Soft Tissue Healing

To develop knowledge and understanding of the soft tissue repair process

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Label each phase of healing

  • Bleeding
  • Inflammation
  • Proliferation
  • Remodelling

Bleeding Phase

  • Immediate
  • Lasts approximately
  • Vascularity of the tissue determines how much it bleeds

 = Increased blood viscosity

  1. Local vaso (brief)
  2.  release - changes occur to platelets to increase clotting
  3. Platelet activation - serotonin release
  4. Coagulation - clots form upon conversion of fibrinogen to fibrin. Formation of fibrin collagen attracts RBC’s and WBC’s to make the clot even stronger.

Inflammation Phase

  • Rapid onset
  • Peaks to maximum reaction over
  • Gradually resolves after 2-3 weeks
  • 2 essential elements to the inflammatory events =  Vascular and Cellular

 

Vascular Cascade

Onset caused by remaining chemicals from the coagulation stage

Vaso and Vasopermability - increases blood flow locally

Increased exudate - mast cells release hyaluronic acid which binds with exudate to form gel like substance to  flow.

 

Cellular Cascade

 - Movements of phagocytes/leucocytes (WBC's) from blood flow to injury site

Phagocytosis - Removal of dead cells, fibrin and clot residue - this produces  which stimulates proliferation

Proliferation Phase

  • Rapid onset () – begins weakly during  
  • Peaks at approx 2-3 weeks
  • 2 fundamental processes involved = Fibroplasia and Angiogenesis

 

Fibroplasia

Repairs  

 - Chemically mediated by macrophages & migrate to injury site to lay down type lll collagen ()

 

Angiogenesis

New formation

- Grown and bud towards repair zone and increase blood flow through region increasing  - important for collagen production

 

Remodelling Phase

Overlaps  phase

Reabsorption & maturation of type lll collagen to type l

  1. fibroblast activity
  2. Increased organisation of the extracellular matrix
  3. blood flow
  4. Decreased water content
  5. organisation of new tissue
  6. Resumption of normal cell activity

 

 

Scar Tissue

  • Scar tissue is less functional and flexible than the original tissue
  • Scar tissue is more functional and flexible than the original tissue
  • Scar tissue has less tensile strength than the original tissue
  • Scar tissue has more tensile strength than the original tissue
  • Scar tissue is fibrous and relatively avascular
  • Scar tissue has a high level of vascularity

Inflammatory interventions

  • PRICE
  • Ultrasound
  • Soft Tissue Therapy
  • NSAIDs
  • Early strengthening
  • Manual Therapy