soft tissue(muscle, ligament, tendon)의 healing stage에 의한 치료 전략

[문형철]

연부조직(skin, muscles, ligaments or tendons)이 손상되면 3단계의 회복과정을 거친다. 

1) inflammatory

2) proliferation 

3) re-modelling phase

예를들어 인대(ligament)는 3가지 단백질로 구성되어 있다. 

• 90% Type 1 collagen
• 9% Type 3 collagen
• 1% fibroblast cells (the cells that produce collagen)
• 
  

섬유아세포에 의해 인대는 재생과 회복 과정을 거친다. 

치료는 반드시 손상된 조직의 재생에 최적을 자극강도, 자극 빈도, break time, 재배열방향을 고려한 치료적 운동자극이어야 한다. 

너무도 많은 치료적 운동자극이 인체움직임에 최적의 조건을 주는 배열이 망가지는 방향으로 무분별하게 이루어지고 있다. 

이 공부를 알려준 김송준 첨단 스포츠 레하센터 소장님께 감사의 마음을 전한다.

Inflammatory Phase

The inflammatory phase follows trauma to collagen fibres and lasts for 3-5 days, depending on the severity of the injury. Chemicals are released which produce pain, and there is bleeding in the tissues. This, together with fluid from damaged cells, produces swelling within the joint, putting pressure on nerve endings and causing more pain.

Rehabilitation time can be greatly reduced by appropriate treatment in this acute stage. This consists ofprotecting the injured part from further damage (e.g. the use of crutches), rest from activity involving the injured part, ice (never apply ice directly to the skin), compression, elevation and the administration of anti-inflammatory medication.

Repair Phase

The repair phase is mediated by blood clotting over the damaged tissue. Blood platelets form a mesh to initiate healing. Also present in the blood clot are fibroblast cells, which proliferate and begin to lay down Type 3 (immature) collagen tissue, between 3-21 days after the injury. The use of electrotherapy in this phase has been shown to encourage fibroblast activity that ultimately provides a structurally stronger ligament.

Remodelling Phase

The remodelling phase follows the repair phase and can last for up to a year. It involves maturation of collagen tissue from Type 3 to Type 1 and realignment of collagen tissue. When it is first laid down, the collagen tissue is haphazard and does not possess a lot of tensile strength. The ligament gradually becomes stronger through being subjected to controlled strain in a functional pattern, which aligns the fibres in a longitudinal fashion. Physiotherapy, in the form of controlled exercises progressing to functional activity, aid this process of remodelling.

Because the remodelling phase lasts for up to a year, there is a potential weakness in the ligament and a risk of re-injury. This risk is reduced by providing additional stability with a strapping, increasing the strength of muscles which also provide support to the joint, and by doing proprioceptive exercises to increase the patient's sense of joint positioning.