Post on 17-Dec-2015
Using Therapeutic Modalities To Affect The Healing Process
Using Therapeutic Modalities To Affect The Healing Process
Phases of the Healing ProcessPhases of the Healing Process
Inflammatory- Response PhaseInflammatory- Response Phase Fibroblastic-Repair PhaseFibroblastic-Repair Phase Maturation-Remodeling PhaseMaturation-Remodeling Phase
Healing Process Is A ContinuumHealing Process Is A Continuum
Injury Day 4 Week 6 2-3 Years
Inflammatory-Response Phase
Healing Process Is A ContinuumHealing Process Is A Continuum
Injury Day 4 Week 6 2-3 Years
Inflammatory-Response PhaseFibroblastic-Repair Phase
Healing Process Is A ContinuumHealing Process Is A Continuum
Injury Day 4 Week 6 2-3 Years
Inflammatory-Response PhaseFibroblastic-Repair PhaseMaturation-Remodeling Phase
Inflammatory-Response PhaseInflammatory-Response Phase
Symptoms Include Swelling, Pain, Warmth, Symptoms Include Swelling, Pain, Warmth, and Crepitusand Crepitus
Direct Destruction Of Soft Tissue CellsDirect Destruction Of Soft Tissue Cells Vascular ReactionVascular Reaction Cellular ReactionCellular Reaction
Vascular ReactionVascular ReactionInjury
Immediate Vasoconstriction Of Vascular Walls
Vasodilation With Hyperemia
Stagnation and Stasis
(Initial Effusion of Blood and Plasma Lasts24-36 Hours)
Immediate Vascular ReactionImmediate Vascular ReactionInjury
Vessels Endothelium Disrupted
Platelets Adhere To Exposed Collagen
Sticky Matrix For Platelets and Leukocytes
Formation of A Plug
Obstructs Local Lymphatic Drainage
Localizes Injury Response
Cellular ReactionChemical Mediators Released From Cell
Cellular ReactionChemical Mediators Released From Cell
Histamine Vasodilation & Cell PermeabilityHistamine Vasodilation & Cell Permeability Leucotaxin Margination Leucotaxin Margination (Leukocytes Line Cell Wall) (Leukocytes Line Cell Wall)
& Cell Permeability Forming Exudate& Cell Permeability Forming Exudate
Necrosin Turns On PhagocytesNecrosin Turns On Phagocytes
Clot Formation
Damaged Cell
Thromboplastin
Prothrombin
Thrombin
Fibrinogen
Fibrin ClotCompleted Within 48 Hours
Clot Formation
Damaged Cell
Thromboplastin
Prothrombin
Thrombin
Fibrinogen
Fibrin ClotCompleted Within 48 Hours
Inflammatory-Response PhaseInflammatory-Response Phase
Injured Area Is Walled-OffInjured Area Is Walled-Off Leukocytes Phagocytize Foreign DebrisLeukocytes Phagocytize Foreign Debris Sets Stage For Fibroblastic-Repair PhaseSets Stage For Fibroblastic-Repair Phase Lasts 2-4 Days After Initial InjuryLasts 2-4 Days After Initial Injury
Chronic InflammationChronic Inflammation Occurs When Acute Response Does Not Occurs When Acute Response Does Not
Eliminate Injuring AgentEliminate Injuring Agent Leukocytes Replaced By Macrophages, Leukocytes Replaced By Macrophages,
Lymphocytes, and Plasma CellsLymphocytes, and Plasma Cells Specific Mechanism Which Causes Specific Mechanism Which Causes
Conversion Is UnknownConversion Is Unknown Overuse or Overload With Cumulative Overuse or Overload With Cumulative
Repetitive MicrotraumaRepetitive Microtrauma
Fibroblastic-Repair PhaseFibroblastic-Repair Phase
Proliferative, Regenerative Activity Which Proliferative, Regenerative Activity Which Leads To A Period Of Scar Formation Leads To A Period Of Scar Formation (Fibroplasia) And Repair Of Injured Tissue(Fibroplasia) And Repair Of Injured Tissue
Fibroblastic-Repair PhaseFibroblastic-Repair Phase
FibroplasiaFibroplasia
Begins Within The First Few Hours Begins Within The First Few Hours Following InjuryFollowing Injury
Signs Of Inflammation SubsideSigns Of Inflammation Subside Pain and Tenderness To TouchPain and Tenderness To Touch May Last 4-6 WeeksMay Last 4-6 Weeks
Vascular ReactionVascular ReactionGrowth of Endothelial Capillary Growth of Endothelial Capillary
Buds Into the AreaBuds Into the Area
(Stimulated By Lack of Oxygen)(Stimulated By Lack of Oxygen)
Increased Blood FlowIncreased Blood Flow
Increased delivery of Essential Increased delivery of Essential Nutrients for Tissue RegenerationNutrients for Tissue Regeneration
Cellular ReactionCellular ReactionBreakdown of Fibrin ClotBreakdown of Fibrin Clot
Formation of Granulation TissueFormation of Granulation Tissue
(Fibroblasts,Collagen,Capillaries)(Fibroblasts,Collagen,Capillaries)
Fibroblasts Accumulate Along Fibroblasts Accumulate Along Capillary BedsCapillary Beds
Synthesizes Extracellular MatrixSynthesizes Extracellular Matrix
(Collagen,Elastin,Ground Substance)(Collagen,Elastin,Ground Substance)
By Day 6 or 7By Day 6 or 7
