— Inflammatory / (Maximum) Protective Phase
— Signs of inflammation are present: swelling, redness, heat, pain at rest, and loss of function.
— Clot formation
— Pain before resistance -> aka pt guards before can actually hit R1 (resistance).
— 4-6 days.
Goals as a PT: control the effects of inflammation, facilitate wound healing, and maintain normal functioning in unaffected tissue and body regions.
Structural and Functional Impairments:
— Inflammation, pain, edema, muscle spasm
— Impaired mov't
— Joint effusion (if joint = injured or arthritis)
— Decrease use of associated areas.
Plan of Care
— Educate pt
— Control pain, edema, and spasms.
— Maintain soft tissue and joint integrity and mobility
— Reduce joint swelling if Sx are present (may require further medical attention if swelling is v rapid).
— maintain integrity and function of associated areas.
— inform pt about recovery time and how to protect it when doing ADLs.
— ice, compression, elevation, massage (48 hrs); avoid positions that cause it stress!
— Gentle (grade 1 and 2) oscillations with joint in pain-free position
— appropriate amount of passive mov'ts within limit of pain.
— appropriate amount of E-stim
— Active-Assistive, free, resistive, and/or aerobic exs depending on proximity to the associated area!
— Assisted devices if necessary to help them with ADLs.
**Signs of TOO MUCH mov't = increased pain or increased inflammation!!!
— Proliferation, repair, and healing stage
— decrease inflammation
— pain = resistance
— lasts 14-21 days after injury, up to 6 weeks.
— increases in fibroblastic activity, collagen formation, and granulation tissue development.
— depending on injury, wound closure usually takes 5-8 days in muscle and skin and 3-6 weeks in tendons and ligaments.
— thin an unorganized immature connective tissue is present and can be easily injured if over-stressed.
— active movement can begin in the pain-free ROM.
— goal = to initiate and progress non-destructive ex and activities.
Plan of care:
— Edu pt
— Promote healing of injured tissue
— restore soft tissue, muscle, and/or joint mobility
— develop neuromuscular control, muscle endurance, and strength in involved and related mm.
— Maintain integrity and function of associated areas.
Intervention & Exercises:
— Cardiovascular = SOB, heavy chest, pulsating pain anywhere in the body, swelling without injury.
— GI/Genito-urinal = severe abdominal pain, heartburn or indigestion, frequent nausea or vomiting, changes in bowel or bladder function, unusual menstrual irregularities
— Neurological = changes in hearing, severe headaches, problems with swallowing or change in speech, changes in vision, problems with balance or falling, fainting, numbness of the face, bilateral or quadrilateral weakness or parenthesia
— Musculoskeletal = swelling and redness in any joint without history of injury