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W4 Flashcards

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1
Q

overuse injury

A

an injury of the musculoskeletal system that results from exposure to a repetive force beyond its ability to withstand such force

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2
Q

intrincic factors to overuse injury

A

– Age
– Gender
– History of previous injury
– Biomechanics/alignment
– Aerobic fitness
– Limb dominance
– Flexibility
– Muscle strength
– Foot morphology

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3
Q

extrincic risk factors to overuse injuries

A

– Skill level
– Shoe type
– Playing surface
– Equipment
– Use of tape/ brace
– Training errors
– Level of competition

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4
Q

Non/Mild - Moderate Irritability of overuse injuries & goals of mamangemtn

A

➢ Not affecting ADLs
➢ Pain during the activity
➢ Pain may reduce with warming
up
➢ Pain may continue during the
activity and after stopping the
activity
goals of managment Treat and train while de-loading
tissues

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5
Q

Moderate - Severe Irritability of overuse injuries & goals of mamangemtn

A

➢ Pain is affecting or limiting ADLs
➢ May have constant symptoms
goals of mamangemtn
➢ Cease activity that
produced/aggravates pain/injury
➢ Attend to pain +/- inflammation as
priority
➢ De-load tissues to relieve pain &
encourage normal function

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6
Q

Overuse injuries: management of low to server

A
  • Modification activity
  • HEP
  • Muscle conditioning
  • Neuromuscular control
  • Flexibility/ROM
  • Cardiovascular fitness
    Massage (TP, adhesions)
  • Joint mobilisation
  • Pain relief
  • Healing
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7
Q

Overuse injuries: management Moderate - Severe Irritability

A

relative rest
* Muscle conditioning
* Neuromuscular control
* Flexibility/ROM
* Cardiovascular fitness
* Pain relief
* Healing
Massage (TP, adhesions)
* Joint mobilisation

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8
Q

Late stage rehabilitation

A
  • Incorporate function/sport specific exercises
  • Return to function/work/sport guided by
    ① Time constraints for soft tissue healing
    ② Pain-free full ROM
    ③ No persistent swelling
    ④ Adequate strength & endurance
    ⑤ Good flexibility
    ⑥ Good proprioception/balance
    ⑦ Adequate cardiovascular fitness
    ⑧ Function/sport specific skills regained
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9
Q

Reinjury risk

A

– Inadequate rehabilitation
– Build up too quickly
– Inadequate healing time
– Client not listening
– Fitness not fully restored
– Predisposing factors not
fully addressed
- Previous risk patterns not
recognised & managed
accordingly

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10
Q

What causes tendinopathy?

A

Overuse- high tendon load, repetive load or sudden increase
* Altered lower limb function/biomechanics- muscle weakness/ imbalance, alt absorbition of loading forces, foot posture
* Intrinsic factors- gender, genetics, body composition (type 2 diabetes)

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11
Q

Clinical presentation of tendinopathy

A

pain after exercise or the following morning upon rising
painfree at rest
Can ‘run through’ the pain or disappears when ‘warms up’ only to return when cool down

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12
Q

PE of tendinopathy

A
  • Examination reveals local tenderness in the tendon and/or
    thickening
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13
Q

Reactive tendinopathy

A
  • Non-inflammatory
  • Occurs with acute tensile or compressive overload eg increase in volume, activity following low levels, direct blow
  • Predominantly younger athletes
  • proliferative response –tendon cells activated and producing repair
    proteins, esp. proteoglycans
  • Reduces stress and increases stiffness
  • Short-term adaptive thickening of tendon that reduces stress
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14
Q

Tendon dysrepair

A
  • Worsening pathology
  • Attempt at healing
  • Chronically overloaded tendon
  • Spectrum of ages & load environments
  • Thicker
  • Some reversibility with load management is possible
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15
Q

Tendon dysrepair Imaging (MRI/US) results

A
  • Discontinuity of collagen fascicle
  • Hypoechoic areas on US
  • ↑ vascularity on Doppler US
  • Swollen tendon on MRI
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15
Q

Degenerative tendinopathy

A

mostly older ppl or prolonged elite athletes
multiple history of repeated tendon pain
* Tendon is heterogeneous – degenerativec pathology interspersed with other stages
of pathology and normal tendon

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16
Q

Degenerative tendinopathy Imaging (MRI/US) results

A
  • Progression of matrix and cell changes
  • Cell death → areas of acellularity
  • Matrix disorder and breakdown
  • Filled with vessels
  • Vascular changes extensive – many & large vessels on Doppler US
  • Hypoechoic regions (few reflections
    from collagen fascicles)
  • ↑ tendon size
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17
Q

Load management (reduction!) Reactive tendinopathy & early dysrepair

A

– Allows tendon time to adapt
– Cells become less reactive
– Matrix resumes more normal
structure
– Reduces pain

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18
Q

Adapting tendon to increased load

A

– Use of training diary to monitor load
– Increase load without increasing symptoms
* Doesn’t need to be painfree
* Can be low VAS but stable
* Care not to create increased pain day after exercise/activity

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19
Q

Maintenance of repair after Reactive tendinopathy

A
  • Program maintained until full function restored
  • Minimum 3 months, typically 6-
    12mths
  • Adjust as required to complement
    load demands
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20
Q

is load reduction helpful for Late dysrepair/degenerative tendinopathy

Study These Flashcards
A

not generally helpful
* Load modification - address contributing factors
Lower limb biomechanical issues
– E.g. Ankle joint mobility, muscle
length, foot posture* Training & technique factors
– Volume
– Technique (running, jumping)
* Kinetic chain function
– Coordination, strength & endurance
– Lumbopelvic and hip stability

