Healing considerations: muscle
- rich blood supply
- contracting/stretching stimulates blood flow
- healing time = 2-4 weeks
Healing considerations: tendon
- less blood supply than muscles
- blood supply stimulated by activities that cause eccentric tension to tendon
- overload=injury
Healing considerations: bone
- heal best when load is applied when bone is immobilized (e. boot cast)
- normalize movement
- promote blood flow
Healing considerations: ligaments
- less blood supply than muscle or tendon
- protect injury site with motion of joint
- grades of injury
Grade 1 ligament injury
- mild sprain
- stretching and small tears
Grade 2 ligament injury
- moderate sprain
- small tear
Grade 3 ligament injury
- complete tear
- surgery
Healing considerations: cartilage
- avascular
- aneural
- nutrition maintained by flushing mechanism of fluid to lubricate the joint and this is activated by movement
Healing considerations: nerve
- slow healing rate
- pain, muscle weakness, numbness, tingling
What is tissue injury?
- when mechanical and physiological tissue stress exceeds tissue tolerance
Tissue stress: mechanical factors
LOAD
- amplitude
- direction
- rate
Tissue stress: physiological factors
Modifiable and non-modifiable factors
- metabolic
- neural
- vascular
Tissue response to stress: determinants
- physiological
- mechanical
- tissue composition and structure
- body systems
Steps of typical injury response
- Inflammation (acute)
- Proliferation (sub-acute)
- Remodeling (maturation)
Peace and love after acute injury
P- protection
E- elevation
A- avoid anti-inflammatories
C- compression
E- education
&
L- load
O- optimism
V- vascularization
E- exercise
Irritability
- the amount of vigorous activity it takes to aggravate the patient’s symptoms
- how long does the pain last, how much can you do before it hurts?
Severity
- the intensity of the condition respective to the patient’s subjective pain level and MOI
- how much is this affecting ADLs, was the MOI traumatic?
Ultimate goal of the healing process
Create the environment for a functional scar to form that can cope with all the normal stresses that are placed on it as well as the original tissue did
Functional quality of scar is determined by the collagen’s ability to:
Form along same line of stress
Be the same length (full ROM)
Allow independent movement
Be of sufficient quantity
