Inflammation Overview
Stages of Inflammation
Acute and chronic are terms commonly used to refer to the
duration or the length of the problem, giving inaccurate
information about the
actual stage of inflammation. For clarity of treatment, we need to define
healing by the stage of inflammation and the symptoms, not the duration of the
problem.
The three stages of inflammation:
-
Acute -swelling stage
-
Subacute - regenerative stage
-
Chronic - scar tissue maturation and
remodeling stage
Acute Inflammation is the swelling
stage. During this stage there is inflammation, redness and swelling due
to the vascular changes. There is exudation of cells and chemicals that
cause the swelling and the pain. If there is bleeding, hematomas form in
this stage. Secondarily, the chemical irritants are neutralized, the area
is sealed off from surrounding tissue and circulation is impaired. there
is early fibroblastic cell activity. Symptoms are pain at rest and aggravated by
activity. the pain is felt over a diffuse area. Secondary muscle
spasm and guarding restrict passive movement. In ROM, pain is felt before
the tissue resistance is felt. With injury to very deep structures or
poorly vascularized areas, surface swelling and edema may not be
noticeable.
The subacute stage is the time of healing and
repair. Noxious chemicals are further neutralized. New capillary beds
growing into the damaged areas are supported by connective tissue growth
(collagen fibers) and together form granulation buds. This new tissue is
fragile and must be handled gently as it is easily injured. Visible signs
of inflammation subside. ROM increases with pain felt at the point of
tissue resistance.
The Chronic Inflammatory stage is the
remodeling stage. Signs of inflammation are absent and scar tissue is
maturing. Pain is felt in the ROM after the tissue resistance at the end
feel. Maturation refers to the growth of the fibroblasts to fibrocytes and
remodeling refers to the organization of and shrinking of collagen fibers along
lines of stress.
In order to determine if the condition of the
injury is in the acute, subacute or chronic inflammatory stage an adequate case
history is needed along with assessment. The history should include all
incidence leading to the condition, past injuries and activities and a
description of the symptoms being experienced. The assessment should
include a visual scan, active muscle testing, passive range of motion testing
and resisted isometric muscle tests and palpation of the structure involved.
Treatment in acute stages includes
intervention for the inflammation: ice, compression, elevation, relaxation and
drainage. Sports massage techniques use only gentle applications with no
direct application of compression to the site of swelling. Lymphatic
drainage and relaxation of the muscle spasm are the acute treatment focus.
Avoid massaging the site of acute inflammation for the first 24 hours (unless
you have been trained in this). Activities should be limited to avoid
unnecessary work of an injured part. Too much use can re-injure the
tissue. However, a normal level of function and movement needs to be
maintained to encourage proper tissue modeling and repair.
A prolonged chronic stage or persistent
disorder is not healing properly. This may be caused by abnormal modeling
of tissue during resolution of an acute disorder or injury. Without
resolution, abnormal amounts of collagen are produced, forming crosslinks that
adhere to adjoining structures. This limits the extensibility of the
structure as well as prevents the formation of a smooth gliding surface between
adjoining structures. Proper amounts of mobilization are required for
normal healing and prevention of adhesions.
Immature scar tissue is susceptible to
re-tearing during repeated use. Mobilization too early in the
rehabilitation program can interfere with healing if the tissue is re-injured
before it is properly healed. Lack of adequate mobilization can result in
adhesions that tear the injured tissue once movement is introduced. The
goals of treatment have not been met, inflammation has not been resolved and
exercise to maintain normal use has not been incorporated.
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