Week 7 (parts 1 and 2) Flashcards
(28 cards)
part 1
exercise prescription for strength, power and endurance
what is the difference between strength, power, hypertrophy and endurance
Strength = the ability of muscle to exert a maximum force at a specified velocity
Power = the force exerted multiplied by the velocity of the movement
Hypertrophy = muscle growth
Endurance = the ability to sustain an activity for extended periods of time or the ability to resist fatigue
what are the objective measures of strength
Oxford measures
Isometric measurers
Maximum capacity tests
Dynamometry
what analysis and planning is needed for exercise
Assessment and problem list formation (where is your patient now?)
Collaborative SMART Goal setting (where do they need / would they like to be?)
Plan your exercise programme (how you are going to get them there?)
Remember specificity - every patient is different so every exercise programme will be different!
what do you need to think about when planning exercise for a patient
What muscle group(s) need strengthening?
What type of strengthening do they need (strength, power, endurance)?
How is it best to train for this (eccentric, concentric, isometric)?
What dose will you prescribe (resistance, frequency, intensity, rest FITTVP)?
What can your patient achieve (consider pain, fitness, time)?
part 2
pain reduction and patient advice
what is pain
’an unpleasant sensory and emotional experience associated with, or resembling that associated with actual or potential tissue damage’
what are the 2 pain pathways
Peripheral (PNS):
Transmits sensory information to the CNS and motor commands from the CNS to the muscles
Central (CNS):
Is responsible for processing sensory information and generating appropriate commands / responses
what is nociception
The process of encoding noxious stimuli
what is allodynia
‘Pain due to a stimulus that does not normally provoke pain’
what is Hyperalgesia
Increased pain from a stimulus that normally provokes pain
what is central sensitization
‘Increased responsiveness of nociceptive neurons in the central nervous system to their normal or subthreshold afferent input’ (Allodynia + Hyperalgesia = central sensitisation)
what is neuropathic pain
Pain caused by a lesion or disease of the somatosensory nervous system
what is Nociplastic pain
Pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain
what is chronic/ persistent pain
Pain that persists or recurs for longer than 3 months
what is a normal pain response
Unpleasant sensation associated with actual or potential harm
Caused by stimulation to mechanical, chemical and thermal receptors.
Receptors are stimulated and ion channels open.
Positive ions enter the neurone if a threshold reached - action potentials created.
The action potential travels along the nerve to the spinal cord
what are the mechanics of pain
- At the end of a nerve are receptors – mechanical, chemical and thermal.
- Receptors are stimulated and ion channels open.
- Positive ions enter the neurone. Once a specific amount have entered it triggers a response – an action potential.
- This action potential travels along the nerve to the spinal cord.
- If the neurone is a nociceptive neurone the message is a ‘danger’ message.
- The brain decides how to interpret that message – it might ignore it, or give a response. That response might or might not be pain.
- Chemicals can affect the receptors – local anaesthetic eg lidocaine, blocks them so you don’t feel pressure, think of dental injections. Other chemicals can hold receptors open increasing the pain response. Sting ray venom is supposed to do this.
- These receptors have a short life – only a few days. Then they die and are replaced by new sensors. This means that pain sensitivity is constantly changing and can also be changed. If you brain decides it needs more information it will produce more sensors and sensitivity will increase. Similarly, if it decides fewer are needed then it will slow down production and more die than are produced, reducing overall sensitivity.
- Following an injury mechanoreceptors and chemical receptors are stimulated. Inflammation contains chemicals that increase sensitivity in the tissues as a normal response to injury. This is a normal response to a painful stimulation. In an abnormal pain state
why do we not feel pain all the time
When the messages reach the spinal cord there is another gateway neurone.
This second gateway neurone also needs stimulating to pass on the ‘danger’ response to the brain.
However, the brain can block these messages from ascending.
The brain decides whether to let messages through and once through what they mean and how best to deal with the information.
When the massages reach the spinal cord there is another gateway, or synapse that chemicals need to pour into and that needs to reach another critical level.
Once this critical level has been reached the message will be sent to the brain – unless the brain blocks it….
The brain can flood the synapses with chemicals like opioids and serotonin. These push out the ‘danger’ signal chemicals and chill out the receptors making then mess likely to get excited and trigger a response
how can pain be interpreted differently
Many examples of when pain and tissue damage or forces do not match up.
Traumatic amputations are often described by patients as feeling like a thud or tug.
Paper cuts are really painful
Rugby players regularly get stood on, kicked and piled on top of, but report no pain.
Research looking into pain found that patients with their hand in a sham simulator experienced more pain as a dial was increased. The dial wasn’t connected to anything!
what changes in persistent pain
- The ‘danger’ system becomes more sensitive and better at passing on messages.
- Thresholds that trigger responses are lowered causing hypersensitivity and allodynia.
- Non nociceptive neurones sprout new neurones near synapses and start taking ‘danger’ messages to the brain.
- The spinal cord amplifies the information going up to the brain and can even make things up!
- Unsurprisingly the brain thinks the danger level has increased – therefore it increases the pain sensation.
- Thoughts start to influence pain. The endocrine system gets involved. The immune system gets involved.
- Thresholds that trigger responses are lowered causing hypersensitivity and allodynia - this means that things that used to hurt now hurt more. This is called ‘hyperalgesia’. It also means that things that didn’t hurt before now hurt. This is called ‘allodynia’.
- Non nociceptive neurones sprout new neurones near synapses and start taking ‘danger’ messages to the brain. But these could be light touch neurones so light touch becomes painful.
- The spinal cord amplifies the information going up to the brain – like ramping up the volume on a speaker or increasing the sensitivity/ speed of a computer mouse.
- Unsurprisingly the brain thinks the danger level has increased – therefor it increases the pain sensation.
- It is working with duff information so can’t be relied upon!
- Thoughts start to influence pain – it has been shown that thought processes can be powerful enough to maintain a pain state. These thoughts are often related to a lack of knowledge and understanding on pain mechanisms and best treatments. Things like “if I’m in pain I shouldn’t move” and “I need to rest until the pain goes away”
- The endocrine system gets involved – changes in cortisol (stress hormone) and adrenaline affect how we feel pain and how much pain is felt.
- The immune system changes as a response to persistent pain. There are more pro-inflammatory cytokines floating around. These upregulate inflammatory reactionsFollowing an injury mechanoreceptors and chemical receptors are stimulated. Inflammation contains chemicals that increase sensitivity in the tissues as a normal response to injury. This is a normal response to a painful stimulation. In an abnormal pain state this sensitivity returns when the immune system releases pro-inflammatory cytokines.
what is a physiotherapists role in pain management
Assessment – don’t treat fracture, ruptures, cauda equina, malignancy (cancer) patients (red flag pathologies)
Treatment and needed
Red flag assessment
Pain education / demystifying pain
Goal setting
Encourage self management
Onwards referral to pain specialist
what are the main parts in pain assessment
Subjective ratings scales – VAS (visual analogue scale), NRS (numerical pain scale), faces pain scales
Objective measures – McGill pain questionnaire, Pain beliefs and attitudes inventory, EQ-5D
Visual observations – pain behaviours, communication changes
Physiological responses – HR, BP, sweating, colour
what factors affect pain
Anatomy / pathology
Mood
Sleep
Stress
Environment
Lifestyle eg work Upbringing / childhood
Past experiences
Friends / family reactions
what is pain education
One of the most important areas of our patient advice and education.
The physiology of pain can be easily understood by men and women in the street.
Understanding pain physiology changes the way people think about pain, reduces its threat value and improves their management of it.
