E1-Healing Phases and MET Flashcards by Caitlyn Griffin

what are the characteristics of direct trauma

obvious trauma
rapid onset of symptoms including surgery

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what are the characteristics for overuse syndrome

no trauma
sudden changes in parameters of activity
subsequent onset of symptoms- tendinitis

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what are the characteristics of repetitive strain syndrome

no trauma
gradual onset of symptoms without change in parameters of activity
biomechanical limitation or degenerative disease

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what are the characteristics of regional interdependence

increased nociceptive response and decreased pain inhibition, peripherally and centrally
gradual onset of symptoms- victim vs real culprit
doesn’t fit traditional biomechanical model
often unsuccessful treatments

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what are the general phases of tissue healing

hemostasis
inflammation
proliferation/repair
remodeling

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can healing occur without inflammation and vice versa

no, healing will always include inflammation

yes, inflammation can occur without the presence of healing

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how long does the acute inflammation last

24 hours to 2 weeks

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what are the the acute inflammation cardinal S&S

red
swollen
hot
P!

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what is the purpose of the acute inflammation phase

protect and preparation

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what happens systemically during vascular reaction

vasoconstriction from pain and SNS stimulation to- shunt blood from injury site, start clotting, slow bleeding

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what happens at the site of injury during vascular reaction

local vasodilation and vascular permeability brings cells to kill and clean

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what happens at the cellular level during hemostasis and inflammatory stages

serotonin released
platelets aggregate- release growth factors
histamines, etc released for local dilation
WBCs

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Because of vasodilation in the local area of injury, what happens

local stasis= edema
increased viscosity
increase of chemicals and acidity leads to chemical muscle guarding

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what is the “glue” of cellular reactions in the hemostasis/inflammatory stages

RBCs, cellular debris, fibronectin

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what is the general Rx during the hemostasis/inflammatory stage

max protection
POLICED

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what is POLICED

protection
optimal
loading
Ice
Compression
Elevation
Drugs

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what does the P stand for in POLICED

protection with possible….
activity modification
immobilization- bracing/taping
assistive device

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what does “OL” mean for POLICED

optimal loading thru activity and MET..
P! and inflammation
early motion
promote tissue repair
muscle activation to combat inhibition

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Why can drugs be limited for POLICED

NSAIDs may impair healing by impairing histamines from causing vasodilation and local permeability
drugs should only be used if ADLs are impaired because of pain

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how long can the repair phase last

24 hours to ~10 weeks

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what is the purpose of the repair phase

collagen production by respective tissue cell
formation of new blood vessels
restoration of skin

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what is the general Rx for the repair phase

continue inflammatory phase Rx
greater ROM restrictions and tissue with manual therapy/MET
progress MET for optimal loading with dose response to direct and protect new collagen but achieve neuromuscular benefits

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what general Rx would benefit the following tissues in the repair phase: articular cartilage, annulus, disc (fibrocartilage)

compression, distraction, gliding

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what general Rx would benefit the following tissues in the repair phase: bone

compression and distraction

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what general Rx would benefit the following tissues in the repair phase: muscle, tendon, ligament, capsule, outer annulus, menisci (fibrocartilage)

tension

what is the time period for the remodeling phase

2 weeks to a year, but may continue up to 3 years

what is the purpose of the remodeling phase

collagen conversion and organization- immature collagen to mature collagen wound contraction by myofibroblasts

what is the general Rx for the remodeling phase

return to function address symptoms- move away from passive treatment restore full ROM with MT/MET progress to higher MET

what could possibly go wrong and create a set back?

subacute inflammation chronic/persistent inflammation abnormal scar tissue

what are the differences between acute, subacute, and chronic inflammation

acute= healing subacute= mild prolonging of inflammatory response chronic= pitting edma, release of inflammatory products

how could you treat chronic inflammation

heat- lowers the viscosity of the edma

what is remodeled tissue

combination of original and secondary types of collagen

What level of tissue dosage is MET considered

High dosage exercise More reps, exercises, aerobic activity

What is the primary purpose people come to PT

Pain, inflammation, and muscle guarding

What are benefits of treating pain, inflammation and muscle guarding with PT

Reduce symptoms Improve circulation and venous return Facilitate lymphatic drainage Limit atrophy

When is it OK to have mild pain with exercise

Non acute or persistent conditions: Muscular strain Tendinopathies Nociplastic conditions

What are some rationales that Pts need to know about their treatment

Demonstrate hurt does not equal harm Alleviates mental fear of movement Reduces sensitivity of CNS Same or better gains

What is it not OK to treat when the pt has pain

Acute conditions Remaining tissues/conditions: age related change, hypermobility/instability, stenosis

What purpose needs to be achieved earliest for muscle function using MET

Muscle activation

How is endurance related to MSK in PT

We are stressing the integrity of tissues. The act of tissues withstanding stress over a period of time

How can you change the integrity of tissue with endurance

Tissue dose response: motor activation, skill, coordination development

What are characteristics of motor skill/coordination

Controlling increased motion and speed Occurs very early More and better fiber recruitment

What purpose has to be obtained first for better outcomes with motor skill/coordination

Activation

How do we prescribe to reach motor skill/coordination

Can occur at <50% 1 RM Work or quick concentric, brief isometric hold, then slower eccentric action

What is muscle strength

Force generation

What is the best intervention for sports injuries

Muscular strength Decrease sports injuries by 1/3 Decrease overuse injuries by nearly 1/4

When can you see hypertrophy or increase in fiber size

6-8 weeks

If hypertrophy is not seen until 6-8 weeks, what is changing

Neurological adaptations are taking place

What is the 2nd best injury preventer

Agility

What is plyometrics

Eccentric load or lengthening followed by concentric action through the stretch reflex

What are the plyometric parameters

Explosive and up to 5 reps with heavier load

What are the benefits of plyometrics

Achieve greater cross bridging Length and speed feedback from muscle spindle that links synergistic muscles to act

What do aerobic components help with

Endogenous influence Even more optimal stresses for a better dose response More movement to combat fear avoidance behaviors Oxygenation of tissue

What is the frequency needed for exercises

At least 2-3x/wk

What weight and reps would you do to achieve pure strength and power

Heavy load with max 8 reps

What weight and reps would you do to achieve ROM, activation, integrity, coordination, and agility

Moderate load with max 30 reps

What are the indications to do isometrics

Unable to perform motion with even the lightest resistance Pain modulating benefits To use heavier loads when more motion is painful

What are isometric exercise parameters

Varied 3-5 reps of 10-45 sec holds

Based on Oddvar Holden diagram, what sets and reps would be appropriate for acuity

1-2 sets with light resistance

Based on Oddvar Holden diaphragm, what is appropriate for tendonosis

3 sets of 10-15 reps with heavy resistance

What would you do for sets and reps with this case: Disc herniation Avascular/hypovascular tissue Needs better tissue endurance/integrity or healing

3x30 with moderate load

What would you do for sets and reps with this case: Shoulder impingement due to joint hypermobility and insufficient rotator cuff Better motor activation and coordination

3x30 with moderate load

What would you do for sets and reps: Patellofemoral Pain Syndrome Impaired trunk and hip strength

3x15-20 reps with moderate load

What would you do for sets and reps with this case: Ankle joint hypo mobility and adaptive muscle shortening following prolonged immobilization Improve ROM

3x30 reps with moderate load

E1-Healing Phases and MET Flashcards

(64 cards)