Inflammation: As an initial response to tissue injury, there is blood and tissue fluid in the injured area. Any superficial bleeding will be noticed as a bruise. Sometime later, the bruise may be noticed in an area lower than the injured area. This is due to the effect of gravity. The building up of tissue fluid may result in swelling. Repair is started at the site of injury and the inflammatory reaction is the acute response phase. It may last up to 72 hours from the time of injury. Redness, heat, swelling, pain and loss of normal function of the area are the initial signs and symptoms. Applying the principle of rest, ice, compression, elevation and referral as soon as possible after sustaining the injury is key to minimizing the recovery time.
Repair: Over the next period, which may last up to six weeks, certain processes occur within the damaged tissue where an initial hematoma that was formed during the inflammatory phase is now replaced with fibrous tissue. This new fibrous tissue or "scar" tissue is not as organized and neatly laid down as the original tissue before damage. A process of re-organization is started so that the phase of repair moves on the the remodeling phase. At this point in the recovery process treatment by a physical therapist is valuable. The therapist will employ massage, stretching, exercise, mobilization techniques and electrical modalities to speed up healing.
Remodeling: During this phase the disorganized scar tissue is changed into a more structured tissue that is laid down in parallel arrangement. This phase is successful when the new tissue is strong and allows for full function and no risk of re-injury. Treatment in this stage involves rehabilitation and proprioception. All strengthening is still done under supervision to prevent any damage to soft tissue structures.The following treatment should be started as soon as possible after the injury has been examined, a fracture excluded and a sprain diagnosed.Resting the affected area speeds up recovery time. Activity and massage done to soon following the injury may aggravate bleeding and slow the healing process.Ice the injured area, but never apply the ice directly to the skin to prevent skin burn. A thin fabric can be placed between the ice and the skin. Do not apply ice if you have circulatory problems in the extremities. Never apply ice over open wounds or areas with impaired sensation. For a superficial injury the ice can be applied for 15 minutes. If it is a deeper injury, 30 minutes of ice may be applied. The application of ice should numb the affected area. You may experience sensations of cold, then a short period of warming, followed by aching and pain and thereafter the sensation of numbness will be felt. Prepare yourself for these sensations as numbness is the aim of the ice treatment. Apply the ice 2 hourly for when you are awake, a minimum of 4 times per day. Continue with the compression and elevation between the periods of ice treatment.
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