Fibroblasts Begin Producing Collagen Fibroblasts Begin Producing Collagen Which Is Deposited Randomly Throughout Which Is Deposited Randomly Throughout the Scarthe Scar
Tensile Strength Increases Proportionally Tensile Strength Increases Proportionally To Collagen SynthesisTo Collagen Synthesis
Normal SequenceNormal Sequence
Formation of Minimal ScarFormation of Minimal Scar Increase in Tensile Strength and a Decrease Increase in Tensile Strength and a Decrease
in the Number of Fibroblasts Signals the in the Number of Fibroblasts Signals the Beginning of the Maturation-Remodeling Beginning of the Maturation-Remodeling PhasePhase
Abnormal ResponseAbnormal Response
Persistent Inflammatory Response Causes Persistent Inflammatory Response Causes Extended Fibroplasia and FibrogenesisExtended Fibroplasia and Fibrogenesis
Maturation-Remodeling PhaseMaturation-Remodeling Phase
Realignment of Collagen Fibers Along Realignment of Collagen Fibers Along Lines of Tensile ForceLines of Tensile Force
Ongoing Breakdown/Synthesis of CollagenOngoing Breakdown/Synthesis of Collagen Increase in Tensile Strength of Scar MatrixIncrease in Tensile Strength of Scar Matrix At 3-weeks a Contracted, Non-vascular At 3-weeks a Contracted, Non-vascular
Scar ExistsScar Exists May Require Several Years To CompleteMay Require Several Years To Complete
Role of Controlled MobilityRole of Controlled Mobility
Wolff’s Law Wolff’s Law - Bone and Soft Tissue - Bone and Soft Tissue Will Respond to the Physical Will Respond to the Physical Demands Placed on Them Causing Demands Placed on Them Causing Them to Remodel Along Lines of Them to Remodel Along Lines of Tensile ForceTensile Force
You Must Expose Injured Structures To Increasing Loads
During The Maturation -Remodeling Phase
You Must Expose Injured Structures To Increasing Loads
During The Maturation -Remodeling Phase
Controlled Mobilization Superior To Immobilization
Controlled Mobilization Superior To Immobilization
Decreases Scar FormationDecreases Scar Formation Increases RevascularizationIncreases Revascularization Facilitates Muscle RegenerationFacilitates Muscle Regeneration Reorientation of Muscle and Ligament Reorientation of Muscle and Ligament
FibersFibers
Immobilization During the Inflammatory-Response Phase
Will Facilitate Healing By Controlling Inflammation
Immobilization During the Inflammatory-Response Phase
Will Facilitate Healing By Controlling Inflammation
Progression CriteriaProgression Criteria
Use Aggressive Active ROM ExercisesUse Aggressive Active ROM Exercises Use Pain and Increased Swelling as GuidesUse Pain and Increased Swelling as Guides
Factors That Impede HealingFactors That Impede Healing
Extent of InjuryExtent of Injury EdemaEdema HemorrhageHemorrhage Poor Vascular SupplyPoor Vascular Supply Separation of TissueSeparation of Tissue Muscle SpasmMuscle Spasm
Atrophy Atrophy CorticosteroidsCorticosteroids Keloids and Keloids and
Hypertrophic ScarsHypertrophic Scars InfectionInfection Humidity, ClimateHumidity, Climate Age, Health, NutritionAge, Health, Nutrition
Using Specific Modalities During Different Phases of
Healing
Using Specific Modalities During Different Phases of
Healing
Immediate First Aid Management of InjuryImmediate First Aid
Management of Injury
Minimize the Early Effects of Excessive Inflammation By:
Minimize the Early Effects of Excessive Inflammation By:
Controlling EdemaControlling Edema Modulating PainModulating Pain Facilitating HealingFacilitating Healing
Initially Everything You Do Should Be Directed Toward
Limiting The Amount Of Swelling
Initially Everything You Do Should Be Directed Toward
Limiting The Amount Of Swelling
If You Limit The Amount Of Swelling Initially You Will
Significantly Decrease The Time Required For Rehabilitation
If You Limit The Amount Of Swelling Initially You Will
Significantly Decrease The Time Required For Rehabilitation
Immediate First AidImmediate First Aid
PProtectionrotection
RRestricted Activityestricted Activity
IIce ce
CCompressionompression
EElevationlevation
ProtectionProtection Protect From Additional Injury By Protect From Additional Injury By
Applying Appropriate Splints, Pads, Braces, Applying Appropriate Splints, Pads, Braces, or Other Immobilization Devicesor Other Immobilization Devices
Restricted Activity(Rest)
Restricted Activity(Rest)
Allow the Inflammatory-Response Phase to Allow the Inflammatory-Response Phase to Do What It Is Supposed To Without Do What It Is Supposed To Without InterferingInterfering
Rest Does Not Mean Do Nothing!Rest Does Not Mean Do Nothing!
