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factors that determine length of time for tissues to heal

specific tissue damaged, severity of the damage, overall health of the person

inflammation occurs in

vascularized tissue

inflammation causes


3 phases of inflammation

acute, repair, maturation

inflammatory response phase

initial phase of injury

inflammatory response phase lasts

4-6 days

what happens in the inflammatory response phase

release of cellular material, vascular changes, clot formation

purpose of modalities

to make the environment better for inflammation to progress

clinical signs of the inflammatory response phase (acute stage)

swelling, redness, heat, pain, loss of function

inflammatory response phase removes


inflammatory response phase allows for growth of

new capillaries

inflammatory response phase is initiated and controlled by

chemical released by cells and activated by plasma proteins

inflammatory response phase stimulates

free nerve endings. pain causes spasms

muscle spasm starts the

pain cycle

modalities used for RX of

acute injuries and persistent pain (pain at rest)

modalities in the acute stage of inflammation help speed recovery by

interrupting pain-spasm cycle, restoring functional ability

chemical mediators cause opening of

capillary beds

increased blood flow causes

redness, warmth at inflammation site, capillaries become more permeable, proteins attract water and causes swelling

inflammatory response lasts until

damaged tissue has been removed, new capillary network has been formed to support tissue repair.

purpose of acute inflammation

clears neurotic tissue, builds new capillaries

in the inflammatory response phase modalities are used to

decrease circulation, pain, and enzyme activity rate; controlling motion; promoting inflammation progression

fibroplastic repair phase aka

sub acute phase

scar fomation occurs during what phase

sub acute (fibroplastic repair phase)

sub-acute stage lasts

10-17 days

breakdown of clots happen during

sub-acute phase (fibroplastic repair phase)

clinical signs of the sub acute phase

acute clinical signs are decreased; pain with tissue resistance at end range, developing soft tissue formation

beginning of the sub-acute stage (proliferation stage) is marked by

new blood vessels; granulation tissue; fibroblasts (cells responsible for production of new growth)

length of the sub-acute phase depends on

size and site of injury, type of tissue involved

matrix has 2 components

non fibrous element (ground substance)

sub acute phase: ground substance fills __ and reduces __

fills spaces bt fibers and reduces friction

sub acute phase: fibrous elements

collagen, reticulin, elastin (provides strength and resilience to stress

sub acute phase: type III collagen is

weak and thin

external signs of the sub acute phase

redness bc of capillaries and water, swelling, pain when stretched

sub acute phase: modalities are used to

increase circulation and enzyme activity rate; promote collagen deposition along lines of stress, progression on inflammation

maturation-remodeling phase is aka

chronic phase

maturation-remodeling phase lasts


reallignment of collagen fibers happens in what stage

chronic (maturation/remodeling phase)

collagen is easier ro remodel when it is


clinical signs of the chronic stage (maturation-remodeling stage)

no signs of inflammation, may have decreased strength and ROM

in the chronic stage, as healing takes place type III collagen is replaced by

type I

fiber allignment improves and links bt fibers become stronger in what phase

chronic (maturation/remodeling phase)

in the maturation-remodeling phase if too much stress is applied too soon

tissue fails (bc it's weak) and re-injury occurs

focus of rehab in the maturation-remodeling phase

functional activities and return to activity

rate of progression in the maturation-remodeling phase depends on

nature and extent of injury, person's overall fitness, demands of activity returning to

in the maturation-remodeling phase modalities are used to

alter balance of collagen deposition and reabsorption and improve alignment of new collagen fibers

chronic inflammation increases

immature collagen production (type III)

chronic inflammation degenerates

mature collagen (type I)

clinical signs of chronic inflammation

increased pain and swelling hours after activity

possible reasons for chronic inflammation

excessive mechanical stress due to overly aggressive RX plan, non compliance by pt, infection

causes of inflammation

ST trauma (strains, sprains, contusions), FX (fracture), foreign bodies, autoimmune disease, microbial agents, chemical agents, thermal agents, irradiation

acute stage treatment goals

control edema, spasm, pain, maintain ST and jt integrity, decrease jt. swelling, maintain functional level of associated areas, educate pt.

sub-acute stage treatment goals

promote healing of injured tissue, progressively restor ST and jt mobility, strengthen involved and related muscles, maintain functional level of assoc. areas, educate pt.

chronic stage treatment goals

decrease pain from stress on contractures, adhesions, increase ST and jt. mobility, strengthen all areas, increase endurance, progress to independance, educate pt.

chronic inflammation treatment goals

promote healing, eliminate causes, maintain integrity, progress functional independance, correct environmental factors, develop strong mobile scar, structural balance and support in related areas.

ice does not

slow bleeding

swelling at time of injury increases

cell permeability

swelling is caused by

increased proteins in interstitium and osmotic pressure of proteins

treatment of swelling

elevation (decreases hydrostatic pressure); external pressure (min. oxmotic pressure exerted by free proteins in interstitium); muscle contractions (facilitate lymphatic drainage)

joint effusion

excessive amt of fluid produced when synocial is irritated

joint effusion cause

loose bodies, torn meniscus

joint effusion impairs

function, normal mechanics of a jt.

swelling in the lower extermity due to venous insufficiency can cause

chronic swelling

1 way valves in veins fail with

increased age

elevation of the feet allows

gravity to pull venous blood toward heart, decrease hydrostatic pressure at venule, promotes interstitial drainage

function of compression stockings

increase interstitial resistance to fluid loss and help control edema

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