Soft tissue healing

Question 1

When is passive range of motion indicated?

Answer 1

1. In regions where there is acute, inflamed tissue
2. when a patient is not able or supposed to actively move a segment of the body (comatose, paralyzed or complete bed rest)

Question 2

When is AROM indicated?

Answer 2

1. when a patient is able to contract the m actively and move a body segment
2. Assist AROM is used when pt is weak - allows m to be used at full firing to build strength
3. used on regions above and below immobilized segment to maintain the areas in as normal a condition as possible
4. can be used for aerobic conditioning program

Question 3

What is passive range of motion?

Answer 3

movement of a segment within the UNRESTRICTED ROM that is produced by an external force

Question 4

What are precautions and contraindications to range of motion exercises?

Answer 4

1. when motion is disruptive to the healing process

2. when pt response or the condition is life-threatening

Question 5

What are signs of too much or the wrong motion?

Answer 5

increased pain and inflammation

Question 6

Stage of healing: Inflammatory reaction; pain at rest, hot; goal to maintain ROM (not increase)

Answer 6

Acute stage

Question 7

Stage of healing: repair and healing; pain at rest is gone, less hot; goal to either maintain or increase ROM depending on the patient

Answer 7

Subacute stage

Question 8

Stage of healing: maturation and remodeling; inflammatory stage should be gone; pain only comes when provoked; goal to increase ROM

Answer 8

Chronic stage

Question 9

What are the cardinal signs of inflammation?

Answer 9

1. Redness
2. Warm
3. Edema
4. Pain
5. Decreased function
   - present in acute, decreasing in subacute, absent in chronic stage

Question 10

What treatment should be used in acute stage of healing?

Answer 10

PROM

Question 11

What treatment should be used in early subacute stage of healing?

Answer 11

AAROM, Isometrics

Question 12

What treatment should be used in late subacute and chronic stage of healing?

Answer 12

stretching

Question 13

What are the clinical signs of the inflammatory stage and what are the PT goals and intervention?

Answer 13

Signs: inflammation and pain before tissue resistance
PT goals and intervention:
-Protection phase
1. control effects of inflammation (RICE)
2. prevent deleterious effects of rest (nondestructive movement: PROM, massage, m. setting with caution)

Question 14

What are the clinical signs of the proliferation, repair, and healing stage and what are the PT goals and intervention?

Answer 14

Signs: decreasing inflammation, pain synchronous with tissue resistance
PT goals and intervention:
- controlled motion phase
1. develop mobile scar (selective stretching, mobilization/ manipulation of restrictions)
2. Promote healing (nondestructive active resistive, OC and CC stabilization, m. endurance, and cardiopulm endurance exercises, carefully progressed)

Question 15

What are the clinical signs of the maturation and remodeling stage and what are the PT goals and intervention?

Answer 15

Signs: absence of inflammation, pain after tissue resistance
PT goals and intervention:
- Return to function phase
1. increase tensile quality of scar (progressive strengthening and endurance exercises)
2. Develop fxn’l independence (fxn’l exercises and specificity drills)

Question 16

What is the intervention used for chronic inflammation/ cumulative trauma syndromes?

Answer 16

non stressful PROM

Question 17

What is contraindicated in the acute stage of healing?

Answer 17

stretching and resistance exercises

Question 18

What are the precautions for acute stages of healing?

Answer 18

proper dosage of rest and movement must be used

Question 19

What are the precautions for the subacute phase of healing?

Answer 19

• discomfort should not last longer than a couple of hours

- sings of too much motion or activity are resting pain, fatigue, increased weakens, and spasm lasting beyond 24 hours

Question 20

What are the signs of excessive stress with exercise or activities?

Answer 20

1. soreness that does not decrease after 4 hours and not resolved after 24 hours
2. pain that comes on early or is increased over the previous session
3. progressively increased feelings of stiffness and decreased ROM
4. Swelling, redness and warmth
5. progressive weakness over several exercise sessions
6. decreased fxn’l usage of involved part

Question 21

What are the precautions during the chronic phase of healing?

Answer 21

• There should be no signs of inflammation
• discomfort should not last longer than a couple hours after treatment
• activities that progress too quickly = joint swelling, pain lasting longer than 4 hours or that requires medication relief, decrease in strength, or fatiguing more easily