Injury/ Trauma
 Injury occurs when local stress or strain exceeds the
ultimate strength of bones and/ or soft tissues.
 The rate of injury or tissue deformation also
contributes to the degree of injury
Trauma/ Injury
 An injury includes mechanical failure and destruction
of the cells and tissues.
The Phases of Healing
 There are 3 phases of healing:
1. Acute Inflammatory Response
2. The Proliferation Phase
3. The Maturation Phase
Acute Inflammatory Response
 Mechanical trauma, such as a sprain, strain, disc
injury, amputation or burn, results in damaged cells;
 Damaged cells initiate the inflammatory response;
 The sudden and extended release of inflammatory
mediators is necessary to initiate the healing response.
The Inflammatory Response
 The inflammatory response:
 Attracts precursors for cell growth, and
 Encourages repair mechanisms.
 The buildup of fluids causes chemical irritation and
mechanical pressure on the nerve receptors.
 Chemical irritation and mechanical pressure
stimulates pain receptors, which serve a protective
purpose, causing patients to limit motion around the
damaged tissue.
The Inflammatory Response
 Other effects of the inflammatory response include:
 Clogging of the vasculature which results in further cell
death due to cell oxygen deprivation;
 Muscle spasm occurs due to the pain and lack of oxygen,
and
 The patient moves less due to pain and muscle spasm.
Inflammation
 Necessary part of the healing process
 However, if the inflammatory response is prolonged or
particularly intense, it may lead to chronic
inflammation which can be debilitating
 Through use of therapeutic modalities, we can
influence the inflammatory response promote healing
Cardinal Signs of Inflammation
 Heat
 Redness
 Swelling
 Pain
 Loss of Function
Measuring Inflammation
 Measure the amount of swelling compared to the
opp0site side
 Point tenderness on palpation
 Joint range of motion as compared to the opposite side
Typical Presentation in Acute
Inflammatory Response Phase
 Swelling
 Loss of Range of Motion
 Muscle guarding
 Splinting postures
Duration of the Acute
Inflammatory Response
 Begins immediately following injury
 Persists until the stimulus is removed/ mediators
dissipated
 May last a few seconds or a few months
Proliferation Phase
 The number and size of fibroblasts increase allowing
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for the collection of ground substance and collagen to
collect in preparation for tissue repair.
Growth of new tissue
Development of new blood vessels
Development of fibrous tissue
Wound contraction
Formation of collagen matrix
Proliferation Phase
 Removal of debris and temporary repair tissue formed
by the inflammatory response phase
 Development of new, permanent replacement tissues
 Development of new vascular framework to supply
repairing tissues with oxygen and nutrients and cells
needed to restore the area
Proliferation Phase
 Thought to begin approximately 72 hours after injury
 May last 3 weeks
Maturation Phase
 Collagen and Fibroblasts attempt to align themselves
in the original tissue orientation, although this does
not always occur.
 Main focus is:
 Deposition of permanent tissues
 Return to normal function
Ischemia
Trauma
Cell Death
Inflammation
Phagocytosis
Bleeding
Swelling
Blood
Clotting
Clogging of
Blood Flow
Contain Injury
Secondary Trauma
The Injury
Response
Pain, spasm,
atrophy
Wound
Contraction
Wound
Remodeling
Return to normal
function
Tissue Repair
Loss of Function
Revascularization