Factors affecting injuries and healing

Question 1

What are classic abnormal end feels?

Answer 1

Bone to Bone (Bony)
Muscle Spasm End Feel
Empty End Feel

Question 2

What does abnormal bony end feel consist of?

Answer 2

Occurs when one would not expect to find a bone to bone end feel e.g. due to osteophytes, degenerative joint disease, mal-union

Question 3

What is muscle spasm end feel?

Answer 3

Sudden and hard dramatic arrest of movement accompanied by pain which is invoked by the movement
Is springy, rebound due to reflexive muscle guarding and aims to prevent further injury

Question 4

What is empty end feel?

Answer 4

When restriciton is not physical but a result of pain, can have full ROM but with pain e.g. in acute bursitis and joint inflammation

Question 5

What is springy block end feel (internal derangement)?

Answer 5

Springy or rebound sensation in a non-capsular pattern. Usually before end of normal ROM.

Question 6

What is leathery end feel?

Answer 6

Similar to tissue stretch but occurs when ROM is reduced.
Can be hard capsular or Soft capsular

Question 7

What is abnormal boggy / soft end feel?

Answer 7

Occurs if you have a joint effusion or oedema. Results in a mushy or soft quality which can be indicative of acute inflammation

Question 9

What are common postural deviations?

Answer 9

Hyperlordosis
Hyperkyphosis
Scoliosis

Question 10

What are aspects of hyperlordosis

Answer 10

Muscle imbalances such as tight quads

Can lead to discomfort, pain and certain spinal conditions

Pregnancy, obesity and others

Question 11

What are aspects of hyperkyphosis

Answer 11

Can be associated with some conditions of ageing, osteoporosis and poor posture
Can in severe cases reduce lung capacity

Question 12

What are aspects of scoliosis?

Answer 12

Can be structural - so fixed, or non-structural so can be surgically fixed

Depending on degree of curviture can require monitoring, bracing or surgical intervention

Question 13

What types of pelvic tilts are there?

Answer 13

Anterior pelvic tilt = PSIS lifts upwards as ASIS lowers

Posterior pelvic tilt = pSIS lowers as ASIS lifts upwards

Pelvic position can affect spine

Can effect breathing mechanics in severe cases

Question 14

What are cramps / muscle spasms?

Answer 14

Cause moderate -> severe pain, especially on contraction or stretch
There is a lump at the location of the spasm and often occur due to lack of proper hydration or strengthe training without sufficient rest
Lump is hollow adjacent
The limb will be held in a shortened muscle position

Question 14

What is a haematoma?

Answer 14

Localised collection of blood ie bruise

Intermuscular - bleeding between muscles
Intramuscular - bleeding inside a muscle

Intramuscular haematomas can cause more pain due to increased confinement of blood thus creating increased pressure

Question 15

What is haemarthrosis?

Answer 15

Presence of blood within joint space
Symptomatic of an injury to intracapsular structures

Can lead to inflammation, pain swelling and impact mobility.

Inflammatory arthritis and joint trauma can lead to this.

Question 16

What are the strain gradings (muscles/tendons)?

Answer 16

Mild to severe

Grade 1:
- Occurs when <5% of fibres are damaged
- Structural integrity intact

Grade 2:
- Resulting from more extensive damage to fibres
- some loss of function
- pain

Grade 3:
- Severe strain/ total rupture resulting from tearing >95% of fibres
- complete, intense pain
- complete loss of function
- usually surgical intervention required

Question 17

What is a sprain?

Answer 17

Injury to ligament

Grade 1 ligament sprain
- Mild sprain with minimal damage to ligament
- microtear of fibres
Grade 2 ligament sprain
- moderate sprain with partial tearing of ligament
- parital tear
Grade 3 ligament sprain:
- severe sprain caused by complete tearing (rupture) of ligament
- complete tear of fibres

Question 18

What are possible tendon injuries?

Answer 18

Tendinitis

Tendinosis

Tenosynovitis

Question 19

What is tendinitis?

Answer 19

Inflammation of a tendon (acute or chronic)
Typically caused by overuse, repetitive movement and trauma
Pain, swelling and tenderness at effected tendon.

