Chapter 2: Using Therapeutic Modalities to Affect the Healing Process

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Chapter 2 Using Therapeutic Modalities to Affect
the Healing Process

• Jennifer Doherty-Restrepo, MS, LAT, ATC
• FIU Entry-Level ATEP
• Therapeutic Modalities

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Physiological Responses to Injury

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

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Phases of the Healing Process

• 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

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

• S/S
• Redness
• ________
• Pain
• ________
• Tenderness
• ________
• Loss of Function

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Vascular Reaction
Injury Immediate __________________ Of Vascular
Walls _________________________ With
Hyperemia Stagnation and Stasis Initial
Effusion of Blood and Plasma Lasts 24-36 Hours
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Immediate Vascular Reaction
Injury Vessels Endothelium is
Disrupted _______________ Adhere To Exposed
Collagen Sticky Matrix For Platelets and
Leukocytes Formation of A ___________ Obstructs
Local Lymphatic Drainage _____________ Injury
Response
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Cellular ReactionChemical Mediators Released
From Cell

• Histamine
• ________
• ? Cell Permeability
• Leucotaxin
• ________ (Leukocytes Line Cell Wall)
• ? Cell Permeability
• Forming ________
• Necrosin
• Activates ________

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Clot FormationDamaged Cell
Thromboplastin Prothrombin
Thrombin
Fibrinogen Fibrin
ClotCompleted Within 48 Hours
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Inflammatory - Response Phase

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

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Chronic Inflammation

• 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

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

• S/S
• Signs and symptoms of inflammatory response
  subside
• Proliferative, regenerative activity which leads
  to a period of ________ ________ (fibroplasia)
  and repair of injured tissue

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Fibroplasia

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

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Vascular Reaction

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

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Cellular Reaction

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

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By Day 6 or 7

• Fibroblasts begin producing ______, which is
  deposited randomly throughout the scar
• ________ _______ increases proportionally to
  collagen synthesis

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Normal Sequence

• Formation of minimal ________
• Increase in tensile strength and a decrease in
  the number of fibroblasts signals the beginning
  of the __________________ ________

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Abnormal Response

• Persistent Inflammatory Response Phase causes
  extended ___________ and _____________

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

• 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

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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

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Controlled Mobility is Superior To Immobilization

• Controlled mobility
• ________ scar formation
• ________ revascularization
• ________ muscle regeneration
• ________ muscle and ligament fibers
• Immobilization however, during the Inflammatory
  - Response Phase will facilitate ________ by
  controlling inflammation

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Factors That Impede Healing

• Atrophy
• Corticosteroids
• Keloids and Hypertrophic Scars
• ________
• Humidity, Climate
• Age, Health, Nutrition

• Extent of Injury
• Edema
• Hemorrhage
• _________________
• Separation of Tissue
• ________ ________

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Using Specific Modalities During Different
Phases of Healing

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Inflammatory Response Phase

• 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

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Controlling Edema Immediate First Aid Management

• Protection
• Restricted Activity
• Ice
• Compression
• Elevation

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• 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

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Modulating Pain

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

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Facilitating Healing

• Low intensity _________ may be effective in
  facilitating the healing process
• _________ may be used safely immediately
  following injury

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Fibroblastic - Repair Phase

• 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
  ________

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Fibroblastic - 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

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Maturation - 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
  ________

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Goal For Using Therapeutic Modalities

• Assist the natural healing process while doing
  no harm