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Theraputic Exercise > Soft tissue inury, repair and management > Flashcards

Soft tissue inury, repair and management Flashcards

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1
Q

What is a macrotrauma injury?

A

Specific MOI

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2
Q

What is a microtraumatic injury?

A

repetitive strian overload over time; cumulative

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3
Q

What is an acute injury?

A

macrotrauma

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4
Q

what is a overuse injury?

A

microtrauma

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5
Q

what is a chronic injury?

A

Either – depends on MOI and when it started and if got treated or not

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6
Q

What is a contact injury?

A

Occurs when the injured area is directly impacted by another player, object, or the ground.

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7
Q

What is a indirect contact injury?

A

Occurs when contact to a body part other than the injured area leads to the injury.

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8
Q

What is the different injury list?

A

Strain

Bursitis

Sprain

Dislocation

Contusion

Hemarthrosis

Synovitis

Cartilage defect

Laceration

Ganglion

Subluxation

Tendinopathy

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9
Q

Grades of soft tissue injury

what is a grade 1 injury?

A

Mild pain at onset or within the first 24hrs

Mild swelling, local tenderness, and pain occur when injured tissue is stressed

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10
Q

Grades of soft tissue

What is a grade 2 soft tissue injury?

A

Moderate pain requires activity stoppage

Stress and palpation of injured tissue greatly increases pain

Incomplete tearing: with ligamentous injury some fibers are torn resulting in increased joint mobility (hypermobility)

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11
Q

Grades of soft tissue

what is a grade 3 soft tissue injury?

A

Near complete/ complete tear/ avulsion (tendon or ligament) with severe pain

Stress in injured tissue is painless bc it’s not there

Palpation may reveal the defect – separation of fibers

A torn ligament results in joint instability

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12
Q

stages of tissue healing

What is the inflamatory response phase? and typical time frame?

A

Acute stage

Typically first 3-5 days post onset

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13
Q

What is the fibroblastic repair stage and the time frame?

A

Subacute stage

Days 4-21 post-onset; may last up to 6 weeks

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14
Q

What is the maturation-remodeling phase and time frame?

A

Chronic stage

3 week post-onset may last up to 1 year or 2

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15
Q

What is the charcteristics and clinical signs of the acute/inflamtion phase?

A

Tissue responses and characteristics
- Vascular changes – constriction followed by dilation
-Exudation of cells and chemicals
-Stuff (cells, proteins, etc.) oozes pit
- Clot formation
- Phagocytosis, neutralization of irritants – clean up crew
- Early fibroblastic activity

Clinical signs
- Inflammation
- Pain before tissue resistance (body’s way of protecting the tissue)

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16
Q

What is the charcteristics and clinical signs of the subacute/proliferation phase?

A

Tissue responses and characteristics
- Removal if noxious stimuli
- Growth of capillary beds into area
- Collagen formation (laying down new tissue)
- Granulation tissue (skin)
- Very fragile, easily injury tissue (initial laid down is week Type 3 collagen)

Clinical signs
- Decreased inflammation
- Pain synchronous with tissue resistance

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17
Q

What is the charcteristics and clinical signs of the chronic.maturation/remodeling phase?

A

Tissue responses and characteristics
- Maturation of connective tissue
- Contracture and remodeling of scar
- Collagen aligns to stress (type 3 to type 2 collagen)

Clinical Signs
- Absence of inflammation
- Pain after tissue resistance

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18
Q

Wound specific healing time frame? (each phase)

A

1-3 days – inflammation

3-7 days – proliferation

5 days to 8-18 months – remodeling

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19
Q

Bone specific healing time frame? (each phase)

A

Immediately – 4 days – inflammation

4 days to 6 weeks – proliferation

6-12 weeks – remodeling

Near normal strength is attained

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20
Q

Muscle speficic healing time frame (each phase)

A

6 hrs up to 3 weeks – inflammation

7-18 days – proliferation

6weeks to 6 months – remodeling

Contraction ability is 90% normal

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21
Q
A
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22
Q

Articular Cartilage healing time frame (each phase)

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A

48hrs – 5 days – inflammation

2weeks- 1 month – proliferation

2- 6 months – remodeling

Type 1 to type 2 collagen have near normal appearance

23
Q

Tendon healing time frame (each phase)

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A

First 3 days – 1 week – inflammation

10-42 days – proliferation

6-50 weeks – remodeling

40-50 weeks – strength is 85-95% normal

24
Q

Ligament specific healing time frame (each phase)

