The Inflammation Phase of Healing


Dr. Joe Papia

Chiropractor in Tampa FL 33602


What Happens to the Tissue:

  1. External and internal injury result in tissue death and cell death
  2. Decreased oxygen to area increases cell death
  3. Phagocytosis will add to cell death due to excess digestive enzymes

First hour

  1. Vasoconstriction and coagulation occur to seal blood vessels and chemical mediators are released
  2. Immediately followed by vasodilatation of blood vessels

    Second hour

    1. Vasodilatation decreases blood flow, increased blood viscosity resulting in edema (swelling)
    2. Exudates increases (high concentration of RBC’s) due to increased vessel permeability
    3. Permeability changes generally occur in capillary and venules
    4. Margination occurs causing leukocytes to fill the area and line endothelial walls
    5. Through diapedesis and chemotaxis leukocytes move to injured area

    Cellular response

    1. Mast cells (connective tissue cells) and leukocytes (basophils, monocytes, neutrophils) enter area
    2. Mast cells with heparin and histamine serve as first line of defense
    3. Basophils provide anticoagulant
    4. Neutrophils and monocytes are responsible for small and large particles undergoing phagocytosis – ingestion of debris and bacteria

        4. Cellular mediation

        1. Histamine provided by platelets, mast cells and basophils to enhance permeability and arterial dilation
        2. Serotonin provides for vasoconstriction
        3. Bradykinin is a plasma protease that enhance permeability and causes pain.
        4. Heparin is provided by mast cells and basophils to prevent coagulation
        5. Leukotrienes and prostaglandins are located in cell membranes and develop through the arachadonic acid cascade
        6. Leukotrienes alter permeability
        7. Prostaglandin add and inhibit inflammation

        5. Complimentary systems

        1. Enzymatic proteins that destroy bacteria and other cells through their impact on cell lysis

          6. Bleeding and exudates

          1. Amount dependent on damage
          2. Initial stage: thromboplastin is formed
          3. Second stage: Prothrombin is converted to thrombin due to interaction with thromboplastin
          4. Third stage: thrombin changes from soluble fibrinogen to insoluble fibrin coagulating into a network localizing the injury

            Tissue Damage Results In:

            1. Redness: Caused by dilation of arterioles/increased blood flow
            2. Heat: Increased chemical activity & increased blood flow to skin surface
            3. Swelling: Caused by accumulation of blood & damaged tissue cells
            4. Pain: Direct injury of nerve fibers, pressure of hematoma on n. endings
            5. Chemical irritants: – bradykinin, histamine, prostaglandin
            6. Loss of Function Increased pain/ swelling

            Tissue Response:

            Vascular changes

            1. Vasoconstriction – immediately; decreased blood flow to area (approx. 5-10 mins.); platelet plug formed; blood coagulation; produces local anemia
            2. Vasodilation – increased blood flow; increased hydrostatic pressure in blood vessels (­ capillary permeability, plasma proteins leak out; proteins attract H2O – edema)
            1. Cellular Changes – chemical reactions start immediately
            2. Protein presence – changes osmotic relationship between blood & adjacent tissues (Plasma protein while interstitial fluid protein ­. H2O follows plasma proteins out of vessel resulting in edema!)
            3. Neutralizes/destroys offending agents, restricts tissue damage to the smallest possible tissue & prepares area for healing

            Objectives in Inflammation Phase:

            1. Decrease Pain
            2. Reduce Swelling
            3. Reduce Muscle Spasm

            Goal to Limit Swelling using R.I.C.E Principle:

            1. Rest
            2. Ice
            3. Compression
            4. Elevation are critical to limiting cell death

            Restricted Activity (Rest)

            1. Healing immediately begins after injury
            2. Without rest, external stresses are still placed on the injured area, interfering with the healing process- prolonging recovery
            3. Controlled mobility is superior to immobilization
            4. 24-48 hours of rest should be applied prior to active rehabilitation – depends on severity

              Protection & Ice

              1. Protect the injury from further damage
              2. Splint, wrap, immobilize the injured site depends on severity

                Compression

                1. Single most important factor in swelling control
                2. Mechanically reduces space available for swelling accumulation
                3. Using an elastic wrap, firm, evenly applied pressure can be achieved
                4. Compression should be maintained continuously for 72 hours – depends on severity
                5. With chronic inflammatory conditions compression should be applied until the swelling is almost entirely gone

                  Elevation

                  1. Used to eliminate the effects of gravity on blood pooling
                  2. Assists venous and lymphatic drainage of blood and other fluids from the injured area
                  3. Elevation should occur as often as possible during the first 72 hours of the acute injury – depends on severity

                    Treatment:

                    Phase I: Acute Inflammatory Phase

                    Initial swelling management & pain control are crucial

                    • R.I.C.E
                    • Chiropractic Adjustment
                    • Electrical Muscle Stimulation-Pulsed
                    • Ultrasound-Pulsed
                    • Passive Joint Motion

                    If you have any further questions about the inflammation phase of healing call me at 813-229-0207.

                    Dr. Joe Papia Chiropractor in Tampa FL 33602