Soft Tissue Healing

SOFT TISSUE HEALING & PHYSIOTHERAPY MODALITIES Re-visit "Tissue Damage and Healing" from biomed in Physio One module, use resources on soft tissue healing such as http://www.electrotherapy.org/modalities/tissuerepair.htm from Electrotherapy on the Web, and work through the following notes to answer these questions: a. What factors influence healing of soft tissue injuries? b. How can physiotherapy modalities influence physiological factors to promote healing? _________________________________________________________________________ KEY POINTS  Pain modulation - active and passive mobilisation/electrotherapy  Circulation - massage/exercise/electrotherapy  Fibre alignment – ultrasound/exercise/massage

1. Inflammatory Phase Inflammation is an essential part of healing, but as an "all or nothing" response can be harmful. Excessive or prolonged inflammation  • excessive scar formation • pain • oedema • secondary tissue ischaemia • loss of movement and weakness Physiotherapy aims to control inflammation: • prevent disruption of new blood vessels and collagen fibrils • minimise bleeding • promote collagen and ground substance synthesis • reduce oedema • protect healing tissue • provide pain relief PROTECTION e.g. strapping or crutches - avoid further stress REST - avoid further injury and bleeding ICE - helps with swelling and pain relief COMPRESSION - helps reduce oedema ELEVATION - helps prevent stasis/accumulation of oedema Movement during inflammatory phase: ✔ Improves blood flow ✔ Decreases swelling ✔ Relieves pain ✔ Increases phagocytosis ✔ Prevents joint stiffness and muscle weakness in related areas Inflammation control should overlap efforts to promote healing. Healing has not happened once inflammation subsides!

2. Proliferation (regeneration) Phase Use therapeutic techniques to help control pain and swelling; reduce reliance on support and strapping; progress activity levels Applying tension through exercise or manual therapy  • increase collagen synthesis, • promote better collagen alignment • increase tensile strength Early exercise enhances tissue oxygenation and nutrition, minimises unnecessary atrophy and aligns collagen fibres to meet eventual demands. The gradual loading of tissue during the healing process is critical to optimising the mechanical properties of the tissue and hence in preventing tissue re-injury, BUT need to be careful not to stimulate excess collagen production and thicken the scar formation. Movement during proliferation phase: ✔ ✔ ✔ ✔

Increases tensile strength Increases tissue metabolism Promotes extensibility of scar tissue Maintains and improves joint range of movement & muscle strength

3. Remodelling Phase Physiotherapy aims to help the tissues regain as near normal structure and function as possible and control tissue overload by modifying intrinsic and extrinsic factors  Achieve and maintain flexibility of healing tissues  Prevent unwanted adhesions [abnormal deposits of collagen that disrupt gliding between adjacent structures]  Restore functional activity  Address intrinsic and extrinsic causes Movement during remodelling phase: ✔ Restores full range of movement and muscle strength ✔ Counteracts scar contraction ✔ Restores function ✔ Restores confidence