Histamine
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Released from Mast cells
™ Causes vasodilation
™ Increases cellular
permiability
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Allows swelling and
separation of endothelial cells
Leucotaxin
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Causes Margination of
Leukocytes
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Increases local cellular
permiability
local lymphatic drainage
™ Localize injury response
™ Adhere to collagen
™ Creates sticky matrix with Leukocytes to form a
plug
Another Vascular Spasm
allows for Vasodilation
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Lasts 24-36 hours
Allows local hyperemia
Causes fluid seepage
(swelling)
™ Growth of fibrous tissue
™ Supplies area with leukocytes
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Chemical Mediators (Con’t)
™ Necrosin-
responsible for phagocytic activity
™ Bradykinin- increases capillary permiability and
pain (especially in presence of prostaglandins)
™ Prostaglandins- most cause vasodilation and pain.
(target for anti-inflammatories)
™ Heparin- anti-coagulant
Function of Platelets
™ Obstruct
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Clot Formation
™ Begins
12 hours after injury and is completed by
48 hours
™ Due
to release of thromboplastin (a protein
molecule)
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prothrombin to thrombin
fibrinogin to fibrin
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Clot Formation (Con’t)
™ Fibrin-
A sticky substance that shuts off blood
supply
™ Results of these events:
Chronic Inflammation
™ Injury
not eliminated
™ Failure to return to normal physiologic state
™ Leukocytes are replaced with
™ Allows
™ Macrophage
™ Promotes
injured area to wall off
healing process
™ Prepares for the next phase of healing
™ Lymphocytes
™ Plasma
Why does chronic inflammation
occur?
Chronic Inflammation (Con’t)
™ Where
are these cells located?
vascularized areas
™ Highly innervated areas
™ Loose connective tissue
Fibroblastic – Repair Phase
Allows for scar formationFibroplasia
™ Lasts 4-6 weeks
™ Repair of injured tissue
occurs
™ Growth of endothelial
capillary buds into the
wound due to decrease in
oxygen
Unknown!!
Thought to be related to
overuse or overload of
tissues with cummulative
microtrauma
™ No specific time frame
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™ Highly
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cells
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Increase in Nutrients
Formation of Granulation
Tissue
Contains fibroblasts,
collagen, and capillaries
™ Fills in the “gaps”
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Extra-cellular Matrix Formation
™ Collagen,
Elastin, and Ground Substance
™ Day 6 or 7 Collagen deposited randomly to begin
scar formation.
™ Increase in tensile strength leads to decrease in
fibroblasts
™ Normal sequence allows for minimal scar tissue
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Maturation – Remodeling Phase
™ LONG
TERM PROCESS!!!
™ Collagen continues remodeling according to the
stress that is placed upon it. (SAID principle)
™ Realignment of tissues will give greatest efficiency
™ Scar tissue is rarely as strong as uninjured tissues.
Factors that Impede Healing
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Extent of Injury
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Protects the area from further
injury and sets the stage for
healing
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Fibroplastic-Repair Phase
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Maturation-Remodeling Phase
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Begin scar formation
Strengthens and remodels scar
tissue overtime.
Atrophy
Corticosteroids
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Edema
™ Hemorrhage
™ Poor Vascular Supply
™ Separation of Tissue
™ Muscle Spasm
Putting it all Together
Inflammatory-Response Phase
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Microtears
™ Macrotears
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Causes traction on tissue
Inhibits healing process
Keloids and Hypertrophic
scars
™ Infection
™ Humidity, Climate, and
Oxygen Tension
™ Health, Age, and Nutrition
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Now What?
Determine which
modalities can provide the
best environment for
healing.
™ Figure out when’s the
most appropriate time to
use them!!
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QUESTIONS????
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