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PTA 230 (Ortho) > CH 9: effects of remobilization and exercise, effects of smoking > Flashcards

CH 9: effects of remobilization and exercise, effects of smoking Flashcards

1
Q

What are the leading causes of preventable morbidity and mortality in the US?

A

Smoking

Tobacco use

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2
Q

What has nicotine been implicated in the pathogenesis of various diseases?

A
  • Increasing platelet aggregation
  • Reducing microvascular prostacyclin levels
  • After surgery, inhibiting fibroblasts, RBC, macrophages
  • Decreases in cellular density
  • Decreases in type I collagen gene expression, strength, and stiffness
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3
Q

What does the smoking status impact and have a significant factor on?

A
  • Permanent disability discharge from US Army
  • Decreases in subjective International Knee Documentation Committee scores
  • Decreases in mean overall International Knee Documentation Committee scores
  • Decreased rate of return to sport
  • Increased objective ligament laxity
  • Decreased activity levels based on validated activity scales
  • Decreased quality of life.
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4
Q

What stage of ligament healing occur with weak, fragile tissue?

A

Immediate (Homeostasis and Degeneration)

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5
Q

What stage of ligament healing occurs with vasodilation and scar formation; break down and remove dead cells; unstable type III collagen?

A

Inflammation (Day 3-14)

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6
Q

What stage of ligament healing occurs angiogenesis, very gradual changes in collagen strength, and tissue changes from cellular to fibrous?

A

Proliferation and migration (Day 14-60)

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7
Q

What stage of ligament healing occurs from day 60-360?

A

Remodeling and maturation

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8
Q

What is the treatment during hemostasis and degeneration stage of ligament healing?

A
  • Rice
  • Pain management techniques (TENS, oral meds)
  • NWB or WBAT
  • Can initiate CPM (within limited ROM)
  • Protection of ligaments from unwanted stress (braces, casts, etc)
  • Strict, rigid, long-term immobilization minimized
  • Isometric muscle contractions
  • Contralateral limb exercises as tolerated
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9
Q

What is the treatment during Inflammatory stage of ligament healing (Day 3-14)?

A
  • RICE
  • Active progressive motion
  • Continued ligament protection
  • Progressive WB
  • Protected, controlled, active resisted exercise
  • Cycling (for motion)
  • Isometric exercise progression
  • Electrical muscle stimulation
  • Initiate gentle multiangle static holds (isometrics)
  • Avoid excessive motion
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10
Q

What is the treatment during proliferation and migration stage of ligament healing (Day 14-60)?

A
  • Continued RICE as needed
  • Begin low-load static stretch if needed
  • Preheating tissues if needed
  • FWB
  • Isokinetic exercise with continued ligament protection with bracing
  • Eccentric isotonic exercise
  • Progressive concentric isotonic exercise
  • Hydrotherapy: swimming
  • Progressive cycling
  • Initiate CKC exercise
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11
Q

What is the treatment during remodeling and maturation stage of ligament healing (Day 60-360)?

A
  • Prolonged low-load static stretching
  • Progressive advanced isokinetic and isotonic ex
  • Cycling
  • Stair climbs
  • Proprioception, balance, coordination exercises
  • Advance to CKC exercise
  • Progress to plyometric exercise
  • Jogging
  • Running
  • Jumping
  • Maintaining joint protection with functional brace as needed
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12
Q

What tends to remodel and regain tensile strength slower than ligament tissue after mobilization and therapeutically directed reconditioning?

A

Ligament-bone insertion complex

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13
Q

What are ligament substance and ligament-bone complex sensitive to?

A

Exercise

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14
Q

What can be observed with appropriately directed exercise?

A
  • Orientation, composition, synthesis, concentration of Type I Collagen
  • Ultimate load to failure
  • Increase in tensile strength
  • Stiffness of ligament and ligament-bone complexes
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15
Q

What does dense fibrous tissue (tendon, ligament) respond to?

A
  • Frequency
  • Intensity
  • Duration of exercises
  • Specific type of load applied to tissue
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16
Q

How do tissues that are subjected to repeated compressions respond?

A

Synthesizing larger and greater amounts of proteoglycans than tissues exposed to tension loads

17
Q

Following injury, what can appropriate controlled motion and exercise stimulate for ligament repair?

A
  • Improving matrix organization and composition
  • Increasing weight of injured ligaments
  • Promoting normalized collagen synthesis and strength
18
Q

What can influence and determine the degree and type of healing that occur after trauma and subsequent immobilization?

A
  • Motion
  • Exercise
  • Protected progressive stress
19
Q

What do joints that are immobilized demonstrate?

A
  • Scar tissue

- Adhesions

20
Q

What do joints moved passively through the motions demonstrate?

A
  • Well organized, longitudinally oriented collage

- No adhesions

21
Q

What is the development concept of early protected motion applied to healing soft tissues?

A

CPM (continuous passive motion)

22
Q

When is CPM used?

A
  • Knee joint contractures
  • Postoperative ACL reconstructions
  • Joint effusion
  • Knee, elbow, knee fractures (immoblization)
  • Joint arthrosis
  • Total knee arthroplasty
23
Q

What does early motion after surgery or immobilization help with?

A
  • Enhance and facilitate connective tissue strength, size, shape
  • Evacuate joint hemarthrosis (bloody effusion within joint space)
  • Improve joint nutrition
  • Inhibit adhesions
  • Initiate normal joint kinematics
  • Reduce articular surface changes
  • Minimize other deleterious effects of immobilization
24
Q

When can CPM be used?

A
  • Postoperatively
  • In operating room
  • Few days after surgery
  • Immediately after cast removal
  • Early phases of rehab
25
Q

What is the most common joint CPM is used on?

A

Knee

26
Q

What is calibrated in cycles per minute and degrees of motion?

A

CPM

27
Q

What may be helpful to decrease postoperative pain after ACL reconstruction?

A

CPM

28
Q

What is an exceedingly poor indicator of healing tissue?

A

Absence of pain and swelling

29
Q

How can we help establish normal joint kinematics and gait?

A
  • Encouraging weight bearing as soon as tolerate

- Protecting the joint

30
Q

What do the acute and postacute phases of rehab after ligament injury and repair usually involve?

A
  • Pain management techniques
  • Swelling reduction
  • Muscle reeducation (isometric muscle contraction, functional muscle stimulation)
  • CPM
  • AROM
  • Ligament protection (braces- range adjustable)
  • Weight bearing gait maneuvers (crutches)
31
Q

During early phases of recovery, what is it important to avoid?

A

Excessive motions that may disrupt the intentional scar formation needed for joint stability

32
Q

What must degree of motion, direction of forces, and velocity of joint movement applied during this early acute phase must be?

A
  • Joint specific
  • Functional
  • Protected

PTA 230 (Ortho) (55 decks)

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