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Injury rehabilitation requires sound knowledge and understanding of the etiology and pathology involved in various musculoskeletal injuries that may occur.1,2 When injury occurs, the therapist is charged with designing, implementing, and supervising the rehabilitation program. Rehabilitation protocols and progressions must be based primarily on the physiologic responses of the tissues to injury and on an understanding of how various tissues heal.3 Thus the therapist must understand the healing process to effectively supervise the rehabilitative process. This chapter discusses the healing process relative to the various musculoskeletal injuries that may be encountered by a therapist.


Rehabilitation programs must be based on the cycle of the healing process (Figure 2-1). The therapist must have a sound understanding of the sequence of the various phases of the healing process. The physiologic responses of the tissues to trauma follow a predictable sequence and time frame.5 Decisions on how and when to alter and progress a rehabilitation program should be primarily based on recognition of signs and symptoms, as well as on an awareness of the time frames associated with the various phases of healing.6 The healing process consists of the inflammatory response phase, the fibroblastic repair phase, and the maturation remodeling phase. It must be stressed that although the phases of healing are presented 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.7

Figure 2-1

A cycle of sport-related injury

(Adapted with permission from Booher JM, Thibadeau GA. Athletic Injury Assessment. St. Louis, MO: Mosby; 2000.)

Primary Injury

Primary injuries are almost always described as being either chronic or acute in nature, resulting from macrotraumatic or microtraumatic forces. Injuries classified as macrotraumatic occur as a result of acute trauma and produce immediate pain and disability. Macrotraumatic injuries include fractures, dislocations, subluxations, sprains, strains, and contusions.

Microtraumatic injuries are most often called overuse injuries and result from repetitive overloading or incorrect mechanics associated with repeated motion.8 Microtraumatic injuries include tendinitis, tendinosis, tenosynovitis, bursitis, etc. A secondary injury is essentially the inflammatory or hypoxia response that occurs with the primary injury.


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