The Basics of Healing Understanding the Inflammation Process

The Healing Process • It is practical to have a sense of the healing process this will give you insight into why some injuries take longer than others to recover • In an ideal world, we would let the process take over and allow the athlete to heal properly • In athletics, we do not have the luxury in many cases to allow this to happen

The Healing Process • Consists of 3 phases: 1) Inflammatory response phase 2) Fibroblastic repair phase 3) Maturation - remodeling phase • Anything done when treating an athlete that interferes with this process will likely slow the return to full activity

The Healing Process • There is little that can be done to speed up physiology • But we can provide the optimal environment for healing or do the opposite and impair the process • Understand these phases, although discussed separately, do overlap and sometimes are tough to distinguish

The Healing Process • Inflammatory Response Phase – The initial inflammatory response is critical to the entire healing process. If this response does not accomplish what it is supposed to do, normal healing cannot take place – The body often overreacts in this phase – This is an individual process - each of us are different

The Healing Process • The inflammatory response phase – Signs we are in this phase: • 5 signs of inflammation: – – – Redness Swelling Tenderness Increased temperature Loss of function – How long does this phase last? • Typically 72 hrs if treated correctly

The Healing Process • Inflammatory Response Phase – How do we treat this correctly and allow it to do its thing? – R. I. C. E. • Rest = Do not use the part (crutches, slings, splints, etc) • Ice = Used for pain and vasoconstriction (slow down the body’s overreaction) – 20 min on and 1 hr off – Hunting response - a slight temperature increase during cooling – A reaction against tissue damage from too cold exposure. This is important to educate athletes on how long they should leave ice on • Compression = elastic wrap will help control edema and reduce space for fluids to develop • Elevation = help the lymphatic system by using gravity to return the damaged cells to the core for removal

The Healing Process • Fibroblastic Repair Phase – How do I know? • Generally, signs and symptoms of inflammatory period subside • Tenderness and pain with function remain – How long does it last? • Starts few hours after injury and can last as long as four to six weeks depending on tissue and trauma done

The Healing Process • Maturation - Remodeling Phase – Tensile strength begins to increase – Wolff’s Law states that bone and soft tissue will respond to the physical demands placed on them to remodel or realign along the lines of the tensile force – This is why most patients are now treated with controlled mobilization rather than complete immobilization

The Healing Process • How do I know? – Clinical signs and symptoms will now begin to disappear – As healing progresses to remodeling, controlled activity is warranted with a gradual return to normal flexibility and strength – Usually, this is the time to tape, wrap and brace to allow activity while supporting the structure

The Healing Process • Factors that impede healing: 1. Extent of injury or separation of tissue 2. Amount of edema - increased pressure impedes healing process 3. Hemorrhage 4. Poor blood supply 5. Muscle spasm 6. Infection 7. Health, age and nutrition Allowing activity too early may allow these things to happen!

The Healing Process • Methods used to modify healing: – Drugs: Non-steroidal anti-inflammatory drugs (NSAIDs): ibuprofen, advil, motrin, etc. - combat out of control inflammation – Thermal agents - cold first 72 hrs, usually a combo thereafter – Modalities - Electrical Stimulation = helps with pain and inflammation, Ultrasound = aids in blood flow and healing in later stages – Exercise - trend now is early range of motion (ROM) to aid in maturation-remodeling and avoid adverse biochemical changes

The Healing Process • So how do we apply all this knowledge? • In general: – Sprains and Strains: • RICE for first 72 hrs • “R” may include brief period of immobilization • After 72 hrs, introduce heat (hot packs, ultrasound, whirlpool) and range of motion (ROM) exercises • When symptoms begin to subside and ROM returns - begin strengthening and return to functional • If we handle properly, expected length of recovery: – 1 st degree = 3 -6 wks – 2 nd degree = months – 3 rd degree = months to years

The Healing Process • In general: – Fractures • Immobilize 6 -8 wks depending on severity • Then we begin the process • Expected length of recovery: – 2 -4 months – “itis” • Begin healing modalities, stretching and massage right away in combo with ice and electrical stimulation • Stimulate blood flow • Monitor stages and modify as needed • Generally, we are not going to heal this, we want to keep athlete in functional stages