This page reviews some basic concepts related to tissue healing/repair. Make sure you use your textbook, class notes, and other resources for more details.



Physical Therapist Assistants Must Understand How Tissues Heal





Different Physical Therapy Modalities and Procedures may Influence The Rate or Quality of Tissue Healing/Repair. Physical Therapist Assistants Must Understand the Relationships Between Tissue Healing and Therapeutic Modalities and Procedures



Tissue Healing/Repair May Take Place Over Months or Even Years. However, There Are Indeed Three Distinct Overlapping Phases of Tissue Healing/Repair.

The cardinal signs of inflammation include swelling, redness (erythema), pain, increase temperature to touch, and loss of function.

The proliferation phase is characterized by increased fibroblastic activity and the production of early collagen fibers to facilitate fibrotic repair as well as re-vascularization of the damaged area.

The remodeling phase is the longest phase characterized by the organization and maturation of scar tissue. This phase may last for months to as much as 2 years depending on the extent of the injury.



“How long will it take for me to get better? When can I get back to my usual routine?”



Patients will often ask the physical therapist assistant a version of the above question. Athletes want to get back onto the field of play. Workers want to get back on the job. Just about everyone just wants to feel better.

Physical therapist assistants must take special care in how they respond to such queries. Even with an understanding of the healing process, there are many variables that influence the length of time of recovery.

Extent of injury, amount of rest and offloading, complicating conditions, and nutritional status are just a few factors that may influence healing.



Factor That May Impede Tissue Healing/Repair





Extent of Injury



Overuse injuries such as tendonitis are characterized by microtears within the tissue and represent minor damage. However, macrotears are characterized by significantly more fiber damage. The healing/repair time is prolonged as compared to microtear injuries.



Hemorrhage



The inflammation stage is specialized to limit the loss of blood from broken blood vessels. However, if the vaso-dynamic influences are impaired, prolonged hemorrhage can lead to a slower healing process with increased and persistent edema and other sequelae.



Muscle spasm



Just as muscle spasm may contriibute to the persistence of the perception of pain, it may also retard healing, by applying traction to the damaged tissue, and by intermittent compression on blood vessels, producing ischemia.



Infection



Clearly the persistence of infectious agents within the damaged area may retard healing. People who are immune compromised or have peripheral vascular conditions may also present with slower healing of tissues.



Edema



The increased pressure caused by swelling may retard the healing process. A patient may have increased edema for many reasons beyond damaged tissue. Understanding the individual cause of edema may influence clinical management. Depending on the stage of healing, edema may be treated with heat or cold, elevation, and compression.



Health, age, nutrition



In PTA 20, you learned about the various physiological consequences of aging. Certainly, these consequences may retard healing. Certainly, nutritional status is a critical factor in tissue healing/repair. Crucial vitamins such as A, K, and E, appropriate serum levels of zinc, and a robust number of amino acids are crucial to tissue healing/repair. Oftentimes, depending on the population, patients present in the physical therapy clinic with complicating conditions that the PTA must be aware of.



Healing of Burnt Tissue can be Complex and Protracted Requiring Specialized Care



Rehabilitation following severe tissue burns is a highly specialized area of physical therapy. However physical therapist assistants should have a basic understanding of the factors that influence the healing/repair of burned tissue.

The extent of the tissue damage and the amount of tissue damage (remember the rule of nines) are the predominant healing/rehab factors.

Healing beyond superficial burns will occur via a deeper fibrotic process.

Scar management is a significant goal of physical therapy.


Active scarring can occur for as long as two years post burn.


Scar tissue may:


Reduce ROM

Alter posture

Compromise Respiration

Decrease Muscle Strength





—CHECKPOINT—



This is a good time to pause and assess your knowledge of key concepts. Below are links to a few learning activities that might assist your mastery of the material.

Completing some of the tasks may also earn you class participation credit! However, most importantly it will assist in your learning. You should attempt to complete the assignments without using your text, notes, etc., as they are designed to test your knowledge—just like taking a test in class—but without the grade consequences.

Tasks include mock exams, games, clinical scenarios, and more. Click/tap on the activities and see hoe much you know!


Multiple choice quiz
Tissue Repair Wordle
Clinical scenarios