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applied forces for maximum strength and flexibility. This process of aligning collagen fibers along the lines of stress is called remodeling and is the primary purpose of the final phase of healing. Initially, the collagen fibers that form the substance of mature scar tissue are arranged randomly, spreading in all directions. As forces are placed through the tissue, some collagen fibers are destroyed, allowing greater flexibility, while others are reinforced, providing increased strength. The collagen network continues destroying fibers that limit necessary motion and reinforcing fibers that resist tension as greater and more varied stresses are applied to The Healing Process INFLAMMATORY RESPONSE PURPOSE • wall off injured area • prevent further injury • clean up debris SIGNS & SYMPTOMS Swelling Heat A loss of function Redness Pain (generalized) TREATMENT GOALS • parasympathetic response • maintain pain-free ROM • compensation • edema • spasm TREATMENT TECHNIQUES • cold hydrotherapy • lymph drainage • light myofascial release • passive positional release • energetic and indirect techniques • Swedish massage to associated structures REPAIR PHASE • increase capillary density • produce granulation tissue • inflammation • pain (localized) • range of motion (ROM) • function • inflammation • circulation • soft-tissue mobility • function (associated areas) • vascular flush/contrast hydrotherapy REMODELING PHASE • align collagen fibers along lines of stress • inflammation • ROM • strength and endurance • compensation • tissue adhesions • ROM • function (affected and associated areas) • eliminate compensation • deep tissue to associated structures • myofascial release • proprioceptive techniques • gentle Swedish/increase ROM • hot hydrotherapy • deep myofascial release • deep-tissue techniques • trigger-point therapy • cross-fiber friction • proprioceptive techniques the tissue. Ideally, the new tissue will offer maximal flexibility and strength, according to the demands placed on it during the remodeling phase. The pain associated with inflammation gives way to that of ischemia during the remodeling phase. Blood flow to the injured area decreases as capillaries are deconstructed and mature scar tissue forms. Clients overwhelmingly report decreased mobility as dense networks of collagen replace granulation tissue, making soft tissue less pliable. Pliability may be further diminished if adhesions form between fascial layers in affected and associated areas. Trigger points often develop during this phase due to increasing ischemia. If compensation has been necessary throughout the healing process, chronic dysfunction may occur in associated structures. This includes hypertonic muscles, abnormal movement patterns, and referred pain from trigger points. Many of my clients become frustrated as pain moves to new areas (associated structures from compensation) and mobility decreases. Again, this is quite normal and indicates progress through the healing process. tune in to your practice at ABMPtv 51