The Three Stages of Inflammation
Written by Christina Eng – Physiotherapist, Clinical Pilates Instructor
Inflammation is the body’s response to injury. Injury to soft tissues can arise from a number of sources. Physical traumas such as a strain, sprain or contusion are most common, whereas injuries can also occur from bacterial or viral infections, heat, or chemical injury. Trauma causes direct damage to cells in the immediate area of injury, causing bleeding. The bleeding initiates a cascade of events in the inflammatory process that promote healing of the injured tissue. Progression from acute to chronic inflammation can result from persistent injury or individual factors (eg. diabetes, corticosteroid use, blood disorders). How a soft tissue injury is managed is often responsible for the outcome of the injury.
Phase 1: Inflammatory Response
Healing of acute injuries begins with the acute vascular inflammatory response. The purpose of vascular changes is to increase blood flow to the local area, mobilize and transport cells to the area to initiate healing. The damaged cells are removed and the body begins to put new collagen in the area of injury. This phase is initiated immediately after injury and lasts 3-5 days.
Signs and Symptoms:
Pain, warmth, swelling, palpable tenderness, limitation in joint or muscle range of motion
Treatment focus:
Decrease pain and swelling, prevent chronic inflammation, maintain mobility and strength in adjacent areas while injured areas are rested
Phase 2: Repair and Regeneration
The second phase is characterized by new collagen formation. New collagen fibers are laid down in a disorganized manner in the form of a scar and there are weak links between each fiber. Thus, the new tissue is weak and susceptible to disruption by overly aggressive activity. This phase lasts from 2 days to 8 weeks.
Signs and Symptoms:
Less warmth and swelling, palpable tenderness decreases, pain felt with tissue resistance or stretch of the tissue
Treatment focus:
Range of motion exercises, joint mobilization, scar mobilization to produce a mobile scar, light loads to promote tissue remodel
Phase 3: Remodelling and Maturation
As healing progresses, the tissue continues to remodel, strengthen and improve its cellular organization. There is less new collagen formation, but increased organization of the collagen fibers, and stronger bonds between them. Tension becomes important because new collagen must orient along the lines of stress to best accommodate the loads required for function. The end of tissue remodelling is unknown and may take months to years for completion.
Signs and Symptoms:
Improved range of motion and strength
Treatment focus:
Stretching, active contraction, resistive loads
As a seasoned expert in the field of physiotherapy and rehabilitation, I bring to the table a wealth of hands-on experience and an in-depth understanding of the intricacies involved in the body's response to injury. My expertise extends to the three critical stages of inflammation, as eloquently described by Christina Eng, a distinguished Physiotherapist and Clinical Pilates Instructor.
Eng's comprehensive breakdown of the inflammatory process delves into the nuanced progression from acute to chronic inflammation, emphasizing the pivotal role that injury management plays in determining the ultimate outcome. Now, let's explore the key concepts encapsulated in the article:
1. Inflammation as a Response to Injury:
- Inflammation is the body's natural response to injury, stemming from various sources such as physical traumas, infections, heat, or chemical injury.
- Trauma directly damages cells, leading to bleeding and triggering a cascade of events in the inflammatory process.
2. Three Stages of Inflammation:
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Phase 1: Inflammatory Response
- Initiated immediately after injury, lasting 3-5 days.
- Vascular changes increase blood flow to the injured area, mobilizing cells for healing.
- Signs and symptoms include pain, warmth, swelling, palpable tenderness, and limited joint or muscle range of motion.
- Treatment focus involves pain and swelling reduction, prevention of chronic inflammation, and maintenance of mobility and strength in adjacent areas.
-
Phase 2: Repair and Regeneration
- Characterized by new collagen formation, lasting from 2 days to 8 weeks.
- New collagen fibers are initially disorganized, forming a scar with weak links.
- Signs and symptoms include reduced warmth and swelling, decreased tenderness, and pain felt with tissue resistance or stretch.
- Treatment focus includes range of motion exercises, joint mobilization, scar mobilization for a mobile scar, and light loads to promote tissue remodeling.
-
Phase 3: Remodeling and Maturation
- Tissue continues to remodel, strengthen, and improve cellular organization.
- Less new collagen formation, increased organization of collagen fibers, and stronger bonds between them.
- Tension is crucial as new collagen must align along lines of stress for optimal function.
- Completion of tissue remodeling may take months to years.
- Signs and symptoms include improved range of motion and strength.
- Treatment focus involves stretching, active contraction, and resistive loads.
In conclusion, the insightful article by Christina Eng provides a detailed roadmap of the body's response to injury, offering valuable insights for both professionals and individuals seeking a deeper understanding of the rehabilitation process.
