E1-Healing Phases and MET Flashcards
what are the characteristics of direct trauma
obvious trauma
rapid onset of symptoms including surgery
what are the characteristics for overuse syndrome
no trauma
sudden changes in parameters of activity
subsequent onset of symptoms- tendinitis
what are the characteristics of repetitive strain syndrome
no trauma
gradual onset of symptoms without change in parameters of activity
biomechanical limitation or degenerative disease
what are the characteristics of regional interdependence
increased nociceptive response and decreased pain inhibition, peripherally and centrally
gradual onset of symptoms- victim vs real culprit
doesn’t fit traditional biomechanical model
often unsuccessful treatments
what are the general phases of tissue healing
hemostasis
inflammation
proliferation/repair
remodeling
can healing occur without inflammation and vice versa
no, healing will always include inflammation
yes, inflammation can occur without the presence of healing
how long does the acute inflammation last
24 hours to 2 weeks
what are the the acute inflammation cardinal S&S
red
swollen
hot
P!
what is the purpose of the acute inflammation phase
protect and preparation
what happens systemically during vascular reaction
vasoconstriction from pain and SNS stimulation to- shunt blood from injury site, start clotting, slow bleeding
what happens at the site of injury during vascular reaction
local vasodilation and vascular permeability brings cells to kill and clean
what happens at the cellular level during hemostasis and inflammatory stages
serotonin released
platelets aggregate- release growth factors
histamines, etc released for local dilation
WBCs
Because of vasodilation in the local area of injury, what happens
local stasis= edema
increased viscosity
increase of chemicals and acidity leads to chemical muscle guarding
what is the “glue” of cellular reactions in the hemostasis/inflammatory stages
RBCs, cellular debris, fibronectin
what is the general Rx during the hemostasis/inflammatory stage
max protection
POLICED
what is POLICED
protection
optimal
loading
Ice
Compression
Elevation
Drugs
what does the P stand for in POLICED
protection with possible….
activity modification
immobilization- bracing/taping
assistive device
what does “OL” mean for POLICED
optimal loading thru activity and MET..
P! and inflammation
early motion
promote tissue repair
muscle activation to combat inhibition
Why can drugs be limited for POLICED
NSAIDs may impair healing by impairing histamines from causing vasodilation and local permeability
drugs should only be used if ADLs are impaired because of pain
how long can the repair phase last
24 hours to ~10 weeks
what is the purpose of the repair phase
collagen production by respective tissue cell
formation of new blood vessels
restoration of skin
what is the general Rx for the repair phase
continue inflammatory phase Rx
greater ROM restrictions and tissue with manual therapy/MET
progress MET for optimal loading with dose response to direct and protect new collagen but achieve neuromuscular benefits
what general Rx would benefit the following tissues in the repair phase: articular cartilage, annulus, disc (fibrocartilage)
compression, distraction, gliding
what general Rx would benefit the following tissues in the repair phase: bone
compression and distraction
what general Rx would benefit the following tissues in the repair phase: muscle, tendon, ligament, capsule, outer annulus, menisci (fibrocartilage)
tension
what is the time period for the remodeling phase
2 weeks to a year, but may continue up to 3 years
what is the purpose of the remodeling phase
collagen conversion and organization- immature collagen to mature collagen
wound contraction by myofibroblasts
what is the general Rx for the remodeling phase
return to function
address symptoms- move away from passive treatment
restore full ROM with MT/MET
progress to higher MET
what could possibly go wrong and create a set back?
subacute inflammation
chronic/persistent inflammation
abnormal scar tissue
what are the differences between acute, subacute, and chronic inflammation
acute= healing
subacute= mild prolonging of inflammatory response
chronic= pitting edma, release of inflammatory products
how could you treat chronic inflammation
heat- lowers the viscosity of the edma
what is remodeled tissue
combination of original and secondary types of collagen
What level of tissue dosage is MET considered
High dosage exercise
More reps, exercises, aerobic activity
What is the primary purpose people come to PT
Pain, inflammation, and muscle guarding
What are benefits of treating pain, inflammation and muscle guarding with PT
Reduce symptoms
Improve circulation and venous return
Facilitate lymphatic drainage
Limit atrophy
When is it OK to have mild pain with exercise
Non acute or persistent conditions:
Muscular strain
Tendinopathies
Nociplastic conditions
What are some rationales that Pts need to know about their treatment
Demonstrate hurt does not equal harm
Alleviates mental fear of movement
Reduces sensitivity of CNS
Same or better gains
What is it not OK to treat when the pt has pain
Acute conditions
Remaining tissues/conditions: age related change, hypermobility/instability, stenosis
What purpose needs to be achieved earliest for muscle function using MET
Muscle activation
How is endurance related to MSK in PT
We are stressing the integrity of tissues. The act of tissues withstanding stress over a period of time
How can you change the integrity of tissue with endurance
Tissue dose response: motor activation, skill, coordination development
What are characteristics of motor skill/coordination
Controlling increased motion and speed
Occurs very early
More and better fiber recruitment
What purpose has to be obtained first for better outcomes with motor skill/coordination
Activation
How do we prescribe to reach motor skill/coordination
Can occur at <50% 1 RM
Work or quick concentric, brief isometric hold, then slower eccentric action
What is muscle strength
Force generation
What is the best intervention for sports injuries
Muscular strength
Decrease sports injuries by 1/3
Decrease overuse injuries by nearly 1/4
When can you see hypertrophy or increase in fiber size
6-8 weeks
If hypertrophy is not seen until 6-8 weeks, what is changing
Neurological adaptations are taking place
What is the 2nd best injury preventer
Agility
What is plyometrics
Eccentric load or lengthening followed by concentric action through the stretch reflex
What are the plyometric parameters
Explosive and up to 5 reps with heavier load
What are the benefits of plyometrics
Achieve greater cross bridging
Length and speed feedback from muscle spindle that links synergistic muscles to act
What do aerobic components help with
Endogenous influence
Even more optimal stresses for a better dose response
More movement to combat fear avoidance behaviors
Oxygenation of tissue
What is the frequency needed for exercises
At least 2-3x/wk
What weight and reps would you do to achieve pure strength and power
Heavy load with max 8 reps
What weight and reps would you do to achieve ROM, activation, integrity, coordination, and agility
Moderate load with max 30 reps
What are the indications to do isometrics
Unable to perform motion with even the lightest resistance
Pain modulating benefits
To use heavier loads when more motion is painful
What are isometric exercise parameters
Varied 3-5 reps of 10-45 sec holds
Based on Oddvar Holden diagram, what sets and reps would be appropriate for acuity
1-2 sets with light resistance
Based on Oddvar Holden diaphragm, what is appropriate for tendonosis
3 sets of 10-15 reps with heavy resistance
What would you do for sets and reps with this case:
Disc herniation
Avascular/hypovascular tissue
Needs better tissue endurance/integrity or healing
3x30 with moderate load
What would you do for sets and reps with this case:
Shoulder impingement due to joint hypermobility and insufficient rotator cuff
Better motor activation and coordination
3x30 with moderate load
What would you do for sets and reps:
Patellofemoral Pain Syndrome
Impaired trunk and hip strength
3x15-20 reps with moderate load
What would you do for sets and reps with this case:
Ankle joint hypo mobility and adaptive muscle shortening following prolonged immobilization
Improve ROM
3x30 reps with moderate load
