SOFT TISSUE HEALING & PHYSIOTHERAPY MODALITIES

Re-visit "Tissue Damage and Healing" from biomed in Physio One module, use
resources on soft tissue healing such as
http://www.electrotherapy.org/modalities/tissuerepair.htm from Electrotherapy on
the Web, and work through the following notes to answer these questions:

a. What factors influence healing of soft tissue injuries?

b. How can physiotherapy modalities influence physiological factors
to promote healing?

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KEY POINTS
 Pain modulation - active and passive mobilisation/electrotherapy
 Circulation - massage/exercise/electrotherapy
 Fibre alignment – ultrasound/exercise/massage

1. Inflammatory Phase
Inflammation is an essential part of healing, but as an "all or nothing" response
can be harmful. Excessive or prolonged inflammation 
• excessive scar formation
• pain
• oedema
• secondary tissue ischaemia
• loss of movement and weakness

Physiotherapy aims to control inflammation:

• prevent disruption of new blood vessels and collagen fibrils
• minimise bleeding
• promote collagen and ground substance synthesis
• reduce oedema
• protect healing tissue
• provide pain relief

PROTECTION e.g. strapping or crutches - avoid further stress

REST - avoid further injury and bleeding
ICE - helps with swelling and pain relief
COMPRESSION - helps reduce oedema
ELEVATION - helps prevent stasis/accumulation of oedema

Movement during inflammatory phase:

✔ Improves blood flow
✔ Decreases swelling
✔ Relieves pain
✔ Increases phagocytosis
✔ Prevents joint stiffness and muscle weakness in related areas

Inflammation control should overlap efforts to promote healing. Healing has not
happened once inflammation subsides!
2. Proliferation (regeneration) Phase
Use therapeutic techniques to help control pain and swelling; reduce reliance on
support and strapping; progress activity levels

Applying tension through exercise or manual therapy 

• increase collagen synthesis,
• promote better collagen alignment
• increase tensile strength

Early exercise enhances tissue oxygenation and nutrition, minimises unnecessary

atrophy and aligns collagen fibres to meet eventual demands.

The gradual loading of tissue during the healing process is critical to optimising the
mechanical properties of the tissue and hence in preventing tissue re-injury, BUT
need to be careful not to stimulate excess collagen production and thicken the
scar formation.

Movement during proliferation phase:

✔ Increases tensile strength

✔ Increases tissue metabolism
✔ Promotes extensibility of scar tissue
✔ Maintains and improves joint range of movement & muscle strength

3. Remodelling Phase
Physiotherapy aims to help the tissues regain as near normal structure and
function as possible and control tissue overload by modifying intrinsic and extrinsic
factors

 Achieve and maintain flexibility of healing tissues

 Prevent unwanted adhesions [abnormal deposits of collagen that disrupt
gliding between adjacent structures]
 Restore functional activity
 Address intrinsic and extrinsic causes

Movement during remodelling phase:

✔ Restores full range of movement and muscle strength
✔ Counteracts scar contraction
✔ Restores function
✔ Restores confidence