Mechanics of Tissue Healing

Pain inflammatory mediatorsTissue injury

Soft Tissue Healing

•Three Phases▫Inflammatory Phase▫Regeneration Phase (Proliferation)▫Remodeling Phase (Maturation)

• Bleeding Phase ▫Short lived

6-8 hours Vascular (muscular) bleeds longer (24+hrs) Ligament bleeds less

Inflammatory Phase

• Normal and Essential Component ▫2-3 Days before gradually resolving

• Local Vasoconstriction (shock)▫Zone of Primary Injury▫Necrosis – death of tissue from lack of O2

• Vasodilation▫Zone of Secondary Injury▫Leukocytes

Ingest dead cells/foreign and infectious▫Phagocytosis

Conective tissue carrying heparin/histamine▫Bradykinin

Stimulates nerve endings to cause pain

Regeneration Phase

• Growth of new tissue• 4th-5th day – weak connective tissue has formed

over injury site.• Production of scar (collagen) tissue

▫Rapid onset 24-48 hrs▫Takes longer to peak

2-3 weeks the more vascular the tissue, the shorter the time

taken to reach peak proliferative. Reduces strength approx. 30% Decreases flexibility

• Runs from the first day or two post injury through to its peak at 2-3 weeks and decreases

• Hematoma size sufficiently diminishes

Remodeling Phase•Often overlooked in terms of importance•Longest duration

▫Healing occurs for 1 year or more!•Begins at same time as the peak of the

proliferative phase (2-3 wks)▫Possibly even earlier (1-2 wks)

•Chemical levels return to normal

Cutaneous

Wound Healing

Muscular Healing

•Healing is similar to other tissues•Hemorrhage/Edema

▫By Phagocytosis•Adhesions inhibit muscle fiber

regeneration•Muscle may only regain 50% pre-injury

strength•Rehabilitation Length

▫Fairly lengthy▫6-8 weeks

Tendons and Ligaments

•Tendons require less blood supply than muscles to function, they take more time to heal.

•Ligament damage is a lengthy process▫Joint instability▫Atrophy ▫Increased risk of RE-Injury

ESSAY Questions • 1. Describe goal setting and why it is important

during rehabilitation. (4) • 2. What things can be done to address the

psychological aspects of dealing with an injured athlete? (5)

 • 3. Explain H.O.P.S. – Give 2 examples of each (8)

• 4. What is the difference between zone of “primary” and “secondary” injury? (4)

• 5. Why is scar tissue healing less desired? (4)