Chapel Garden

Connective Tissue Response To Injury and Movement

Lecture Notes

MUSCULOSKELETAL TISSUES ARE CONNECTIVE TISSUES

  • Bone
  • Cartilage
  • Tendon
  • Ligament
  • Muscle

(see detailed discussion about these tissues)

CONNECTIVE TISSUE COMPOSITION

  • Cells that synthesize and maintain the extra cellular matrix
    • fibrocytes (fibroblasts, fibroclasts)
    • osteocytes (osteoblasts, osteoclasts)
    • chontrocytes (chondroblasts, chondroclasts)
  • Cells that mediate inflammatory and immune responses
    • mast cells
    • plasma cells
    • lymphocytes
    • monocytes
    • polymorphoneuclear
    • leukocytes
  • Extra cellular matrix - gives the tissue its unique properties
    • collagen fibers
    • elastin fibers
    • ground substance
      • proteoglycans
      • water
      • other substances

COLLAGEN FIBER ORIENTATION

  • Cross weave to allow extensibility
  • Molecular bonds (links)

EFFECTS OF MOVEMENT AND IMMOBILIZATION DURING IMMOBILIZATION AND REPAIR

  • Immobilization
    • cross links (molecular bonds) are laid down randomly
    • extensibility of the structure becomes limited
  • Movement
    • controlled and appropriate movement allows cross links to be laid down to allow extensibility in the direction of movement
    • This is the major objective for the physical therapist.

INFLAMMATION AND REPAIR AFTER INJURY

  • Repair (scar formation), not regeneration of tissue
  • A necessary and desirable process for healing
  • Phases of inflammation and repair
    • Lag or Cellular (Acute)
    • Fibroblastic (Sub acute)
    • Maturation or remodeling (Chronic)
  • Physical therapy goal - promote normal and speedy progression through the phases (i.e. avoid a delay in progression and/or return to a previous phase)

LAG OR CELLULAR PHASE (Acute)

  • Acute inflammatory response
    • cells and exudate promote phagocytosis and immobilization
  • Lasts from 3 to 5 days
  • Clinical signs
    • redness, heat, swelling
    • pain at rest
  • Treatment guidelines
    • Rest from function
    • Reduce inflammation
    • MINIMUM controlled motion

FIBROBLASTIC PHASE (Sub acute)

  • Vigorous Fibroblastic activity
    • Increased synthesis of collagen and ground substance
  • Lasts from 5 to 21
  • Clinical signs
    • stiffness
    • pain as limitation to range of motion is approached (no pain at rest)
  • Treatment guidelines
    • rest from function
    • moderate controlled motion

MATURATION PHASE (Chronic)

  • Formation of molecular inter fiber cross links
  • Collagen synthesis/lysis GRADUALLY approaches pre injury balance
  • Lasts from 21 days to months
  • Clinical signs
    • pain when the limitation to range of motion is exceeded
    • relatively free movement within the range of motion limitation
  • Treatment guidelines
    • vigorous motion in appropriate directions to insure collagen weave is appropriate
    • promote return to normal function
If you don't see Dr. K's WebSite Menu, go to Dr. Kosmahl's Home Page