Acute

Acute used in treatment time protocols applies to the first 6 weeks of case management. This usage must not be confused with the acute inflammatory reaction to injury which usually last from 24 to 72 hours assuming no complications or aggravations. In effect, acute as used in treatment time protocols is Stage I and II of the healing response. Stage I and II may span a time frame of 6 weeks assuming no complications. The case management goal would be to shorten the time of Stage I an II presentations as much as possible. This will maximize the healing potential. If effective intervention of Stage I and II is interfered with, this will not only complicate the case, but increase the time frame and the possibility of the injury becoming chronic.

Subacute

In treatment time protocols this is given as 12 weeks or 18 weeks post injury. Many mild injuries are self limiting and resolve within the initial 6 weeks. Subacute is defined as a persistence of symptoms beyond the initial presentation of 6 weeks for up to 12 weeks or 18 weeks post injury. Subacute is in effect the first 12 weeks of Stage III response to healing. It is in the early weeks of the fibrosis of repair stage that collagen remodels from ground substance and support phase into dense scar tissue. This process is usually established within 18 weeks which is a combination of the acute and subacute phases.

Chronic

Chronic in treatment time protocols indicates a persistence beyond 18 weeks. Chronic by definition, means not self limiting. A chronic injury can be an acute or overuse injury treated improperly, or ignored. Repeat irritation or aggravation with a low level inflammatory process can lead to local accumulation of scar tissue and granular tissue which remains vascular and supportive of the growth of pain sensitive nerve endings. This tissue is very painful, and proliferates as irritation continues. Many reflex and degenerative effects occur in the affected area. Some of these are: a gradual loss of ligamentous integrity resulting in weaken or stretched ligaments, compartments or capsules, loss of proprioception from the joints, ligaments and capsules, excessive range of motions, reflex splinting or weakness of the surrounding muscles, recurrent pain, and early onset of DJD or DDD. The presentation of the symptoms may be episodic or progressively unremitting. The symptoms may appear as chronic but the so call 'chronic" presentation is really a sequence of acute episodes over a pre-existing weakness or injury. The doctor must be alert to this. The treatment plan must change back to an acute inflammatory response when such aggravations occur. The ultimate goal of treatment must be to get the individual patient back into their profession without or only minimal residuals that are not limiting from a biomechanical standpoint.