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

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