University of Scranton - Department of Physical Therapy
Edmund M. Kosmahl, PT, EdD
send e-mail to Dr. Kosmahl                    copyright 2000 Edmund M. Kosmahl

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PT351 ORTHOPAEDIC PT Dr. E. Kosmahl CONNECTIVE TISSUE RESPONSE TO INJURY AND MOVEMENT (Inflammation and Repair)

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MUSCULOSKELETAL TISSUES ARE CONNECTIVE TISSUES

• Bone
• Cartilage
• Tendon
• Ligament
• Muscle

(see detailed discussion about these tissues)

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CONNECTIVE TISSUE COMPOSITION

• Cells that synthesize and maintain the extra cellular matrix
• fibrocytes (fibroblasts, fibroclasts)
• osteocytes (osteoblasts, osteoclasts)
• chontrocytes (chondroblasts, chondroclasts)
• Cells that mediate inflammatory and immune responses
• mast cells
• plasma cells
• lymphocytes
• monocytes
• polymorphoneuclear
• leukocytes
• Extra cellular matrix - gives the tissue its unique properties
• collagen fibers
• elastin fibers
• ground substance
• proteoglycans
• water
• other substances

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COLLAGEN FIBER ORIENTATION

• Cross weave to allow extensibility
• Molecular bonds (links)

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EFFECTS OF MOVEMENT AND IMMOBILIZATION DURING IMMOBILIZATION AND REPAIR

• Immobilization
• cross links (molecular bonds) are laid down randomly
• extensibility of the structure becomes limited
• Movement
• controlled and appropriate movement allows cross links to be laid down to allow extensibility in the direction of movement
• This is the major objective for the physical therapist.

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INFLAMMATION AND REPAIR AFTER INJURY

• Repair (scar formation), not regeneration of tissue
• A necessary and desirable process for healing
• Phases of inflammation and repair
• Lag or Cellular (Acute)
• Fibroblastic (Sub acute)
• Maturation or remodeling (Chronic)
• Physical therapy goal - promote normal and speedy progression through the phases (i.e. avoid a delay in progression and/or return to a previous phase)

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LAG OR CELLULAR PHASE (Acute)

• Acute inflammatory response
• cells and exudate promote phagocytosis and immobilization
• Lasts from 3 to 5 days
• Clinical signs
• redness, heat, swelling
• pain at rest
• Treatment guidelines
• Rest from function
• Reduce inflammation
• MINIMUM controlled motion

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FIBROBLASTIC PHASE (Sub acute)

• Vigorous Fibroblastic activity
• Increased synthesis of collagen and ground substance
• Lasts from 5 to 21
• Clinical signs
• stiffness
• pain as limitation to range of motion is approached (no pain at rest)
• Treatment guidelines
• rest from function
• moderate controlled motion

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MATURATION PHASE (Chronic)

• Formation of molecular inter fiber cross links
• Collagen synthesis/lysis GRADUALLY approaches pre injury balance
• Lasts from 21 days to months
• Clinical signs
• pain when the limitation to range of motion is exceeded
• relatively free movement within the range of motion limitation
• Treatment guidelines
• vigorous motion in appropriate directions to insure collagen weave is appropriate
• promote return to normal function

To PT351 First Page

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