The Basics of Healing -

Understanding the
Inflammation Process
 The Healing Process
• It is practical to have a sense of the healing process -
this will give you insight into why some injuries take
longer than others to recover

• In an ideal world, we would let the process take over

and allow the athlete to heal properly

• In athletics, we do not have the luxury in many cases

to allow this to happen
 The Healing Process
• Consists of 3 phases:

1) Inflammatory response phase

2) Fibroblastic repair phase
3) Maturation - remodeling phase

• Anything done when treating an athlete that

interferes with this process will likely slow
the return to full activity
 The Healing Process
• There is little that can be done to speed
up physiology
• But we can provide the optimal
environment for healing or do the
opposite and impair the process
• Understand these phases, although
discussed separately, do overlap and
sometimes are tough to distinguish
 The Healing Process
• Inflammatory Response Phase
– The initial inflammatory response is critical
to the entire healing process. If this
response does not accomplish what it is
supposed to do, normal healing cannot
take place
– The body often overreacts in this phase
– This is an individual process - each of us
are different
 The Healing Process
• The inflammatory response phase
– Signs we are in this phase:
• 5 signs of inflammation:
– Redness
– Swelling
– Tenderness
– Increased temperature
– Loss of function
– How long does this phase last?
• Typically 72 hrs if treated correctly
 The Healing Process
• Inflammatory Response Phase
– How do we treat this correctly and allow it to do its thing?
– R.I.C.E.
• Rest = Do not use the part (crutches, slings, splints, etc)
• Ice = Used for pain and vasoconstriction (slow down the body’s
overreaction)
– 20 min on and 1 hr off
– Hunting response - a slight temperature increase during cooling
– A reaction against tissue damage from too cold exposure. This is
important to educate athletes on how long they should leave ice on
• Compression = elastic wrap will help control edema and reduce space for
fluids to develop
• Elevation = help the lymphatic system by using gravity to return the
damaged cells to the core for removal
 The Healing Process
• Fibroblastic Repair Phase
– How do I know?
• Generally, signs and symptoms of inflammatory
period subside
• Tenderness and pain with function remain
– How long does it last?
• Starts few hours after injury and can last as
long as four to six weeks depending on tissue
and trauma done
 The Healing Process
• Maturation - Remodeling Phase
– Tensile strength begins to increase
– Wolff’s Law states that bone and soft
tissue will respond to the physical
demands placed on them to remodel or
realign along the lines of the tensile force
– This is why most patients are now treated
with controlled mobilization rather than
complete immobilization
 The Healing Process
• How do I know?

– Clinical signs and symptoms will now begin to disappear

– As healing progresses to remodeling, controlled activity is

warranted with a gradual return to normal flexibility and
strength

– Usually, this is the time to tape, wrap and brace to allow

activity while supporting the structure
 The Healing Process
• Factors that impede healing:

1. Extent of injury or separation of tissue

2. Amount of edema - increased pressure impedes
healing process
3. Hemorrhage
4. Poor blood supply
5. Muscle spasm
6. Infection
7. Health, age and nutrition

Allowing activity too early may allow these things to

happen!
 The Healing Process
• Methods used to modify healing:
– Drugs: Non-steroidal anti-inflammatory drugs
(NSAIDs): ibuprofen, advil, motrin, etc.- combat out of
control inflammation
– Thermal agents - cold first 72 hrs, usually a combo
thereafter
– Modalities - Electrical Stimulation = helps with pain and
inflammation, Ultrasound = aids in blood flow and
healing in later stages
– Exercise - trend now is early range of motion (ROM) to
aid in maturation-remodeling and avoid adverse
biochemical changes
 The Healing Process
• So how do we apply all this knowledge?
• In general:
– Sprains and Strains:
• RICE for first 72 hrs
• “R” may include brief period of immobilization
• After 72 hrs, introduce heat (hot packs, ultrasound, whirlpool)
and range of motion (ROM) exercises
• When symptoms begin to subside and ROM returns - begin
strengthening and return to functional
• If we handle properly, expected length of recovery:
– 1st degree = 3-6 wks
– 2nd degree = months
– 3rd degree = months to years
 The Healing Process
• In general:
– Fractures
• Immobilize 6-8 wks depending on severity
• Then we begin the process
• Expected length of recovery:
– 2-4 months
– “itis” -
• Begin healing modalities, stretching and massage right away in
combo with ice and electrical stimulation
• Stimulate blood flow
• Monitor stages and modify as needed
• Generally, we are not going to heal this, we want to keep
athlete in functional stages