CH 9: effects of remobilization and exercise, effects of smoking Flashcards
What are the leading causes of preventable morbidity and mortality in the US?
Smoking
Tobacco use
What has nicotine been implicated in the pathogenesis of various diseases?
- 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
What does the smoking status impact and have a significant factor on?
- 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.
What stage of ligament healing occur with weak, fragile tissue?
Immediate (Homeostasis and Degeneration)
What stage of ligament healing occurs with vasodilation and scar formation; break down and remove dead cells; unstable type III collagen?
Inflammation (Day 3-14)
What stage of ligament healing occurs angiogenesis, very gradual changes in collagen strength, and tissue changes from cellular to fibrous?
Proliferation and migration (Day 14-60)
What stage of ligament healing occurs from day 60-360?
Remodeling and maturation
What is the treatment during hemostasis and degeneration stage of ligament healing?
- 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
What is the treatment during Inflammatory stage of ligament healing (Day 3-14)?
- 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
What is the treatment during proliferation and migration stage of ligament healing (Day 14-60)?
- 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
What is the treatment during remodeling and maturation stage of ligament healing (Day 60-360)?
- 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
What tends to remodel and regain tensile strength slower than ligament tissue after mobilization and therapeutically directed reconditioning?
Ligament-bone insertion complex
What are ligament substance and ligament-bone complex sensitive to?
Exercise
What can be observed with appropriately directed exercise?
- Orientation, composition, synthesis, concentration of Type I Collagen
- Ultimate load to failure
- Increase in tensile strength
- Stiffness of ligament and ligament-bone complexes
What does dense fibrous tissue (tendon, ligament) respond to?
- Frequency
- Intensity
- Duration of exercises
- Specific type of load applied to tissue
How do tissues that are subjected to repeated compressions respond?
Synthesizing larger and greater amounts of proteoglycans than tissues exposed to tension loads
Following injury, what can appropriate controlled motion and exercise stimulate for ligament repair?
- Improving matrix organization and composition
- Increasing weight of injured ligaments
- Promoting normalized collagen synthesis and strength
What can influence and determine the degree and type of healing that occur after trauma and subsequent immobilization?
- Motion
- Exercise
- Protected progressive stress
What do joints that are immobilized demonstrate?
- Scar tissue
- Adhesions
What do joints moved passively through the motions demonstrate?
- Well organized, longitudinally oriented collage
- No adhesions
What is the development concept of early protected motion applied to healing soft tissues?
CPM (continuous passive motion)
When is CPM used?
- Knee joint contractures
- Postoperative ACL reconstructions
- Joint effusion
- Knee, elbow, knee fractures (immoblization)
- Joint arthrosis
- Total knee arthroplasty
What does early motion after surgery or immobilization help with?
- 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
When can CPM be used?
- Postoperatively
- In operating room
- Few days after surgery
- Immediately after cast removal
- Early phases of rehab
What is the most common joint CPM is used on?
Knee
What is calibrated in cycles per minute and degrees of motion?
CPM
What may be helpful to decrease postoperative pain after ACL reconstruction?
CPM
What is an exceedingly poor indicator of healing tissue?
Absence of pain and swelling
How can we help establish normal joint kinematics and gait?
- Encouraging weight bearing as soon as tolerate
- Protecting the joint
What do the acute and postacute phases of rehab after ligament injury and repair usually involve?
- 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)
During early phases of recovery, what is it important to avoid?
Excessive motions that may disrupt the intentional scar formation needed for joint stability
What must degree of motion, direction of forces, and velocity of joint movement applied during this early acute phase must be?
- Joint specific
- Functional
- Protected
