Unit
- Phases of healing: Wound healing progresses through hemostasis, inflammation, proliferation, and remodeling. Each phase involves specific cellular activities and signaling molecules. Physical therapists must understand these phases to select appropriate interventions and avoid disrupting the healing cascade.
- Hemostasis phase: Immediately after injury, vasoconstriction and platelet aggregation form a clot. Platelets release growth factors like PDGF and TGF-beta that initiate the inflammatory response. This phase lasts minutes to hours and is critical for establishing a scaffold for cell migration.
- Inflammatory phase: Neutrophils and macrophages clear debris and pathogens. Macrophages secrete cytokines that stimulate fibroblast and endothelial cell activity. This phase typically lasts 2 to 5 days. Excessive or prolonged inflammation can delay healing and increase scarring.
- Proliferative phase: Fibroblasts produce collagen and extracellular matrix, while angiogenesis restores blood supply. Epithelial cells migrate across the wound surface. Granulation tissue forms, filling the defect. This phase lasts from 3 days to 3 weeks depending on wound size and patient factors.
- Remodeling phase: Collagen is reorganized from type III to type I, increasing tensile strength. Wound contraction occurs via myofibroblasts. This phase can last months to years. Physical therapy interventions such as controlled loading and scar management can influence remodeling.
- Factors affecting healing: Local factors include infection, ischemia, and edema. Systemic factors include nutrition, age, comorbidities (diabetes, vascular disease), and medications (steroids, chemotherapy). Physical therapists assess these factors to modify treatment plans.
- Wound classification: Wounds are classified by etiology (surgical, traumatic, chronic), depth (superficial, partial-thickness, full-thickness), and contamination status. The TIME framework (Tissue, Infection/Inflammation, Moisture, Edge) guides assessment and intervention selection.
- Clinical relevance: Understanding healing physiology allows therapists to time interventions appropriately. For example, aggressive stretching during inflammatory phase may cause tissue damage, while gentle mobilization during remodeling can improve collagen alignment. Knowledge of growth factors guides use of biologics.
- Wound assessment tools: Validated tools include the Bates Jensen Wound Assessment Tool, Pressure Ulcer Scale for Healing, and the Wound Healing Scale. These tools measure wound dimensions, exudate type, tissue type, and periwound condition. Consistent use of assessment tools enables objective tracking of healing progress and supports clinical decision making regarding treatment adjustments.
- Debridement methods: Debridement removes necrotic tissue and biofilm to promote healing. Types include autolytic (dressings), enzymatic (collagenase), mechanical (wet to dry), sharp (instrument), and biosurgical (maggots). Physical therapists may perform sharp debridement if within scope and after appropriate training. Selection depends on wound type, pain, and patient tolerance.
Scope of Practice
Role: Physical Therapist in Wound Care
Within scope:
- Assess wound characteristics and healing stage using validated tools.
- Apply non-invasive physical modalities such as electrical stimulation, ultrasound, and negative pressure therapy under appropriate supervision.
- Select and apply wound dressings based on moisture balance and exudate levels.
- Prescribe therapeutic exercise and functional activities to optimize loading and mobility.
- Document wound progress and communicate with interdisciplinary team.
Outside scope:
- Prescribe systemic medications or antibiotics.
- Perform surgical debridement or incision and drainage.
- Diagnose underlying pathology (e.g., arterial vs venous etiology) without physician confirmation.
- Independently change advanced surgical dressings without protocol.
- Provide wound care beyond state practice act limits.
Quick Revision
- Wound healing has four overlapping phases: hemostasis, inflammation, proliferation, remodeling.
- Local and systemic factors profoundly influence healing rates and outcomes.
- Physical therapists apply knowledge of healing physiology to guide modality selection and timing.
- The TIME framework provides a systematic approach to wound assessment and management.
- Scope of practice requires collaboration with physicians and adherence to regulations.
Disclaimer
Educational use only. Not intended for practical surgery, incisions, or other surgical procedures. It does not qualify you to perform physical operations.