Sports Medicine Final

Acute Inflammatory Phase of the Healing Process

A. This is the immediate response to tissue injury, aiming to protect the area, remove damaged cells, and prepare for healing

B. It typically lasts 0-4 days. Vascular responses begin with vasoconstriction, then shift to vasodilation and increase capillary permeability. Neutrophils and macrophages migrate into the area to remove debris and initiate cytokine release. Symptoms include swelling, heat, redness, pain, and loss of function.

C. A common modality is cryotherapy.

D. Cryotherapy lowers local temperature. Decreasing metabolic demand and inflammatory cell activity, reducing secondary tissue damage and controlling edema. It also slows nerve conduction to help relieve pain.

Firboblastic Proliferation/Repair Phase of the Healing Process

A. This phase focuses on tissue regeneration and scar formation.

B. It typically spans day 3 to several weeks post-injury. Fibroblast lay down Type III collagen and form granulation tissue. Angiogenesis helps restore blood supply. Pain and inflammation decrease, but tissue is weak and susceptible to reinjury.

C. Pulsed therapeutic ultrasound is effective here.

D. It promotes fibroblast activity, protein synthesis, and collagen alignment without generating heat, this accelerating organized tissue repair during this non-thermal phase.

Maturation Phase of the Healing Process

A. This final healing phase is also known as the remodeling phase.

B. It begins around 3 weeks post-injury and can last up to a year. Collagen transitions from Type III to Type I. Scar tissue is reorganized along line of stress, restoring tensile strength. Symptoms largely subside, though tightness or dysfunction may persist if untreated.

C. Continuous ultrasound or most heat packs are commonly used.

D. These modalities enhance blood flow, increase collagen elasticity, and support functional remodeling, especially when followed by stretching and strengthening exercises.

Electropiezo Effect and Ultrasound in Healing

The electropiezo effect, also called the reverse piezoelectric effect, is how ultrasound waves are produced in therapeutic ultrasound devices. An alternating electrical current is applied to a piezoelectric crystal in the ultrasound transducer. The crystal rapidly expands and contracts, converting electrical energy into mechanical sound waves. These waved penetrate tissue and create mechanical and/or thermal effects that improve healing through increased circulation, fibroblast activity, and collagen synthesis.

Gate Control Theory of Pain

The gate control theory of pain proposed that non-painful sensory input can “close the gate” to painful stimuli at the spinal cord leave, thereby reducing or blocking pain perception. According to this theory, large-diameter afferent fiber (A-beta fibers) transmit non-nocipetive stimuli such as touch, vibration, or electrical stimulation, which in hit the transmission of pain signals carried by small-diameter nocieptive fibers (A-delta and C fibers) within the dorsal horn of the spinal cord. A therapeutic modality that effectively used this mechanism is Transcutaneous Electrical Nerve stimulation (TENS). When TENS is applied at high frequency (typically 80-150 Hz) and low intensity, it stimulates A-beta fibers, promoting inhibitor inter neuron activity that prevents pain signals from ascending to the brain. This creates a non-painful “tingling” sensation that overrides pain perception. TENS is particularly beneficial in both acute and chronic pain management scenarios, such as soft tissue injury or during rehabilitation, offering a non-invasive, drug free method for pain modulation by leveraging the gate control theory.

Managing Swelling in Acute and Sub-acute Phases

Controlling swelling is crucial to maintain tissue oxygenation and allow proper healing. In the acute phase, cryotherapy reduces capillary permeability and metabolic activity, slowing fluid accumulation. Compression support lymphatic return. In the sub-acute phase, modalities like intermittent pneumatic compression help mobilize excess guild, while active movement and elevation further assist in edema resolution. Managing swelling reduces complication like joint stiffness, delayed healing, and pain.

Core Stability: Transverse Abdominis and Multifidi

The transverse abdominis and multifidi are key stabilizers of the lumbar spine. The TrA acts like a corset, increasing intra-abdominal pressure, while the multifidi provide segmental spine control.

Phase I: Supine abdominal bracing focuses on activating the TrA without spine movement.

Phase II: Quadruped bird-dog targets both muscles with contra lateral arm/leg lifts, emphasizing stability.

Phase III: Palloff press with trunk rotation in standing challenges anti-rotation and reactive control, integrating core stability into functional movement.