Pro Motion Physiotherapy & Sports Injury Clinic

The Body's Response To Injury

The body responds with a predictable sequence of events following trauma. Knowledge of such helps you and your healthcare professional decide on the most appropriate form of post injury management.

I. Inflammatory Phase (4-6 days post injury)

This is the body's initial response to trauma.

• The inflammatory process serves as a protective mechanism and is necessary for subsequent healing to occur.
• It involves the release of chemicals which change the permeability of the walls of small blood vessels. This allows the escape of blood plasma and proteins into the surrounding tissue, producing the swelling often associated with soft-tissue injuries.
• Blood clots form and the chemical irritants causing the pain are neutralized.
• Scavenger cells begin to 'clean up' the cellular debris/dead tissue which may slow down tissue repair.
• Tissue repair and regeneration cannot occur until the inflammatory process has subsided.

II. Repair Phase

(2-3 weeks up to 6 weeks post injury)

• Begins once the inflammatory phase has subsided and painful stimuli have been removed.
• Marked by the production and laying down of collagen (the most abundant protein found in connective tissue of which ligaments , tendons, bones, cartilage and blood vessels are composed).
• A dense network of small blood vessels and connective tissue forms a 'bridge' across the damaged tissue.
• Wound closure in muscle takes 5-8 days and 3-5 weeks in tendons and ligaments.
• Damaged tissue heals by regeneration: the replacement of damaged cells by like tissue, and repair: the replacement of damaged cells by scar tissue. Generally, there is always more scar tissue than original tissue laid down and thus the repaired tissue is never as strong as the original tissue.
• The immature connective tissue formed has many small blood vessels, is very fragile, is largely disorganized and is easily damaged if over stressed.

III. Maturation/Remodelling Phase

(3 wks up to point where pain free status attained)

• Randomly arranged collagen and scar tissue fibers become aligned in parallel fashion in the direction that stress is applied to them. This forms the strongest possible repair. Unorganized collagen/scar tissue is weak and easily re-injured.
• Connective tissue can easily be remodeled with persistent, gentle treatment up to 8-10 weeks after the injury
• If proper stresses are not applied to the new tissue, it will adhere to surrounding structures and form restricting scars.
• After 14 weeks the scar tissue is unresponsive to remodeling and any lengthening changes must occur in surrounding tissues or else by surgical release.

Chronic Inflammation

• Not a normal phase of healing.
• Occurs when excessive stresses are applied to the developing and remodeling collagen tissue. It was once thought that this would result in a continuing, low level, inflammatory phase causing a weakening and limitation of motion of the involved tissues. Recent research suggests that the chronic pain experienced during this phase is due to collagen breakdown in the absence of inflammation.
• Attempts to stretch this tissue causes further irritation and stiffness.

Why Pro Motion Physiotherapy?

Physiotherapy is beneficial for the recovery from soft-tissue injury for the following reasons:

• Aides in decreasing and limiting the inflammatory phase and increasing blood flow to the repairing tissue (repair phase) through use of ice, laser, ultrasound, interferential current, TNS and heat.
• Provides guidance on appropriate activities to maximally load repairing tissue without causing further damage, thus creating the strongest possible repair in the maturation/remodeling phase.
• Limits the effects of immobilization such as joint stiffness, muscle weakness, cartilage degeneration, weakened tendons and ligaments.