Stages of Healing Ch.1

Question 1

What are the 4 stages of healing?

Answer 1

1. ) Hemostasis
2. ) Inflammatory
3. ) Proliferation (repair)
4. ) Remodeling/maturation

Question 2

Hemostasis involves what and lasts how long?

Answer 2

Initial blood clotting to stop bleeding. Lasts seconds -> minutes.

Question 3

What is another name for the inflammatory stage, and how long does it last?

Answer 3

The acute phase.

Hours -> days -> weeks

Question 4

How long is the proliferation phase?

Answer 4

Weeks -> months

Question 5

How long is the maturation phase?

Answer 5

Months -> year

Question 6

Does the cause of injury change the stages of the healing process? Are there any exceptions?

Answer 6

No. Time can vary

Question 7

Are the stages of healing clearly demarcated and occur separately?

Answer 7

No, there is much overlap.

Question 8

What is the purpose of the Inflammation (acute) phase?

Answer 8

To defend against foreign intruders (infection), Remove damaged tissue and debris, Immobilize area.

Question 9

How well will avascular or poorly vascularized tissue heal?

Answer 9

Not well

Question 10

What are the signs of Inflammation?

Answer 10

Rubor - redness
Calor - heat
Dolor - pain
Tumor - swelling
Functio laesa - loss of function

Question 11

What characterizes the inflammation stage at the site of injury?

Answer 11

Vasodilation, Increased capillary permeability, Phagocytosis by neutrophils and macrophages.

Question 12

Which inflammatory chemicals cause pain?

Answer 12

Bradykinin, prostaglandins, serotonin

Question 13

Inflammation can cause secondary injury. What are the 2 types of secondary injury?

Answer 13

Secondary enzymatic injury, secondary hypoxic injury.

Question 14

What characterizes secondary enzymatic injury?

Answer 14

Lysosomal enzymes released
Not specific
Healthy tissue is damaged

Question 15

What characterizes secondary hypoxic injury?

Answer 15

Hemorrhage, edema, clotting, spasm, hematoma.
These lead to decreased O2 and nutrients.
Damage to surrounding uninjured tissue.

Question 16

What are the doctor’s goals and intervention in the acute phase?

Answer 16

Goals: limit extent of inflammation, preserve ROM

Intervention: PRICE (protect, rest, ice, compress, elevate).

Question 17

What is the time frame for the acute phase of an ankle sprain with each grade?

Answer 17

Grade 1: 1-3 days

Grade 2: 2-4 days

Grade 3: 3-7 days

Question 18

What is the Doctor’s focus during the acute phase of an ankle sprain?

Answer 18

Decrease swelling
Decrease pain
Protect from re-injury
Maintain appropriate weight bearing

Question 19

What are the protective measures needed for the acute phase of an ankle sprain?

Answer 19

Taping
Functional bracing
Remove cast or walking boot
Rest
Crutches

Question 20

What are the interventions needed for the acute phase of an ankle sprain?

Answer 20

Ice (to decrease pain and swelling)
Compression
Elevation (above heart, add in ankle pumps - dorsi/plantar flexion)

Question 21

What characterizes the proliferative (repair) stage at the site of injury?

Answer 21

Angiogenesis (new capillaries)
Fibroblasts, chondroblasts, Osteoblasts
Extracellular matrix (type III collagen, Proteoglycans)
Proprioception

Question 22

What is the timing of the proliferation phase by grade?

Answer 22

Grade 1: 2-4 days
Grade 2: 3-5 days
Grade 3: 4-8 days

Question 23

What are the doctor’s goals for the proliferation phase?

Answer 23

Decrease pain
Decrease swelling (if still present)
Encourage and increase proliferation
Increase pain free range of motion
Begin non-weight bearing proprioceptive training
Provide protective support as needed.

Question 24

What kind of passive care interventions are appropriate for the proliferation phase?

Answer 24

Decrease pain and swelling: IFC, PreMod, Hi-Volt, Ice, Contrast baths, Massage (gentle)
Soft orthotics

Administer EPA’s to increase proliferation: Thermotherapy, ultrasound, low level laser therapy, microcurrent.

Question 25

What are the active care interventions appropriate for the proliferation phase?

Answer 25

Increase weight bearing (as pain permits). Partial to full weight bearing progression). Active range of motion: (can be performed in water). Plantar/dorsiflexion, foot circles, alphabet. Proprioceptive training, progressing to unstable surface: Seated (less of a challenge), standing (more challenge/risk), wobble boards, dynadiscs. Strength exercises (to limit atrophy): isometrics in a pain free range. toe curls with towel, pick up objects with toes. Stretching: Passive ROM (dorsi/plantarflexion as pain allows), achilles stretching, joint mobilization.

Question 26

What characterizes the remodeling/maturation phase?

Answer 26

``` Scar contraction (can lead to joint adhesion, loss of motion). Decrease of blood vessels. Type III collagen replaced by type I (collagen aligns across stress lines). Cross linking continues. ```

Question 27

Tension on connective tissue causes:

Answer 27

Increased collagen fibril diameter Increased cross linking Increased number of collagen fibrils Increased collagen fibril packing density

Question 28

What is beneficial about collagen fibers aligned in an organized, parallel fashion?

Answer 28

Forms the greatest number of cross links. Possesses optimal strength.

Question 29

What is the timing associated with the remodeling phase of an ankle sprain by grade?

Answer 29

Grade 1: 1 week Grade 2: 2 weeks Grade 3: 3 weeks

Question 30

What are the goals of the remodeling phase of an ankle sprain?

Answer 30

``` Increase pain-free ROM Progress proprioceptive training Regain full strength Normal biomechanics Protect and strengthen any residual joint instability ```

Question 31

What are the active care interventions for the remodeling phase of an ankle sprain?

Answer 31

Stretching: (gastroc/soleus) Joint mobilization. Strengthening: heel toe raises (controlled), stair steps, quarter squats, eccentric/concentric with weight cuffs. Proprioceptive training: progress to single leg exercises.

Question 32

What are some task specific skills appropriate for active care in the remodeling phase?

Answer 32

Running, alternating jogging to sprinting in a straight line, agility training, proprioception (e.g. multi-directional lunges) Power: plyometrics, box jumps, etc.

Question 33

Properly applied external forces enhance what?

Answer 33

Collagen organization (arrangement).