The Healing Process

1. Platelets and leukocytes lines vascular cell wall

2. 1. Inflammatory-Response Phase

2.1. Very crucial and acute stage

2.2. Leukocyte cells (WBC) that fights infection and tissue damage and cleans up damaged cells

2.3. Phagocytic cells destroy and ingest cellular debris

2.4. Clotting is formed

2.5. Chemical Mediators

2.5.1. Leukotrienes: responsible for margination

2.5.2. Histamine: causes vasodilation and increase cell permeability

2.5.3. Cytokines: help Leukocytes and attracts them to injury site

2.6. Injury

2.7. Chemical mediators released

2.8. Vascular Reaction

2.9. Clot Formation

2.10. Phagocytosis

3. 2. Fibroblastic-Repair Phase

3.1. Regeneration and proliferation activity which leads to scar formation (Fibroplasia)

3.2. Scar Formation

3.2.1. Fibroblasts begin to produce collagen fibers that deposit in random fashion

3.3. Revascularization

3.4. Cells Involved

3.4.1. Macrophages

3.4.2. Pericytes

3.4.3. Lymphocytes

3.4.4. Angiocytes

3.4.5. Neurocytes

3.4.6. Fibroblasts

3.4.7. Keratinocytes

3.4.8. Epithelial

4. 3. Maturation-Remodeling Phase

4.1. Longest Phase

4.2. Increased tensile strength of scar matrix

4.3. Continuation of collagen synthesis and breakdown

4.4. Process can take up to seven years to totally complete

4.5. At 3 weeks - A firm, strong, and contracted nonvascular scar is formed

4.6. Cells Involved

4.6.1. Fibrocytes

4.6.2. Fibroblasts

5. Therapeutic Modality and Inflammatory Response Phase

5.1. Should be used to decrease swelling and control pain

5.2. Cryotherapy should be used to minimize excessive swelling

5.2.1. Heating too soon can cause more damage

5.3. Should incorporate active range of motion and passive range of motion exercises

6. Therapeutic Modality and Fibroblastic Repair Phase

6.1. Thermotherapy can be used to increase circulation and promote healing

6.2. Intermittent Compression can be used to facilitate the removal of injury by-products

6.3. Electrical Stimulation can be used for pain modulation and elicit muscle contraction

7. Therapeutic Modality and Maturation Remodeling Phase

7.1. Longest healing process

7.2. Thermotherapy is the most beneficial to healing

7.2.1. Specifically DEEP heating

7.3. Ultrasound and Diarthermy to increase circulation to deeper tissue

7.4. Electrical stimulation for pain modulation and muscle contraction

7.5. continue with strengthening exercises