Achilles tendon and rotator cuff tendons in the shoulder

Question 20

What is tendonosis

Answer 20

Degenerative change
Without inflammation
Often part of ageing process
Can cause localised pain and can be a palpable lump

Question 21

What is tendosynovitis?

Answer 21

Inflammation of the synovium of a tendon

E,g, De Quervain’s tenosynovitis - also in trigger finger
inflammation of the synovium of the thumb tendons

Question 22

What is bursitis?

Answer 22

Inflammation of the bursae
Often result of direct friction e.g. prolonged kneeling

Question 23

What is haemabursa?

Answer 23

Subtype of bursitis

Due to bleeding or damage due to trauma or injury
Impact damage to bursa resulting in it becoming filled with blood

Question 24

What is neurapraxia?

Answer 24

Bruising or compression of a nerve Mild form of nerve injury Associated with tingling, numbness in the area BUt often can resolve by self over time

Question 25

What is neurotmesis?

Answer 25

A severe nerve injury that disrupts the entire nerve Usually results in a permanent neurological impairment Does not resolve self and may require surgical intervention, can require lots of rehabilitation.

Question 26

What are the aims of acute treatment?

Answer 26

May need referral onwards If treatable without referral aim to - reduce pain - reduce inflammation - protect area - minimising risk of further injury - minimising swelling - minimising secondary risk of secondary death - promote healing: adequate rest, nutrition, - promote early mobilisation to prevent stiffness - education on nature of injury

Question 27

What are sub-acute treatment aims?

Answer 27

When formation of collagen fibres can be affected to optimise scar tissue formation Treatment aims include: - Developing mobility - Minimising swelling - Increasing blood flow to damaged tissues - Minimising scare tissue formation - Minimising pain - Minimising further bleeding

Question 28

Chronic stage treatment aims

Answer 28

After the repair phase, treatment aims revolve around restoring function: - developing mobility - developing flexibility (towards full ROM) - developing strength - developing proprioceptive abilities - can include sport specific training

Question 29

What framework is there for acute injury support?

Answer 29

PEACE and LOVE Protect Elevate Avoid NSAIDS - similar issues with ice Compress Educate Load - optimal loading without pain Optimisation - target psychological factors Vascularisation Exercise

Question 30

What occurs in acute stage injuries?

Answer 30

First 72 hours Fibroblasts act on the sticky matrix, not directly on damaged tissues Not severity of injury that determines the amount of scar tissue that results from the injury Amount of blood surrounding the injury, which contains fibrinogen, will determine the eventual amount of scar tissue For this reason, heat should be avoided and only cold therapy used during early stages

Question 31

What are the 4 stages that guide the application of cryotherapy?

Answer 31

Regardless of type of soft tissue, good guideline for application of ice is the four stages of cold application: Appreciation of cold Burning Aching or throbbing Numbness General pattern experienced Should be stopped once numbness is experienced

Question 32

What are contraindications to cryotherapy?

Answer 32

Requires healthy skin as a thermal barrier and suficient circulation Elderly - thin skin, poor circulation Cardiovascular problems - poor circulation Diabetic complications - poor circulation Radiotherapy / chemotherapy (damaged skin) Raynaud's disease (poor distal circulation)

Question 33

What are possible adverse reactions to cryotherapy?

Answer 33

Ice burns Loss of circulation Discomfort or pain Sudden increases in BP Uncontrolled shivering Tiredness, fatigue Hyper/hypoventilation Confusion Irregular pulse

Question 34

Sub-acute stage treatment methods

Answer 34

Suitable techniques include - Mob exs - General massage - Frictions - Heat / ice - Gentle stretches - Muscle energy techniques Correct technique selection depends on an understanding of the injury

Question 35

How can heat be applied?

Answer 35

Modalities: - heat packs (conduction) - hydrotherapy (convection) - ultrasound (conversion) Methodology: - Between 5-30 mins - Temperatures normally 40degrees to 45 degrees Safety - need to be aware of lowered blood pressures - avoid burns through overuse or abnormal skin conditions