Midterm 1 Flashcards
(41 cards)
______ informs clinical decisions to design program that supports what?
physiology
healing
Healing continuum - IRR SUMMARY
Inflammation
Repair
Remodel
inflammation - part of the healing process, often seen as negative
repair - transition - scaffold
remodel - apply stresses here to create
1 - Inflammation
Standard chemical responses (3) causing vascular changes (2 parameters)
- response description
- fxn
- interventions to calm response
INITIATE inflammation:
histamine = swelling, similar with allergy and itchiness responses - vasodilation and permeability (anti-histamine) prostaglandins = from endothelial of the blood vessel -vasodilation (aspirin) BK = increase permeability along with histamine - as well as increasing sensitivity of local areas
permeability - allow fluid from the blood to reach the tissue = SWELLING (not bleeding)
diameter - allows for more BLOOD FLOW
What are nociceptors and how can their thresholds change?
free nerve endings that are constantly detecting general threat to the body (chem, mech, temp)
bradykinin - decrease threshold, increase ease of firing
So what kind of superficial changes in the tissue would you see with inflammation? (3)
red, swollen, heat
How long does inflammation last? (chronic vs. acute)
acute - 48-72 hrs (WELL MANAGED)
chronic - any more than 72 hrs - threat still may be there if still in active inflammation
2 - Repair
____ & lymph system
_____blasts
______genesis
What time of tissue is formed between this stage and the previous?
Timeline of this stage
What overall improvements/changes in status are happening at this stage?
WBC - phagocytize dead cells, clots, and debris into the lymph system
Fibroblasts - lay down type III collagen fibres and elastin -quick sloppy template
Angiogenesis - formation of new blood vessels (from existing ones) to feed new tissue
Granulation tissue - hypervascular, scabby
Timeline: peak @ 48 hrs, lasts 3-6 weeks
Great change in appearance, decreased pain, little inflammation, increase fxn…..therefore risk of injury
3 - Remodeling
What happens to reduce the gap in the severed tissue?
Collagen conversion and __________
-influenced by balance between which two processes, and is dependent on what kind of stimulation?
Timeline
One thing to remember during this phase
myofibroblasts bridge the ends of the tissues
reorganization
influenced by rates of synthesis and lysis - this is the time to add stresses to the structure in order to ensure the creation a stronger final structure
Timeline: 3 weeks - 2 years post injury
structure may be functional but it is not 100%!!
4 pillars of rehab programs
ROM
Resistance exercise
NM communication
Pain+other symptoms
5 PASSIVE ROM limiters (aka. possible place of intervention to increase ROM)
stress of injured structure = PAIN; decrease pain = increase ROM; also decrease increase of flexor muscle activity (which is triggered by pain to protect joint)
joint effusion (SWELLING) - decrease swelling = increase ROM; if they are in active inflammation - treat the inflammation; >5 weeks after inflammation…move out fluid
CT factors:
JOINT CAPSULE COMPLEX & CT FASCIA (-myesiums) - tight
SCAR TISSUE ADHESION (within muscle) - improper remodeling
Cyclic ROM
Specific to…
Goals? (why should we focus on this)
Can be performed….
joint ROM - ie. do 10 neck rotations
preserve ROM (script, especially in over-protective ppl) lymph drainage of fluid via muscle contraction (ie. flush hammies)
actively or passively
Passive stretching
muscle specific or…
how can we pre-warm target?
stretch duration?
joint specific if you are focusing on gross ROM
pre-warm target by massage, hot pack, light exercise - increase temp from within
CREEP FX - if a muscle is held at its max length…it will continue to loosen and increase in length; however effects are temporary; OPTIMAL TIME - TBD IN RESEARCH
THE MAIN ACTIVE ROM limiter (aka. possible place of intervention to increase ROM)
Lead to and/or a result of what two things?
What can we do about it?
acute muscle spasm + habitually overactive muscles (ie. traps)
MF trigger points - point of high innervation concentration along the muscle - can be HYPER ACTIVE; uncomfortable with pressure - can be irritated by stretching therefore active solution is best
overall: OVER ACTIVE = ACTIVE TREATMENT
What is SMR?
Techniques?
