Muscle Health and Injury Flashcards
What processes occur in regeneration of soft tissue?
Regeneration: replacing damaged tissue using surrounding undamaged cells.
Repair: Tissue granulation occurs to form mature scar tissue.
Describe the first stage of muscle healing
The bleeding phase. Starts immediately after injury. Bleeding is 6-8 hrs but depends on tissue type and injury. Eg less vascular tissues bleed less but crush injuries to highly vascular muscle tissue can bleed up to 24hrs.
Blood cells, plasma and ATP are released into the wound site. Bleeding is essential, it’s an ‘inflammatory mediator’ via platelet activation
Describe the second phase of tissue healing, including the main signs
The 2nd phase is the inflammatory phase. This aims to stop bleeding so hay cross-over with the bleeding phase.
Damaged cells release kinase and histamine which stimulate pain receptors and cause vasodilation. This ⇡ blood flow to the area so we see redness/heat.
⇡ blood flow increases metabolic rate in the tissue cells to stimulate healing. Capillaries become permeable/leaky, causing oedema which leads to pain, swelling and temporary loss of function.
Describe the third phase of tissue healing
The proliferation/regeneration phase can start 24hrs post injury and can last around 2-3 weeks:
- Fibroplasia: formation of fibrous tissue.
- Angiogenesis: formation of blood vessels
- Fibroblasts cells are stimulated, and lay down type III collagen which is more elastic.
- Fibroblasts become myofibroblasts. Thick actin protrusions extend to the wound edges and contracts to minimise scar.
What is the final phase of healing?
The final phase is the remodelling phase which lasts many weeks. In this phase hay scar formation:
- Orientation of collagen fibres
- Collagen deposition: type 1 replaces type 3 collagen
- Capillaries diminish in number, which reduces redness
- Tensile strength increases.
Oedema ⇣ (as extracellular matrix substances reduce), and reduced pain (less neuroexcitability + stronger scar).
Which risk factors affect tissue health?
History of Injury, Fatigue/Overuse, Weak muscles
Decreased flexibility, Failure to stretch/warm-up, Disease
High risk activities, Mechanical dysfunction, Age
Medication use: NSAID or steriods
How would a clinician first approach a muscle injury?
Subjective Assessment: Mechanism, symptoms, PMH to identify risk factors
Objective Assessment: Clinical assessment & findings, Investigations including diagnostic imaging.
How are muscle injuries classified?
A= w/in the muscle belly. This is more vascular so has greater opportunity for healing
B= In connective tissue, C= in the tendon
How would a clinician manage a muscle injury?
First consider the stage of muscle healing, and the patient’s hopes, fears and support. Approaches:
Medical: Pain - Analgesia. Use the “Analgesic ladder”. For swelling/inflammation & pain, use non-steroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen/Naproxen
Surgical: eg rotator cuff repair
Conservative/alternative: implies excluding 1 thing to favour another, eg just acupuncture
Complimentary: coexistence. 2 things complementing each other’s deficiencies.
Outline the best management principles for muscle injury
Describe the role of physiotherapy in soft tissue management.
Physio promotes optimal management, tissue healing, function and independence. It emphasises exploring patient hopes into short + long term goals. It inc:
Exercise, using appropriate load. Education.
Manual therapy: promotes functional movement of joint, muscle and nerves as required
Electrotherapy: intended to promote natural tissue healing and repair processes.
Outline the role of complimentary therapies in soft tissue injury and rehabilitation
Acupuncture: Useful in pain treatment, muscle spasm, nausea. Moderates pain via endorphin release
Cupping: Decompressive effect thought to lift the skin off the underlying fascia. This promotes blood flow, tissue healing and pain relief