IceIce
Decreases metabolism To Control Decreases metabolism To Control Secondary Hypoxic InjurySecondary Hypoxic Injury
AnalgesiaAnalgesia Possibly Cause VasoconstrictionPossibly Cause Vasoconstriction Use for 20 Minutes - 1 HourUse for 20 Minutes - 1 Hour Use Ice Bags, Ice Packs, CryocuffUse Ice Bags, Ice Packs, Cryocuff
CompressionCompression
Mechanically Reduces Space For Swelling Mechanically Reduces Space For Swelling To AccumulateTo Accumulate
Use An Elastic Wrap and Compression Use An Elastic Wrap and Compression Dressing For At Least 72 HoursDressing For At Least 72 Hours
Use Intermittent Compression, Cryocuff, Use Intermittent Compression, Cryocuff, Elastic WrapsElastic Wraps
ElevationElevation
Reduces Pooling of Blood in the Reduces Pooling of Blood in the ExtremitiesExtremities
Facilitates Venous and Lymphatic DrainageFacilitates Venous and Lymphatic Drainage
Modulating PainModulating Pain
Cold Can Be Used For AnalgesiaCold Can Be Used For Analgesia Electrical Stimulating Currents May Also Electrical Stimulating Currents May Also
Be UsedBe Used Low-Power LASER Has Been Low-Power LASER Has Been
Recommended For Pain ModulationRecommended For Pain Modulation
Facilitating HealingFacilitating Healing
Low Intensity Ultrasound Can Be Effective Low Intensity Ultrasound Can Be Effective In Facilitating The Healing Proces and Can In Facilitating The Healing Proces and Can Be Used Safely Immediately Following Be Used Safely Immediately Following InjuryInjury
Inflammatory-Response PhaseInflammatory-Response Phase As with First Aid Management, modalities
should be used to control pain and reduce swelling
Cryotherapy should still be used to reduce likelihood of swelling
Ice bags, cold packs, or ice massages provide analgesic effects
Heating an injury too soon is a bigger mistake than using ice on an injury for too long
Inflammatory-Response PhaseInflammatory-Response Phase
Intermittent compression can decrease swelling by facilitating resorption of the by-products of inflammatory process by lymphatic system
Electrical stimulating currents and low-power laser can be used to help reduce pain
Incorporate active and passive ROM exercise
Fibroblastic-Repair PhaseFibroblastic-Repair Phase
Treatments may change from cold to heat
Thermotherapy techniques may include hydrocollator packs, paraffin, warm
whirlpool to increase circulation to the injured area to promote healing
Heat modalities can also produce some degree of analgesia.
Fibroblastic-Repair PhaseFibroblastic-Repair Phase
Intermittent compression can facilitate removal of injury by-products
Electrical stimulating currents assist process by eliciting a muscle contraction inducing a muscle pumping action
Electrical currents can be used for modulation of pain, as can stimulation of trigger points with low-powered laser
Fibroblastic-Repair PhaseFibroblastic-Repair Phase
Continue to stress importance of ROM and strengthening exercises and progress them appropriately during this phase
Maturation-Remodeling PhaseMaturation-Remodeling Phase
Heating modalities are beneficial to healing
Deep-heating modalities, ultrasound, shortwave and microwave diathermy used to increase circulation to deeper tissues
Superficial heating modalities are less effective
Maturation-Remodeling PhaseMaturation-Remodeling Phase
Electrical stimulating currents used both in pain modulation and to stimulate muscle contractions for increasing both ROM and strength
Low-power laser used to modulate pain
Role of controlled mobility
Goal For Using Therapeutic Modalities
Goal For Using Therapeutic Modalities
Assist the Natural Healing Processes of the Assist the Natural Healing Processes of the Body While Doing No HarmBody While Doing No Harm