Modalities & Exercise Exam 2 Flashcards
(39 cards)
Why Do We Need To Learn This?
Most TM applications are directed at relieving pain.
This information will make it make sense later.
Knowledge of all aspects of pain improves the ability to evaluate the individual on a multidimensional level and progress them through rehab safely.
Necessary to understand that not all pain experiences are related to an acute inflammatory response.
The whole evidence based practice thing .
What is Pain?
“an unpleasant physical and emotional experience which signifies tissue damage or the potential for such damage”
International Association for the Study of Pain (IASP)
Pain exists if the individual says it exists
Pain is essential to survival
Pain motivates the injured athlete to seek care and can help us make assessments
Etiological factors
factors that cause a condition
Sensory component
Rate your pain on a 1-10 scale, Visual Analog Scale, other pain scales
Pain Disability Index – comprehensive questionnaire
Oswestry Pain and Disability Index (p.98)
Validated?
Sensory + Affective-Motivational Component
Varies between individuals
Previous pain experiences, family experiences, cultural background, situation specific… these can create somatic markers (emotional memories)
Persistent pain outlasts its usefulness in identifying and injury, A-M aspect
Four types of peripheral sensory receptor
Special
Visceral
Superficial
Deep
Special Sensory Receptors
Sight Taste Smell Hearing Balance
little impact on the perception of (and response to) musculoskeletal pain
Visceral Sensory Receptors
Hunger
Nausea
Distension
Visceral pain
Superficial Sensory Receptors
AKA cutaneous receptors
“peripheral” because they are on the periphery (outside CNS)
Superficial Sensory Receptors
Mechanoreceptors
Stroking, touch and pressure
Some adapt rapidly (pressure and touch)
-Meissner’s corpuscles and Pacinian corpuscles (hair follicle receptors)
Some are more slowly adapting (pressure and skin stretch)
-Merkle cell endings and Ruffini endings
Superficial Sensory Receptors
Thermoreceptors
Temperature and temperature change
Slowly adapting, but discharge in bursts with rapid temperature change
Warm receptors stop discharging at temps that damage the skin
Cold receptors continue to discharge when tissue cooling is perceived as painful
Why don’t freezing injuries such as frostbite hurt as much?
Superficial Sensory Receptors
Nociceptors
Free nerve endings
Stimulated by: potentially damaging mechanical, chemical, and thermal stress
Sensitized by: prostaglandins, bradykinin, substance P, serotonin and others…
Contain the neurotransmitter L-glutamate which increases pain sensation
Deep Tissue Receptors
Muscle
Muscle Spindles and Golgi Tendon Organs (GTOs)
Sense changes in muscle length and tension
May also be sensitive to chemical stimuli
Joint Structures
Pacinian Corpuscles: Adapt rapidly and respond to changes in joint position and vibration
Ruffini Endings: Adapt slowly and are most active at the end ranges of joint motion
Both have Nocioceptors
Free nerve endings that say ‘Whoops, this is/that was too far!”
The Acute Pain Pathway
Ascending Pathways
Afferent Pathways
“First Pain”
Neocortical Tract
Fast, three-neuron pathway from the periphery (outside the CNS) to the cortex (area of the brain that identifies the location of pain)
Important Parts Nociceptor (skin, soft tissue, periosteum) Sensory nerve (first order neuron) T-cell (second-order neuron) Thalamus Sensory Cortex
Afferent Pathways
Impulses from sensory receptors are transmitted to higher brain centers by AFFERENT (OR SENSORY) NERVES
FIRST ORDER AFFERENT NERVE
In the periphery (outside the CNS)
Cell body in the DORSAL ROOT GANGLION
Synapses in the dorsal horn of the spinal cord
A-Beta Fibers (1st order afferent sensory nerve)
Originate from hair follicles, Meissner’s corpuscles, Pacinian corpuscles, Merkle cell endings, and Ruffini endings
Transmit info regarding touch, vibration and hair deflection
Large diameter and myelinated = FAST CONDUCTING
Relatively low threshold = EASILY STIMULATED
A-Delta Fibers (1st order afferent sensory nerve)
Get info from warm and cold receptors, a few hair receptors, and free nerve endings
Transmit info regarding touch, pressure, temperature pain
Free nerve endings primarily respond to pain: pinching, pricking, crushing
Small diameter and myelinated = SLOWER CONDUCTING
Higher threshold = NOT AS EASILY STIMULATED
C- Fibers (1st order afferent sensory nerve)
Smallest afferent peipheral nerves associated with pain
Also include efferent postganlionic fibers of the SNS
Primarily mechano and nocioceptors
A few are themoreceptors
Smallest diameter and NON-myelinated = SLOWEST CONDUCTING
Highest Threshold= REQUIRE MUCH HIGHER STIMULATION
where did that first order afferent sensory nerve synapse?
Dorsal Horn of the spinal cord
SECOND ORDER AFFERENT NERVE
Cell body is within the DORSAL HORN (grey)
2nd order neuron’s axon (white) makes up the ascending pathway
Synapses in the thalamus for both pleasant and noxious input
AKA “T-Cell” because they transmit info on
different tracts
T-Cells (2nd order neurons) cross the spinal cord (decussate) to transmit information up to the thalamus
Pain, temperature, touch, vibration and deep pressure
THIRD ORDER AFFERENT NERVE
Cell body is within the THALAMUS
Thalamus becomes a relay center
Sensory information is organized here
Facilitatory and inhibitory circuits established
Basically gets it ready to send to the somatosensory cortex of the brain
ALSO – the thalamus transfers input to the limbic system
Emotional, autonomic, and endocrine response to pain
Paleocortical Tract Pain
“Second Pain”
Slower and more complex than the acute pain pathway
Deals with the complex emotional components of pain
More intense stimuli activate polymodal nociceptors
These promote a more diffuse, unpleasant and persistent burning sensation that continues past the acutely painful stimulus
Peripheral Pain Modulation Techniques
GOAL: Desensitize the peripheral nocioceptors
ATCs try to counteract the effects of acute inflammation that sensitizes free nerve endings and peripheral nocioceptors
Bradykinin, prostaglandin E2 and serotonin facilitate nociceptor sensitivity
How can we do this?
Cryotherapy
Ice lessens the effects on chemical mediators and slow conduction velocity of all sensory input
Subsensory-level Estim and Non-thermal US
Microcurrent… proposed to affect pain modulation at peripheral level
Non-thermal ultrasound… empirical results