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A

First few days – 72 hours – inflammation

3 days to 6 weeks – proliferation

14 days up to 1-2 years – remodeling

40-50 weeks near normal tensile strength is restored

25
Phase 1 of rehabilitation is?
Maximum protection
26
During phase 1 of rehabilitaiton what are the impariments of body strucutre and funciton?
- Inflammation, joint effusion, pain, edema, muscles spasm - Impaired movement - Restricted use of associated areas (regional interdependence)
27
During phase 1 of rehabilitation what is the PT's role?
- Controls inflammation - Facilitate healing - Maintain normal function in unaffected tissues and regions (aka if ankle injured Hip and Knee
28
What is the goal during the 1st phase of rehablitation?
Control inflammation Prevent deleterious effects of rest 1-2 weeks start deconditioning of muscle and aerobic
29
what are the precautiosn during the 1st phase of rehab?
the proper dosage of rest and movement must be used during inflammatory stage
30
What are the contraindictions during the 1st phase of rehabilitation?
Stretching and resistance exercise should not be performed at site of the inflamed or swollen tissue 
31
# POC up 1 week post-injury During phase 1: How to do POC: control pain, edema, joint effusion, spams
- Compression, elevation and massage - Immobilize the injured tissue - Avoid stress to the injured tissue - Gentle-G1 or G2- joint mobilizations in pain free prepositions
32
During phase 1: POC: maintain soft tissue and joint integrity and mobility
Appropriate dosage of passive movements respecting pain and the tissue injured What passive movements are safe based on the tissue injured? Appropriate method and dosage of interknitted muscle activation. What method of activation? – isometric What muscles? What is an appropriate dosage? – start as 25%, submaximal, high rep. Just trying to get the muscles activated Appropriate aerobic exercises depending on proximity to associated areas and effect on injured tissue It depends on the tissue but typically low impact and or seated
33
Phase 2: moderate protection/ controlled motion what are the impairments of body structure and function ?
Pain at end of available ROM Edema and or/joint effusion (decreasing but may still be present) Contractures in immobilized region Muscle weakness from reduced usage or pain Restricted function related to involved tissues
34
PT’s role during this stage of healing is critical. The patient is feeling better and active movements can begin; however, its easy to (do what?)
PT’s role during this stage of healing is critical. The patient is feeling better and active movements can begin; however, its easy to
35
Goals during phase 2 of rehabiliation?
Promote healing Delelop a mobile scar
36
What are the Precautions during phase 2 of rehab?
Signs of inflammation normally decrease early in this stage Some discomfort will occur as activity is progressed, but is should decrease within 2- 4 hours Signs of too much and/or too soon may indicate: Pain after 24 hours Increased weakness Fatigue Resting pain Increased inflammation
37
# POC and Intervention (up to 3 weeks post-injury POC: promote healing of injured tissues (what are we doing?)
- Monitor response and modify PRN - Protect healing tissue with Ads, orthoses, tape, etc. PRN - Gradually increasing time, the injured tissue is free to move - Decrease use of supportive equipment as pain allows and strength improves (gradually)
38
# POC and Intervention (up to 3 weeks post-injury POC: restore soft tissue, muscle and or joint mobility (what are we doing?)
- Progress PROM to AAROM to AROM per tolerance - Gradually increase mobility of scar tissue - Progress mobility of related structures if limiting ROM
39
# POC and Intervention (up to 3 weeks post-injury POC: develop neuromuscular control, muscle endurance, and strength in involved and related muscles (what are we doing?)
- With caution and mild resistance, progress multiple-angle isometric exercise, then initiate AROM Protected weight-bearing Balance Stabilization exercise - Gradually progress dynamic exercises with increased repetitions for muscle endurance - Emphasize movement control proper mechanics - Progress resistance later in this stage
40
# POC and Intervention (up to 3 weeks post-injury what are we educating the patient on during rehab phase 2?
Review healing timeframes and protective strategies HEP Rx and encourage appropriate functional activities
41
# POC and Intervention (up to 3 weeks post-injury POC: maintain integrity and function of associated areas (what are we doing?)
- Progressive strengthening and stabilizing exercises - Resume low-intensity activities involving healing tissue that do not exacerbate the symptoms
42
# Phase 3: Minimum to no protection/ return to function Impairments of body structure and function in phase 3
- Contractures/ adhesions that limit mobility - Decreased muscular performance - Decreased usage of the involved part - Inability to participate per PLOF
43
What is the PTs role during phase 3 of rehab?
PTs role is to design a progression of exercise that safely stresses the maturation connective tissue to the patient can resume, regular activities and participate in work, community mobility, recreation/ sports, etc..
44
What are the goals during phase 3 of rehab?
Increase tensile quality scar Develop functional independence
45
What are the precautions during phase 3 of rehab?
There should be no signs of inflammation Some discomfort with progression of activity is acceptable but shouldn’t lasy > 2-4 hours
46
During phase 3 what are we educaing the patients on?
Instruct patient in safe progressions of exercise and stretching Monitor understanding and compliance Teach ways to avoid reinjuring the part Teach safe body mechanics and provide ergonomic counseling as appropriate
47
What are the Signs of excessive stress with exercise or activities
- Exercise or activity soreness that does not decrease after 4 hours and is not resolved after 24 hours * Exercise or activity pain that comes on earlier or is increased over the previous session * Progressively increased feelings of stiffness and decreased ROM over several exercise sessions * Swelling, redness, and warmth I the healing tissue * Decreased functional usage of the involved part * Exercise progressions may cause some temporary soreness that can last 4 hours, but if the above s/s occur, intervention is too stressful and should be modified
48
How would POC: increase soft tissue, muscle, and/or joint mobility
Joint mobilization /manipulation STM Manual stretching and flexibility training
49
What are ways to progress exercise in the POC: improve neuromusuclar control, balance, stregnth abd muscular endurance?
- Protected weightbearing to full weightbearing - Single plane to multiplanar motions - Simple to complex motions - Submaximal to greater resistance - Variable contraction types - Low repetitions to high repetitions - Slow speeds to high speeds
50
During phase 3 of rehab how to POC: progress activities and participation in life situations 
Use supportive equipment’s PRN until functional ROM and adequate strength are restored Progress functional training with simulated activities Protected and controlled to Unprotected and variable Continues to progressive functional and performance training activities until desired level of function is restored
50
What is chronic inflammation and persisting dysfunction
Prolonged or recurring pain with limitation is often result of stress imposed on tissue(s) that are unable to adequately attenuate that stress “overuse” “Cumulative microtrauma” “Repetitive strain” Do not exceed maximum load capacity!
51
Why does chronic inflamation and persisting dysfunction happen?
Too much too soon Training errors Mobility deficits Muscle Soft tissue Joint Muscle weakness Muscle strength and length imbalances Impaired motor control Faulty positional and movement mechanics Etcetera and any combinations thereof…
52
POC: intervention for controlled motion and return to function?
Identify barriers to healing and address associated impairments all the while respecting patient tolerance and tissue status

Theraputic Exercise (6 decks)

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