21
Q

Late dysrepair/degenerative tendinopathy treatment aim

Study These Flashcards
A

Treatments aim to stimulate
cell activity, increase protein
production, restructure matrix

22
Q

exercise in Late dysrepair/degenerative tendinopathy

Study These Flashcards
A
  • Eccentric exercise, heavy slow resistance training (conc and ecc) particularly effective for tendon
    structure & pain
    – ↑ collagen production
    – ↓ tendon vessels
    – Improve tendon structure
    – Pain relief in 4-6 weeks
23
Q

Isometric Exercise - Patellar Tendinopathy (PT)

Study These Flashcards
A
  • Isometric contractions used to reduce pain without a reduction
    in muscle strength
  • Isometrics could be used pre-sport for pain relief without producing fatigue
  • Metronome timing for CS effects
  • Isotonic exercise effective for tendon rehabilitation, not
    appropriate prior to activity
24
Mobilisation
Passive movement technique applied to a spinal or peripheral joint performed within control of patient Assessment and treatment * Physiological or Accessory movements * Oscillatory small/large amplitude * Sustained stretching +/- oscillations at limit of range
25
Manipulation
* Sudden movement or thrust performed at the limit of joint range such that patient is unable to prevent movement: * Treatment only * High velocity * Small amplitude
26
Oscillations or sustained stretches may consist of:
Physiological movement Accessory movement
27
Physiological movement:
* movements that a person can carry out actively * E.g. ankle dorsiflexion
28
Accessory movement:
* movements that a person cannot perform independently but are necessary for joint movement * Roll, spin, slide/glide * Distraction, compression * E.g. anteroposterior glide of talus during ankle dorsiflexion
29
Contraindications and Precautions to mobilisation
fracture, circulatory insufficiency Post fracture – until union proven Inflammatory joint diseases Total joint replacements When manual therapy is aggravating the condition Patient’s current and past history/ general health requires further investigation
30
Principles of Mobilisation
1. Direction 2. Patient position 3. Therapist position 4. Localisation of forces 5. Application of force: Grades, Rhythm 6. Dosage parameters
31
How do we work out which direction to mobilise?
Based on movement-related joint signs 3 types of joint ‘play’: * Gliding * Traction (distraction) * Compression
32
Direction - Gliding
* Convex joint surface: move in opposite direction to the direction of restricted movement of the distal aspect of the bone e.g. head of humerus moves inferiorly for restricted shoulder abduction * Concave joint surface: move in same direction e.g. tibia condyles glide anteriorly for restricted knee extension
33
Patient position during mobilisation
Completely relaxed May be selected to replicate functional position Neutral (open/loose packed) position if pain is main problem At limit of range if aiming to stretch structures / manage stiffness
34
Localisation of forces
Confident, comfortable grasp Stabilisation where required Point of contact to influence joint Applied line of force should match direction intended
35
grade 1 of mobilisation
small amplitude movement at beginning of the available range
36
grade 2 of mobilisation
large amplitude movement within a resistance-free part of available range
37
grade 3 of mobilisation
large amplitude movement performed into resistance or up to the limit of available range
38
grade 4 of mobilisation
small amplitude movement performed into resistance or up to limit of available range
39
grade 5 of mobilisation
small amplitude movement at end of available range
40
Application of forces – Rhythm for mobilisation
* Stationary holding (sustained) * Slow, smooth movement/oscillation * Fast, sharp, staccato movement/oscillation
41
Dosage parameters Grade I or II mobilisation
Techniques designed to have an immediate modulating effect on severe or irritable movement related pain: Slow smooth rhythm Short duration (< 2 minutes) Repeated only 1-2x in a session
42
Dosage parameters Grade III or IV
Techniques designed to have an effect on movement related stiffness & pain: Quicker, sharper staccato rhythm Performed for several minutes Repeated several times within a session
43
Mobilisation progression
Driven by symptomatic response & reassessment Options for progression: * Repeat technique * Alter a component of technique * Add in new techniques * Change the technique * Manipulate * Stop treatment
44
Recording way to write
treatment position, techniques, grade, rhythm used, number of times/ duration, effect WHILE it was being preformed
45
Mobilisation with Movement
Application of a sustained passive accessory force to a joint while the patient actively performs a task that was previously identified as being problematic
46
Mobilisation with Movement PILL response
* Pain-free application of mobilisation & movement components * Instant result at time of application (50-100% improvement) * Long Lasting effects beyond the technique’s application
47
Mobilisation with Movement Volume/Dosage:
Influenced by condition, response & sustainability of response 6-10 repetitions 1-3 sets Rest period: time for re-assessment Constant assessment of comparable signs Progressions *Increase force *Increase difficulty/level of physiological movement eg: NWB ->FWB *Increase frequency/sets
47
Volume/Dosage Mobilisation with Movement Application
“Glide, move, unmove, unglide” Physiological movement usually relates to the pain provoking movement *Effects can be maintained by tape
48
Adverse effects of manual therapy
* most were short-lived and minor * Adverse effects predominately related to manipulations * Adverse effects similar to those of exercise prescription * Most occur within 24 hours and resolve in 72hours * Risk of major adverse event is very low ( lower than taking medication * Risk should be weighed against patient-perceived benefit and alternative treatments

musculeoskeletal (13 decks)

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