A Review of Tissue Healing

Acute Stages of Tissue Healing

"coagulation and inflammation" stage

Value: 1

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Vasoconstriction, followed by vasodilation and cellular infiltration trigger the outward, cardinal signs of inflammation:

redness, heat, swelling, pain, functional loss - in the acute stage, these are all good signs that a team of healing cells are on the way and going to work.

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protect the area - bracing, taping, assistive devices as needed, activity modification to maintain function
pain control - cryotherapy; modalities for pain decrease sensory feedback and muscle inhibition due to pain
minimize edema - cryotherapy, modalities, appropriate compression and elevation all help "shrink" the fluid and other elements in the extracellular spaces that stress and stretch related areas
minimize reflexive muscle guarding and atrophy - heat/ice, gentle movements to related, adjacent areas
prevent long-term motion loss (joint and soft tissue) - this includes PROM, sub-maximal isometric exercises, self-massage, gentle soft-tissue and joint mobilization to optimize tissue length during healing
medications - over-the-counter or prescribed as recommended by primary care provider or pharmacist
Role of Compression

high resting pressure from elastic bandages faciliate fluid return and support injured structures
rigid tape provides somewhat firm support to affected tendons and ligaments
elastic tape can facilitate fluid return and decrease muscle guarding through gentle kinesthetic inputs

"migratory and proliferative" stage

Value: 1

specialized cells migrate into the injured soft tissue and grow to help repair the strength and function of the affected tissue
this results in an organized mix (matrix) of cells that prevent infection and progressively connects new tissue to the surrounding area
as the cells work to "fill in" the soft tissue area, they remain relatively weak and are susceptible to reinjury if overstressed

promote functional ROM - interventions are chosen to help restore optimal length-tension relationships in soft tissue (e.g., PROM, AAROM, AROM, stretching with stable pain symptoms, manual soft tissue mobilization) and normal joint mechanics (e.g., joint mobilization)
recover strength and endurance: submaximal isometrics throughout available range, gravity as resistance before adding weight, sets and reps to challenge endurance and allow recovery,

compression from fitted elastic sleeves provide modest joint protection and limits forces in end-ranges
rigid tape can support and provide kinesthetic feedback during progressive AAROM
elastic tape can augment kinesthetic input to optimize muscle recruitment patterns