Body Sense

Winter 2011

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Alternate movement strategies or compensation (like limping on an injured ankle) may occur immediately following injury and are normal and necessary to minimize further injury. Treatments that reduce or eliminate inflammation (ice, anti-inflammatory medications, etc.) may decrease the discomfort and inconvenience associated with inflammation and improve function in the short term. On the down side, they may also allow activities that cause further injury and slow the long-term healing process. Repair The inflammatory response gives way to the repair phase once the debris from injured structures is removed and the area is protected against invading pathogens. Much like the aftermath of a flood or tornado, wreckage must be removed and the area secured before rebuilding can begin. Once clean up is complete, the signs and symptoms of inflammation subside and efforts turn toward Granulation tissue, a fragile form of scar tissue, fills gaps left after removal of damaged structures. This process is much like filling potholes prior to repaving a road. The fill creates an even, level surface for paving, as does the granulation tissue. The amount of granulation tissue produced and time required for repair depends on the extent of damage and ability to deliver construction materials (circulation). The bigger the hole, the more material needed to fill it and the more time it will take to heal. Also, areas with poor circulation, or people with conditions that limit circulation, will take longer to repair. You may be tempted to test the injured Listen to your body and discuss your experience so you and your health-care team can recognize where you are in the healing continuum. repair of injured tissue or replacement with scar tissue. Pain becomes more specific or localized as the chemicals of inflammation dissipate and construction begins in specific areas of damage. My clients will often tell me they can put their finger "right on" the injured or painful spot, where they could not do so before. This experience, when combined with decreased inflammation, is a sign of moving into the repair phase of healing. As the body begins to repair damaged tissue, new blood vessels grow in the injured area, creating a transport system. This new network delivers the materials necessary for repair and removes waste products associated with tissue construction. You may have noticed that scar tissue on the surface of the body is very pink at first, becoming pale over time. It is this new network of blood vessels that makes it appear pink in the beginning. 10 Body Sense area as pain localizes, swelling decreases, and function improves. You may even experience brief, pain-free periods where you forget about the injury. It is important to remember that granulation tissue is neither strong nor flexible and will not tolerate heavy use. Doing too much, too soon is similar to driving through newly-filled potholes and displacing the filler material. Re-injury is common during this phase of healing because you feel better and want to get back to normal life. Use caution when returning to activities previously altered or avoided in an effort to prevent re-injury. Remodeling The third and final phase of the healing process involves complete regeneration of damaged tissue or construction of permanent scar tissue. Going back to the example of fixing a road: all of the holes are filled and it is time to pave. As you sleep, the body lays down scar tissue randomly, spreading in all directions and limiting all motions. Imagine a dense web spreading around and through the damaged tissue. Upon waking, the injured area may feel stiff and sore as these fibers limit movement and circulation. Once you get up and moving, some fibers are destroyed, allowing greater flexibility. You may feel the fibers breaking followed by improved mobility during this phase. As function returns and various demands are placed on the new tissue, the structure must adapt. Fibers limiting necessary motions are eliminated, and those resisting applied tension or compression are reinforced. Arranging scar- tissue structure to tolerate specific stresses is called remodeling. This progressive process

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