Soft Tissue Response

Question 1

what are the 2 steps to a logical process to evaluate the extent of an injury

Answer 1

1. understand the mechanism of the traumatic sequence
2. understand how to methodically inspect an injury (HOPS)

Question 2

what is soft tissue?

Answer 2

non-bony tissue
- skin, muscle, tendon, ligament, fascia, blood vessel, nerve
- common injuries include sprains, strains, contusions, tendinosis/tendinopathy
-each tissue will have a yield point (or elastic limit)

Question 3

tissue structures are…

Answer 3

stronger in resisting forces from certain directions compared to others

Question 4

what does the anatomical design of joints mean

Answer 4

that they are more susceptible to injury from a given direction

Question 5

how is force categorized

Answer 5

according to direction from which force acts

Question 6

define compression + example

Answer 6

axial loading along an axis
landing from a jump

Question 7

define tension + example

Answer 7

stretching, pulling along an axis
lateral ankle sprain

Question 8

define shearing + example

Answer 8

oppositely directly loads that are parallel
plant & turn

Question 9

what injuries are a result of forces applied in different directions

Answer 9

abrasions
incisions
laceration
avulsion
puncture
blisters

Question 10

what is open wound management

Answer 10

control bleeding
gauze to apply pressure
clean the wound (soap and water or saline; remove debris)
dress the wound
make sure ends are approximated; use butterfly or steri-strips or stitches

Question 11

what are the two physical responses to physical trauma

Answer 11

inflammation and healing

Question 12

what is necrosis

Answer 12

when deprived of oxygen results in cell death

Question 13

what is hematoma

Answer 13

pool of blood with disrupted tissue

Question 14

result of trauma primary injury

Answer 14

bleeding and damaged tissue

Question 15

result of trauma secondary injury

Answer 15

damage occurring secondary to the primary injury

Question 16

describe the components of blood

Answer 16

liquid fraction: plasma
- makes up 55%
formed elements: Blood cells
- makes up 45%
- RBC
- WBC
- Platelets (thrombocytes)

Question 17

what is inflammation

Answer 17

complex biological response of vascular tissues to harmful stimuli such as pathogens, damaged cells, or irritants
includes a complex set of events – series of interrelated physical and chemical activities

Question 18

what does inflammation do

Answer 18

localize the extent of the injury so there doesn’t become a secondary one
remove foreign material and dying tissues so that healing can begin

Question 19

what are the 3 phases of inflammation

Answer 19

1. acute vascular response/inflammation (4-6 days)
2. repair and regeneration/proliferation (2-24 days)
3. re-modeling and maturation (21 days - 2 years)

Question 20

define vasodilation

Answer 20

widening of bloodvessel

Question 21

define vasoconstriction

Answer 21

constriction of bloodvessel

Question 22

define hypertrophy

Answer 22

increasing cell size

Question 23

define atrophy

Answer 23

decreasing cell size

Question 24

define necrosis

Answer 24

death of cell

Question 25

describe phase 1 (acute vascular response)

Answer 25

- injury - increase blood flow - mobilize and transport cells - remove damaged cells - body puts out new collagen immediate vasoconstriction then histamine causes vasodilation and increased vascular permeability. WBC and macrophages get rid of unwanted substances and platelets seal off area. fluid leaks out of blood vessels and results in edema (swelling) causing secondary injury and then gets drained through lymphatic system

Question 26

what are some signs and symptoms of inflammation

Answer 26

signs ---> redness, swelling, heat, pain symptoms ---> loss of function, limited joint or muscle ROM, palpable tenderness

Question 27

treatment for inflammation

Answer 27

decrease pain and swelling prevent chronic inflammation maintain mobility and strength in adjacent areas injured areas rest

Question 28

describe phase 2 (repair and regeneration (proliferation)

Answer 28

begins once the debris is cleared the dense capillary network will form fibroblasts proliferate damaged areas and makes collagen collagen forms a loose mesh network of connective tissues at the injury site new collagen fibers a laid down in a disorganized manner - in the form of a scar weak links between each fibre new tissue is weak and susceptible to disruption by overly aggressive activity

Question 29

signs and symptoms of proliferation

Answer 29

less warmth and swelling palpable tenderness decreases pain felt with tissue resistance or stretch of the tissue

Question 30

treatment focus of proliferation

Answer 30

ROM exercises joint mobilization light loads to promote tissue remodel

Question 31

describe phase 3 (remodelling and maturation)

Answer 31

begins once fibroblasts disappear scar tissue collagen begins to align with direction of stress and the cross-link formation becomes more organized scar tissue is avascular and inelastic remodeling may take months to years to complete

Question 32

signs and symptoms of remodelling and maturation

Answer 32

improved ROM and strength stretching, active contraction, resistive loads

Question 33

what is the therapist's role in the three phases

Answer 33

minimize initial damage and promote the healing process - address the inflammatory response ensure undue stress is avoided until tissues are ready (even on healthy tissues)

