Chapter 10: Tissue Response to Injury

William E. Prentice

OBJECTIVES

When you finish this chapter you should be able to

• Contrast the three phases of the healing process.

• Classify the physiological events that must take place during each phase of healing.

• Identify those factors that may impede the healing process.

• Discuss treatment techniques for modifying soft-tissue healing, including using anti-inflammatory medications, therapeutic modalities, exercise rehabilitation, and platelet-rich plasma injections.

• Discuss the healing process relative to various soft-tissue structures, including cartilage, ligament, muscle, tendon, and nerve.

• Describe the healing process as it occurs in bone.

• Formulate a management plan for treating acute fractures.

• Define pain and discuss the various types of pain.

• Understand the neurophysiology of pain.

• Differentiate among the three mechanisms of pain control.

• Examine the various techniques for assessing pain.

KEY TERMS

• margination

• leukocytes

• diapedesis

• exudate

• neutrophils

• phagocytes

• vasoconstriction

• macrophages

• lymphocytes

• fibroblasts

• fibroplasia

• collagen

• proteoglycans

• glycosaminoglycans

• microtears

• macrotears

• NSAIDs

• prolotherapy

• platelet-rich plasma (PRP)

• avascular necrosis

• trigger points

• nociceptors

• gate control theory

• descending pathway pain control

• β-endorphin

• dynorphin

• visual analog scale

• pain charts

• McGill Pain Questionnaire (MPQ)

• Activity Pain Indicators Profile

• Numeric Rating Scale

THE HEALING PROCESS

It is essential for the athletic trainer to possess an in-depth understanding of the healing process. The healing process consists of three phases: the inflammatory response phase, the fibroblastic repair phase, and the maturation- remodeling phase. The athletic trainer should recognize both the sequence and the time frames for these phases of healing and realize that certain physiological events must occur during each of the phases. Anything that an athletic trainer does that interferes with this healing process will likely slow the return to full activity. The healing process must have an opportunity to accomplish what it is supposed to. At best, the goal of the athletic trainer should be to try to create an environment that is conducive to the healing process. There is little that can be done to speed up the process physiologically, but there are many things that may be done during rehabilitation to impede healing. Although the phases of healing are often discussed as three separate entities, the healing process is a continuum. Phases of the healing process overlap one another and have no definitive beginning or end points (Figure 10–1).