The Use of the Physical Stress Theory to Guide the Rehabilitation of a Patient With Bilateral Suspected Deep Tissue Injuries and Hip Repair

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The physical stress theory states that changes in the amount of physical stress applied to tissue cause an expected response in all biological tissues.

Tissue Responds to Physical Stress in 5 Typical Ways:

Decreased tolerance to stress (atrophy), maintenance of tolerance to stress, increased tolerance to stress (hypertrophy), tissue injury, and tissue death. The purpose of this case report was to describe a simple and inexpensive device that enables the application of the physical stress theory for a patient who needs both decreased stress to facilitate wound healing and increased stress to facilitate improved strength and function.

Case Description:

The patient was a 93-year-old man, status-post open-reduction internal fixation of the left hip to resolve an intertrochanteric hip fracture after a fall. The patient had existing suspected deep tissue injury pressure sores on the posterior aspects of both heels.


After completion of the 16-day stay in inpatient rehabilitation, the patient was able to improve his level of function by using the device compared to initial evaluation. The patient was able to perform all functional activities with modified independence.


The off-loading mechanism that was created and implemented into the patient's intervention strategy was essential to enable the performance of strengthening exercises without further damaging the already-injured tissue.

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