Question 34

whats rehab therapy look like for muscle and tendons

Answer 34

muscle ~ 3 wk tendon ~ 4-6 wk early activity promotes full strength and ROM return. too early could cause increased bleeding and edema and decreased ROM

Question 35

whats rehab therapy look like for ligaments

Answer 35

ligaments ~ 6-12 months stress during remodeling increase collagen strength too early could increase length of fibers and increase joint laxity

Question 36

define shock

Answer 36

diminished amount of blood available to the circulatory system. As a result, not enough oxygen-carrying blood cells are available to tissues

Question 37

describe hypovolemic shock

Answer 37

caused by too little blood volume

Question 38

define cardiogenic shock

Answer 38

due to heart problems

Question 39

define anaphylactic shock

Answer 39

caused by severe allergic reaction

Question 40

define septic shock

Answer 40

due to infection

Question 41

describe neurogenic shock

Answer 41

caused by damage to the nervous system

Question 42

describe obstructive shock

Answer 42

caused by embolism, pneumothorax

Question 43

signs and symptoms of shock

Answer 43

signs pulse; rapid or weak skin; cool, clammy, pale breathing; rapid, shallow sweating; profusely pupils; dilated, dull eyes BP; steadily falling unconsciousness symptom nausea

Question 44

whats the treatment for shock

Answer 44

comforting the athlete and screening the injury maintain body heat, so warm blanket elevate feet and legs continue to monitor vitals

Question 45

what does RICE mean

Answer 45

Rest - prevent further damage (10min - 10 months) Ice - only if huge injury or violent response reduces blood flow and increases stiffness compression - reduces swelling, comfort elevation - reduces swelling, limits blood, encourages venous return support - stabilization and immobilization will prevent further injury

Question 46

what does POLICE mean

Answer 46

Protect Optimal Loading Ice - only if huge injury or violent response compression elevation

Question 47

what is return to play (RTP)

Answer 47

able to return to playing sports or participating in an activity at a pre-injury level

Question 48

what is return to sport (RTS)

Answer 48

if seen by physician and received medical clearance; pain free no swelling no tenderness 80-100% strength 80-100% balance and coordination

Question 49

what is the interdisciplinary approach to functional mechanics

Answer 49

injury occurs due to failure of some biological structure (application of force > adaptation by body)

Question 50

what is the interdisciplinary approach to physiology

Answer 50

if tissues are strong, moderately flexible and not fatigued, there is a better chance of not getting injured

Question 51

what are 3 things to look at in psychological perspective

Answer 51

1. predisposition to injury - identify those at risk 2. reaction to injury - understand typical responses of athletes 3. rehabilitation - optimizing recovery - speed of recovery and maintenance of performance levels

Question 52

what are some psychological issues relative to athletic injury

Answer 52

loss of social aspects loss of identity loss of importance depression, anxiety, other behavioral factors (ED, grades, anger)

Question 53

what is the psychological response

Answer 53

injury occurs ---- athlete has realized the severity of the injury ---- thought process begins (cognitive appraisal)

Question 54

what questions are asked during cognitive appraisal

Answer 54

how bad? how long will i be out? surgery? rehab/treatment? can i get back to where i was athletically? am i finished? what else is there the do?

Question 55

what are the stages of the coping model

Answer 55

denial anger grief or desperation depression acceptance or reintegration but EVERYONE reacts differently

Question 56

describe cognitive appraisal model

Answer 56

personal/situational factors influence cognitive appraisal of injury appraisal influences emotional/behavioral responses, including recovery outcomes takes into account individual differences in response to injury

Question 57

what is cognitive appraisal model influenced by

Answer 57

personal factors - personality traits, locus of control, goals, what the athlete brings to the situation situational factors (anxiety, focus, worry, emotion, confidence etcc) - related to the athletes social context - sport, social, environment (familiarity, star player? length of rehab? social support etc..)

Question 58

what are 3 coping strategies

Answer 58

1. appraisal focus - athlete modifies the way they think 2. problem (action) focus - athlete makes an effort to do something active to alleviate stress 3. emotion focus - athlete tries to regulate emotional consequences

Question 59

how to AT and coaches fit into injury

Answer 59

AT see athlete first (positive or negative for athlete) coaches' reaction to injury WORDS HAVE A POWERFUL IMPACT

Question 60

what prevents athletes from being able to successfully cope with their injuries

Answer 60

adherence and positive attitude

Question 61

psychosocial strategies for athletes

Answer 61

keep the athlete involved with the team use short term goals create variety in rehabilitation understand motivation use effective communication setting realistic goals positive reinforcement

Question 62

how to use positive self talk

Answer 62

identify what identify when replace with positive

Question 63

how to use imagery

Answer 63

facilitate relaxation facilitate healing process control pain maintain skill block replay of injury

Question 64

what are other rehab interventions

Answer 64

education goal setting awareness spare time providing social support

Question 65

what is the rehab wheel

Answer 65

assesses areas to reduce stress to facilitate restoration of physiological and psychological states PERSONAL and PHYSICAL