Soft Tissue Healing PDF

Soft Tissue Healing Adam Squires PT, DPT, Cert SMT, Cert DN Board Certified Specialist in Orthopedic Physical Therapy  Objectives Understand definition of various soft tissue lesions Understand phases of soft tissue healing. Understand general treatment recommendatio...

Soft Tissue Healing Adam Squires PT, DPT, Cert SMT, Cert DN Board Certified Specialist in Orthopedic Physical Therapy  Objectives Understand definition of various soft tissue lesions Understand phases of soft tissue healing. Understand general treatment recommendations during each phase of healing. Understand the acronym PEACE and LOVE as it relates to management of soft tissue injury.  Soft Tissue lesions Strain – musculotendinous unit Sprain – joint capsule, ligament Dislocation – complete displacement Subluxation – partial displacement Tendinopathy – tendon pathology affected by mechanical load Synovitis – synovial membrane inflammation Hemarthrosis – bleeding into a joint Bursitis – inflammation of bursa Contusion – bruising due to trauma  Grades of Sprain/Strain Grade 1 Stretching or microscopic tears in tissue Minimal swelling, localized pain, almost normal ROM Grade 2 Partial tear of tissue Moderate swelling, bruising, and loss of ROM with significant pain Grade 3 Complete tear Severe pain, swelling, bruising, and loss of ROM Grades of Sprain/Strain Healing Times by Grade https://thephysio-group.com/soft-tissue-healing-times/  Soft Tissue Repair Inflammatory Phase Assess the damage and clear out damaged tissue 4-6 days and lasts up to 2 weeks Proliferative Phase Begin repairs 4-24 days but up to 6 weeks in limited circulation (e.g. tendons) Remodeling Strengthen and complete repairs 3 weeks to 2 years depending on tissue and grade of damage  Soft Tissue Repair https://theprehabguys.com/tissue-healing-timelines/ https://www.equilibriummassage.co.nz/post/healing-timeframes-explained  Inflammatory Phase Tissue response and characteristics Chemical signals (e.g. histamine, bradykinin) induce vascular changes and edema Chemotaxis draws leukocytes and other immune cells to the area Clot formation Phagocytosis (leukocytes, macrophages) Clinical Signs Signs of inflammation – redness, swelling, heat, pain Movement - Pain before tissue resistance  Inflammatory Phase Management considerations Control stress to the injured tissue I.e. Protection Reduce swelling Control, but do not interfere with, inflammatory response Pain is guide PEACE Protection, Elevation, Avoid anti-inflammatories, Compression, Education PEACE https://bjsm.bmj.com/content/54/2/72  Proliferative Phase Tissue response and characteristics Growth of capillary beds Collagen formation (Type III) Granulation tissue Clinical Signs Movement - Pain synchronous with tissue resistance Decreasing inflammation signs  Proliferative Phase Management Considerations Continue controlled stressing of tissues Can progress ROM, intensity, frequency More targeted to restrictions Still fragile tissue No quick, explosive stressing of tissue Pain is guide LOVE Load, Optimism, Vascularization, Exercise Proliferative Phase https://bjsm.bmj.com/content/54/2/72  Remodeling Phase Tissue response and characteristics Maturation of scar tissue Contracture of scar tissue Remodeling of Type III collagen to Type I Collagen aligns to stress Clinical Signs No inflammation signs Movement - Pain at end-range tissue resistance  Remodeling Phase Management Considerations Progressive stress to tissues Increase volume, load, intensity Incorporate rapid, quick, power movements Progressive return to prior level of function Avoid pain, but discomfort normal when pushing limits LOVE Remodeling Phase https://bjsm.bmj.com/content/54/2/72  Factors that affect healing Lifestyle factors Diet Activity levels Smoking/Alcohol Stress Comorbidities Age Obesity Diabetes Immunocompromised conditions Application  Application For the following cases Identify which phase of healing the patient is experiencing. Determine when the patient, generally, will move to the next phase. Determine one piece of education you would give the patient about their phase of healing. Determine one appropriate intervention for the patient  Case 1 16 year-old with Grade 1 sprain of ATFL 36 hours ago Slight swelling in the ankle Pain: 4/10 at its worst in the last 24 hours Pain at end-range dorsiflexion and inversion No pain with ambulation, but pain with running, jumping, cutting Wants to be ready to play in the state championship tomorrow night  Case 2 40 year-old with Grade 2 hamstring strain 2 months ago No swelling No pain with daily activities, but discomfort with stairs and running (2/10) Slight pain (2/10) at end-range stretch Wants to be ready for slow-pitch softball season in a couple of months  Case 3 23 year-old strained his back 2 weeks ago moving into a new apartment Slowly regaining his ROM, still pain (4/10) at end-range flexion and rotation No pain at rest except sitting for more than 30 minutes (4/10) Wants to be able to get back to running and be ready for a plane ride to Germany in 1 month. Questions