Case Management I May 11, 2005 Acute Soft Tissue Injuries 3 phases of healing: 1. Inflammatory 2. Repair 3.

Remodeling Phase 1: Acute Inflammatory Phase • The inflammatory phase of healing peaks at day 4 and continues at least until day 10 post-injury (unless the person continues to irritate the tissue, bracing, icing, etc. may be necessary). • The longer you have inflammation, the better chance you will have an infection. Inflammation will tie up your immune system. Phase 2: Reparative Phase • This stage may last from 48 hours up to 6 weeks and is characterized by the synthesis and deposition of collagen. • Microcurrent, interferential, ice, etc. can help this stage get started. • Early ROM and nutrition are vital for collagen formation • Collagen will form in the direction of stress. Without ROM, collagen formation will limit future ROM. • Never sacrifice technique for weight! Collagen: • Triple helix structure (cross links in between the twists) • Cross-linking • Several different types (13-15 types) • Forms in the direction of stress • There is no medication to stimulate the formation of the cross linking! • As long as there is inflammation, you will never complete the healing process (mechanism of OA, GI carcinoma). Phase 3: Remodeling Phase • This phase may last from 3 weeks to 12 months or more • Period in which collagen is remodeled to increase the functional capabilities of the tendon or ligament to withstand the stresses imposed on it. • Torn tissues o Vit C o Protein o Copper o Zinc Protein deficiency and soft tissue injuries • Interstitial edema • Inflammation phase is extended • Length of total healing time is extended • Catabolism of muscle tissue o More muscle tissue is damaged if you don’t have enough protein 1

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Catabolism of visceral tissue Catabolism of connective tissue o Protein deficiency questions?  Dry skin?  Anemic?  Infections a lot?  Hair fall out?  Nails are week?  When you get the flu does it last for a long period of time?

Vitamins and soft tissue injuries o Thiamin o Decreased wound strength (50%) o Decreased hydroxyproline content in collagen o Decreased Type III collagen in wounds o Riboflavin o Decreased collagen content (~28%) o Decreased elastin and elastin cross-links (~50-60%)  Deficiency s/sx • Glossitis • Neuropathies • Chelosis (dry lips) o Pyridoxine o Decreased collagen and elastin cross-links o Increased collagen solubility o Increased homocysteine levels  Prone to B6 deficiency • People that are on oral contraceptives • Elderly taking estrogen therapy • High protein diets o Vitamin C o Antioxidant o Stabilizes cell membranes o Important for collagen formation o Inflammation increases excretion  Tobacco usage is highly correlated with vit C def • For every cigarette = 20 mg of vit C o Vitamin A o Increases tensile strength of scar tissue o Antioxidant o Zinc o Inhibits histamine and leukotriene release o Involve in collagen formation o Antioxidant  Must use in conjunction with copper (7.5:1 ratio)  Hay fever – adult = 50-75 mg/day o Copper o Important for collagen formation 2

o Superoxide dismutase o Arginine o Detoxifies ammonia o Leads to proline’s conversion to synthesize collagen o Promotes a positive nitrogen balance


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