Chapter 2: Using Therapeutic
Modalities to Affect the Healing
Process
Jennifer Doherty-Restrepo, MS, LAT, ATC
FIU Entry-Level ATEP
Therapeutic Modalities
Physiological Responses to Injury

Therapeutic modalities should be selected
and applied based on the ________
________ of the tissues to injury and on
the understanding of how various tissues
________
Phases of the Healing Process
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Inflammatory - Response Phase
Fibroblastic - Repair Phase
Maturation - Remodeling Phase
The ATC must understand the healing process to
make decisions on how and when therapeutic
modalities may best be used to facilitate the
healing process
Healing Process Continuum
Inflammatory-Response Phase
Injury
Day 4
Week 6
2-3 Years
Healing Process Continuum
Inflammatory-Response Phase
Fibroblastic-Repair Phase
Injury
Day 4
Week 6
2-3 Years
Healing Process Continuum
Inflammatory-Response Phase
Fibroblastic-Repair Phase
Maturation-Remodeling Phase
Injury
Day 4
Week 6
2-3 Years
Inflammatory - Response Phase

S/S
Redness
 ________
 Pain
 ________
 Tenderness
 ________
 Loss of Function

Vascular Reaction
Injury
Immediate __________________ Of Vascular Walls
_________________________
With Hyperemia
Stagnation and Stasis
Initial Effusion of Blood and Plasma Lasts 24-36 Hours
Immediate Vascular Reaction
Injury
Vessels’ Endothelium is Disrupted
_______________
Adhere To Exposed Collagen
Sticky Matrix For Platelets and Leukocytes
Formation of A ___________
Obstructs Local Lymphatic Drainage
_____________
Injury Response
Cellular Reaction
Chemical Mediators Released From Cell

Histamine
 ________


Leucotaxin

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
 Cell Permeability
________ (Leukocytes Line Cell Wall)
 Cell Permeability
Forming ________
Necrosin

Activates ________
Clot Formation
Damaged Cell
Thromboplastin
Prothrombin
Thrombin
Fibrinogen
Fibrin Clot
Completed Within 48 Hours
Inflammatory - Response Phase
Injured area is walled-off
 Leukocytes phagocytize foreign debris
 Sets stage for Fibroblastic-Repair Phase
 Lasts ________ after initial injury

Chronic Inflammation
Occurs when _____ inflammatory-response
does not eliminate injuring agent
 Leukocytes replaced by _________,
___________, and ________ ________
 Specific mechanism which causes
conversion to chronic inflammation is
unknown


________or ________ with cumulative
repetitive ____________ may be a cause
Fibroblastic - Repair Phase
Healing Process Continuum
Inflammatory-Response Phase
Fibroblastic-Repair Phase
Maturation-Remodeling Phase
Injury
Day 4
Week 6
2-3 Years
Fibroblastic - Repair Phase

S/S


Signs and symptoms of inflammatory response
subside
Proliferative, regenerative activity which
leads to a period of ________ ________
(fibroplasia) and repair of injured tissue
Fibroplasia
Begins within the first few _____ following
injury
 Signs of inflammation subside
 Pain and tenderness to touch
 May last ________ weeks

Vascular Reaction
Growth of Endothelial Capillary Buds
(Stimulated By Lack of Oxygen)
________Blood Flow
Increased Delivery of Essential
________ for Tissue Regeneration
Cellular Reaction
Breakdown of Fibrin Clot
Formation of ________ Tissue
(Fibroblasts, Collagen, Capillaries)
Fibroblasts Accumulate Along Capillary Beds
Synthesizes Extracellular Matrix
(________, ________, ________)
By Day 6 or 7
Fibroblasts begin producing ______, which
is deposited randomly throughout the scar
 ________ _______ increases proportionally
to collagen synthesis

Normal Sequence
Formation of minimal ________
 Increase in tensile strength and a decrease in
the number of fibroblasts signals the
beginning of the __________________
________

Abnormal Response

Persistent Inflammatory Response Phase
causes extended ___________ and
_____________
Maturation - Remodeling Phase
Healing Process Continuum
Inflammatory-Response Phase
Fibroblastic-Repair Phase
Maturation-Remodeling Phase
Injury
Day 4
Week 6
2-3 Years
Maturation - Remodeling Phase
Long-term process
 Realignment of collagen fibers along lines
of ________ ________
 Ongoing _________________ of collagen
 Increase in tensile strength of scar matrix
 At 3-weeks a contracted, non-vascular scar
exists
 May require several years to complete

The Role of Controlled Mobility in
the Maturation – Remodeling Phase

_________________


Bone and soft tissue will respond to the physical
demands placed on them, causing them to remodel
along lines of ________ ________
Injured structures must be exposed to
__________ loads during the Maturation Remodeling Phase
Controlled Mobility is Superior
To Immobilization

Controlled mobility…





________ scar formation
________ revascularization
________ muscle regeneration
________ muscle and ligament fibers
Immobilization; however, during the
Inflammatory - Response Phase will facilitate
________ by controlling inflammation
Factors That Impede Healing

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Extent of Injury
Edema
Hemorrhage
_________________
Separation of Tissue
________ ________



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Atrophy
Corticosteroids
Keloids and
Hypertrophic Scars
________
Humidity, Climate
Age, Health, Nutrition
Using Specific Modalities
During Different Phases of
Healing
Inflammatory – Response Phase
Immediate first aid management of injury
 Minimize the early effects of excessive
inflammation by:





________ ________
________ ________
________ ________
Initial goal should be to limit ________

Limiting the amount of ________ will reduce the
time required for rehabilitation
Controlling Edema:
Immediate First Aid Management

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
Protection
Restricted Activity
Ice
Compression
Elevation

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Protection from additional injury by applying
appropriate splints, braces, or other immobilization
devices
Restricted activity to allow the Inflammatory Response Phase to elicit its effects
 Rest does not mean ________
Ice for __ _______ to decrease metabolism and
elicit analgesic effects
Compression for ___ _______ to reduce space for
swelling to accumulate
Elevation to reduce blood pooling in the extremities
and facilitate ________ and ________ drainage
Modulating Pain
________ and/or ________ ____________
Currents are typically used for analgesia
 Low-Power LASER may also be used for
pain modulation

Facilitating Healing
Low intensity _________ may be effective
in facilitating the healing process
 _________ may be used safely immediately
following injury

Fibroblastic - Repair Phase
Treatments may change from cryotherapy to
thermotherpy
 Thermotherapy techniques are used to
________ circulation to the injured area to
promote healing
 Heat modalities may also produce some
degree of ________

Fibroblastic - Repair Phase
____________ ____________ may be used to
facilitate removal of injury by-products
 ________ _________ currents may be used…

To elicit muscle contractions (_______ _______)
to reduce swelling
 For modulation of ________


Low-powered LASER may be used for
modulation of pain
Maturation - Remodeling Phase

___________ modalities are beneficial to the
healing process during this phase


_________, shortwave and microwave diathermy
may be used to increase circulation to deeper
tissues
Electrical stimulating currents may be used for
________ ________ and to stimulate muscle
contractions for increasing both ________ and
________
Goal For Using Therapeutic
Modalities

Assist the natural healing process while
doing no harm