3 potential effects?
foam rolling, tiger tail, pressing on your own trigger points
apply pressure active trigger points on the muscle to shut it down
effects:
mechanical - roll out adhesions, increase fluid
neurophysiological - decrease muscle activity
vascular - foam rolling found to increase NO in endothelial tissue
What is PNF stretching?
How does it increase ROM?
The 2 techniques?
proprioceptive NM facilitation
reset NS bias to stretch
effective with hammies
HR - passively take to end range - HOLD 30s - 20% ISOmax for 6-10s - RELAX - take to new end range
CR - passively take to end range - CON contraction through full ROM in 10s - bring back to new end range
Massage (lecture slide)
Effleurage
Petrissage
Tapotement
Effleurage - +/- elevation - superficial…may move fluid
Petrissage - +/- transverse friction…potentially remove scar tissue, improves BF; warm up technique
Tapotement - stimulates NS - commonly used in sports massage
Resistance exercise
What 5 questions must you consider?
- how much of the ROM should you work through? (IT DEPENDS)
- what tissues are injured/non-injured?
- WB status (if they can WB, consider CON exercises)
- what are the local and non-local targets? (weak joint vs. muscles; above/below joint)
- how can you improve or to prevent the MOI? (mech - chronic…LH bicep tendinitis….protracted scapulas, train retractors; lat ankle sprain….target evertors ECC)
Resistance exercise
Name different forms of resistances
Complexity of tasks - which constraints?
4 other variables of resistance exercise?
theraband, free weights, gravity, machines
planes: multi or single planar
target muscles: 1 muscle or integrate multiple
sets, reps, rest, load/intensity
Sample resistance exercise sets/reps/contraction or rest by ASCM
ISOMETRIC
ISOTONIC ENDURANCE
ISOTONIC HYPERTROPHY
How do we choose progression?
ISOMETRIC: 1-3, 10, 5-10s contraction
ISOTONIC ENDURANCE: 1-3, 12-15, 30-60s rest
ISOTONIC HYPERTROPHY : 3-6, 6-12, 1-2 min rest
depends on the function of the target muscles (postural or gross motor); weak muscles that have atrophied may need hypertrophy
2 NM exercises/drills? Why do them?
NM control and efficiency is key. No point having strong muscles when you can’t effectively coordinate them.
Joint repositioning - proprioceptive task
Perturbation drills - eyes closed, therapist displaces limb from neutral position
- 2 constraints: POSITION and AMPLITUDE/DISPLACEMENT
- train responsiveness of NM system
NM - balance and coordination - differentiate. How can these two be manipulated in terms of rehab exercises?
balance - related too COM within BOS (FIRST CHANGE BOS by going from 2 feet to 1 foot, then COM by moving limbs around while balancing)
coordination - related to overall smoothness or efficiency of the movement (can be maintained or improved by practice of the task but to a smaller magnitude - ie. small baseball throws against a wall, unrelated to muscle endurance/hypertrophy)
Muscle actions of:
Glut max (2) Rectus femoris (2) Biceps femoris (3) Adductor longus (2) Gastronemius (2) Peroneus longus (2) Tibialis posterior (2)
Glut max - HIP ABD, HIP EX ROT
Rectus femoris - KNEE EX, HIP FL
Biceps femoris (3) - KNEE FL, [KNEE EX ROT], HIP EX
Adductor longus (2) - HIP ADD, [HIP FL]
Gastronemius - ANKLE PF, [KNEE FL]
Peroneus longus (2) - ANKLE EV, ANKLE PF
Tibialis posterior (2) - ANKLE IN, ANKLE PF
Functions:
Wobble board Airex pad Bosu ball Stability ball Trampoline or rebounder Agility ladder
Wobble board - similar to flat side of bosu ball - proprioception/balance - COMMON FOR ANKLE
Airex pad - balance, joint stabilization; can be used for lunges, squats, one leg stands
Bosu ball - balance, convex side up - train lower leg, ankle stability; flat side up - train abs, hip stability
Stability ball - stability, balance, muscle endurance; can be used for push ups and sit ups
Trampoline or rebounder - jumping jacks, twists, side to side motions, running place
Agility ladder - coordination, proprioception, sequencing, balance
Differentiate nociception and pain
nociception - sensory information from a free nerve ending - detecting a wide range of threats - to be sent to the CNS
pain - subjective experience created by the mind (cognitive, affect/emotional, sensory)
