The Basics of Healing - Understanding the Inflammation Process

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The Basics of Healing - Understanding the
Inflammation Process
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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

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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

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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

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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

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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

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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 bodys 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

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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

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The Healing Process

• Maturation - Remodeling Phase
• Tensile strength begins to increase
• Wolffs 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

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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

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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!

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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

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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

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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