EHR315 - Week 2 Dr Stephen Bird 1 Understanding the Healing Understanding the Healing Process Process • Primary Injury • Inflammatory Response • Role of Mobility • Injuries to Various Tissues • Musculoskeletal Structures Musculoskeletal Structures • Managing the Healing Process Reading: Chapter 2 Quiz 2: Functional anatomy The Healing Process Programs based on healing process framework 1 Bl di No definitive beginning or end 1. Bleeding (Inflammatory) 2. Fibroblastic- repair (Proliferation) 3. Maturation- (remodeling)
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EHR315 - Week 2 Dr Stephen Bird
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Understanding the Healing Understanding the Healing ProcessProcess• Primary Injury
• Histamine: causes vasodilation cell permeability• Leukotrienes: causes margination• Cytokines: attract leukocytes to site of InF
Pl b l l l h i fl id d i• Plug obstructs local lymphatic fluid drainage• Results in localization of the injury• Begins 12hrs post-inj; complete within 48hrs
EHR315 - Week 2 Dr Stephen Bird
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Vascular Reaction
Chemical mediators
Cl tClot Formation
2. Fibroblastic-Repair Phase
Proliferative/regenerative activity leads to scar formation– referred to as fibroplasia
begins within 2 hrs can last– begins within 2 hrs, can last _________________
• Signs associated with InF response subside
Granulation tissue• Breakdown of the fibrin clot
• Consists of fibroblasts, collagen and capillaries
Collagen deposited randomlyg p y _________________• Results in scar tensile strength
Persistent InF response promotes extended fibroplasiaresulting in increased scarring
EHR315 - Week 2 Dr Stephen Bird
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CollagenMajor structural protein
– Forms strong structures that hold connective tissue together
Enables tissue to resist mechanical forces/ deformation– Enables tissue to resist mechanical forces/ deformation
• Collagen fibrils: ___________ elements of connective tissue
– Mechanical/physical properties allow collagen to respond to loading /deformation
– Muscle strength training can enhance joint stability
EHR315 - Week 2 Dr Stephen Bird
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Injuries to Musculotendinous Structures
• Skeletal muscle exhibits 4 traits (page 31)
– .
– .
– .
– .
• Muscle size and architecture often contributeto type and magnitude of motionyp g
– (gross vs. fine, powerful vs. coordinated)
Mechanics of Muscular Contraction
Review the following:
1. .2. .3. .4. .
EHR315 - Week 2 Dr Stephen Bird
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Muscle StrainsStrains occur when the musculotendinous unit is:
1. Overstretched
2 F d t t t i t t t2. Forced to contract against too great a resistance…. (_________________)
• Damage occurs
– Muscle
– Tendon
– ..
– Tendon-bone interface
Armfield, D. R., Kim, D. H.-M., Towers, J. D., Bradley, J. P., & Robertson, D. D. (2006). Sports-related muscle injury in the lower extremity. Clinics in Sports Medicine, 25(4), 803-842.
sifi
cati
on
s
Grade I tear
• some fibers have been stretched or actually torn
• resulting in tenderness and pain on active ROM
• movement painful but full range present
Str
ain
Cla
ss
Grade II tear (minor)
• number of fibers have been torn and active contraction is painful,
• usually a depression or divot is palpable
• some swelling and discoloration result
Mu
scle
S
Grade III
• Complete rupture of muscle or musculotendinous junction
• significant impairment,
• initially a great deal of pain that diminishes due to nerve damage
EHR315 - Week 2 Dr Stephen Bird
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4 st
ages
• produce gel-like matrix leading to fibrosis and scarring
• lead to phagocytosis
1Hemorrhaging
and edema
2Fibroblasts and ground
Hea
ling
: 4 and edema and ground
substance
3Myoblasticcell infiltrate the region
4Collagen
undergoes maturation
Mu
scle
• promotes myofibril regeneration
• active contractions critical to apply tensile stress
the region maturation
Lengthy recovery for each grade, Patience is a must
Tendon HealingTime frame dependant on severity of injury
Wk 0 2Wks 0-2
• healing tendon adheres to the surrounding tissue
Wks 3-4
• tendon separates (varying degrees) from tissues
Wks 5+
• tensile strength increases
Managing the Healing Process Through Rehabilitation
Pre-Surgical Phase
• If surgery can be delayed, ExTh may help to improve outcome
• Maintaining/increasing strength, ROM, CV fitness, NM control enhance athlete’s ability to perform rehabilitation after surgery
EHR315 - Week 2 Dr Stephen Bird
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Phase I – Acute Injury Phase
Initial swelling management / pain control crucial
______________________________
Loading too aggressive first 48hr InF process may not accomplish what it needs toneeds to....
Immobilization for 24-48hrs????
• Day 3-4 engage in mobility ex
gradually bear weight if lower extremity injury
Use of NSAID’s (table 2.1 p.41)
Järvinen, T. A. H., Järvinen, T. L. N., Kääriäinen, M., Äärimaa, V., Vaittinen, S., Kalimo, H., et al. (2007). Muscle injuries: optimising recovery. Best Practice and Research Clinical Rheumatology, 21(2), 317-331.
Hubbard, T.J., & Denegar, C.R. (2004). Does cryotherapy improve outcomes with soft tissue injury? Journal of Athletic Training, 39(3), 278-279.
Machado, A., et al. (2012). The effects of transcutaneouselectrical nerve stimulation on tissue repair: A literature review. Plastic Surgery, 20(4), 237 – 240.
Finberg, M., et al.. (2013). Effects of electro-stimulation therapy on recovery from acute team sport activity. Int J Sports Physiol Perf, 8(3), 293-299.
EHR315 - Week 2 Dr Stephen Bird
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Phase III – Remodeling Phase
Longest phase; ultimate goal R2S/R2A
Continued collagen realignment
Pain continues to decrease with activity
• Regain sports-specific skills
Dynamic functional activities
Sports-directed strengthening activities
Plyometric strengthening
• Functional testing
Determine specific skill weakness Determine specific skill weakness
Werner, G. (2010). Strength and conditioning techniques in the rehabilitation of sports injury. Clinics in Sports Medicine, 29(1), 177-191. p183