Exam 2 Flashcards
What is the benefit of MRI
Detailed evaluation of osseous and soft tissue structures, can evaluate cartilage and fluid in the bone , can tell active vS silent problems
Describe low field MRI
Lower quality image, longer scan times so increased risk of motion artifacts , thicker slices, no risk of general anesthesia
Describe high field MRI
Greater signal emission , thinner slices, under general anesthesia, size limitation, harder to position the horse, greater quality
The medullary cavity of the bone would be - on MRI because-
Hyperechoic because of the fat
Describe a TI weighted MRI
Less contrast between tissues , fluid / cortical bone hypointense , fat hyperintense , muscle in the middle
Describe a T2 weighted MRI
Cortical bone hypointense , fluid/fat hyperperintense, muscle in the middle
Differentiate between a T2 weighted image and a proton density (pd) image
T2 - hypo intense cortisol bone, hyper intense fluid and fat
PD- hypointense cortical bone, hyper intense fluid , fat is intermediate (the difference)
On a Pd image , tendon will be - and a lesion in a tendon will be -
Tendon will be hypointense and a lesion in the tendon will be hyperechoic
Describe a stir image - short time inversion recovery
Cortical bone is hypointense, fluid is hyperperintense - low spatial resolution (grainy appearence ) I suppresses fat to highlight fluid
What is nuclear scintigraphy
Bone scan
Describe the basic principles of a bone scan
IV injection of radionuclide that concentrates in metabolically active bone (abnormal bone turnover and osteoblastic activity
What are benefits of nuclear scintigraphy over rads
Whole horse picture , very sensitive to bone remodeling and turnover, precursor to radiographic change / able to image areas that are hard to radiograph
What are the phases of imaging of a bone scan
Vascular in 90 seconds, soft tissue in 10 - 20 minutes, bone imaging in 2- 3 hours , take quickly after injecting
What is the danside to a bone scan
Spatial resolution is poor so yw con see the bore is not but not exactly where, need to do xrays to confirm
What is chiropracture
Relationship between structure (musculoskeletal system) and function (nervous system)
Chiropractor is a- therapy that uses - to cause a healing response in _
Manual therapy , uses specific location, direction and controlled force to cause a healing response via a change in joint structure , muscle function, neuro reflexes
What are the core chiropractic values
The body will heal itself, the nervous system is king, interference/ disruption happens, chiropractors job is to restore communication
Describe AB large myelinated fibers (gate theory)
Involved wl proprioception , fast signals, stimulates the interneurons that are inhibitors ramp down the proprioceptive pathway
Describe C fibers in the gate theory pathway
Small unmyelinated fibers , largely involved in pain stimuli, slow conduction, inhibit the interneurons (the inhibitors) which allows the pain pathway to ramp up
Define subluxation to a chiropractor
Joint not moving as well as it should (vertebral segment dysfunction )
In chiropractic, you assess thoracic bones - and lumbar bones -
Thoracic - side to side
Lumbar - top to bottom
Chiropractic goes along with _ as therapy to improve strength and stability
Core training exercises
What is most important with restabilization of the multilidus muscles
More important to restore stability and muscle strength than to increase flexibility
Define massage
Manipulation of soft tissue (not joints like in chiropractic)
Define trigger points
Hyper irritable spots in skeletal muscle - palpable nodules in tight muscles, twitch response can lead to good pain
What can cause trigger points to develop
Muscle injury or strain, structural imbalances , rapid growth, systemic infections , arthritic joints, poor nutrition, lack of exercise, stress
Describe active trigger points
Painful, referred pain that spreads down limbs, decreased ROM and circulation, secondary trigger points associated with
Describe latent trigger points
Not currently painful, cause restriction of motion and maybe decreased circulation can become active
What affect do trigger points have on performance
Limit stretch of affected music which alters gait, reflex relaxation of opposing side increasing risk of injury I decreased circulate due to waste buildup in muscle I decreased mobility
How can you treat trigger points
Massage (firm direct pressure for 30 seconds) , aquapuncture, stretch muscle through full ROM and active/passive stretching
What is collagen
Main constant of connective tissue keeps things inline and in bundles , align along lines of stress
Describe the 2 types of collagen fibers
Type 1 - gives support and resistance to tension
Type 2 - supports endothelial cells
Describe the stress strain curve
Elongation will not be permanent up to the elastic limit or yield point, complete rupture occurs at pmax (the maximum load point)
What causes the stress strain curve
Collagen fibers are oriented in the direction of stress and the curve occurs when longitudinal stress is applied to collagen, causing tissue elongation and permanent deformation
How does massage affect the stress strain curve and the collagen within the connective tissue
Low repetitive loads that causes elongation by creep , also elongation by relaxation
How can massage benefit the lymphatic system
Can increase lymph flow, increase interstitial fluid pressure and more find from limbs to core body
How can massage benefit the circulatory system
Replenish tissue fluid and remove inflammatory products
How can massage benefit injury to connective tissue
Stretch shortened tissues, mobilize and soften adhesions
How can massage benefit muscles
Change muscle plasticity by increasing extensibility and strength, reduce soreness, improve recovery after exercise
How does massage affect pain and sensation
Can stimulate nerves and mechanoreceptors, reducing sensitivity increasing pain thresholds, reduce response to stretch
What are general benefits of massage therapy
Pain relief by reducing pain thresholds, improved locomotor function, improve circulation, relaxing, restoring balance and Qi flow
Describe stroking and effleurage techniques
Stroking - opening or closing to assess tissues and cause relaxation
Effleurage - milk find up though lymphatics , decrease swelling, relaxation
Describe petrissage and compression massage techniques
Petrissage- deep pressure to compress underling tissues (kreading, wringing, ete) to mobilize tissues
Compressions - pressure applied over the muscle for 15 seconds in areas with increased muscle tore to soften and increase circulation
Describe holding/ placing and percussion
Holding - light touch held in place to warm, relax, support
Percussion - cupped hand in area to hear a hollow sound over large muscle bellies to improve circulation and promote relaxation
Describe friction and passive movement techniques
Friction - contact rapidly applied over an area to warm tissues and alter blood flow , use with scar tissue to break up adhesions (deep cross fiber pressure)
Passive - ROM at end of treatment when muscles warmed and relaxed, identity areas of continued restriction
Describe myofacial release
Fascia surrounds muscles and connects to tendons/ligaments , simulate areas along facial lines using massage (hands on or instrument assisted pressure)
What is the goal of tui-na
Restore balance and homeostasis in the body, keep Qi in abundance
What are the functions of tui-na
Similar to massage - warming, more accumulation, dispel masses, sedation, correct malpositions (chiropractic)
Describe kinesiology tape
Elasticity gently lifts skin from tissues below allowing space to improve blood and lymphatic flow _ goal is to support mobile and relieve pain, reduce swelling, increase mobility without limiting Rom
Describe T touch
Combo of training and touch massage
Describe the masterson method
Integrated massage modality , lets the horse actively participate in process of releasing tension
Describe reiki
Light touch technique to reduce stress, restriction and improve relaxation - channel energy into patient by means of touch
Describe yin and yang in TCVM
Yin - cold, slow, calm, parasympathetic
Yang - bright, hot, sympathetic
Endless cycle when balanced, pathologic imbalanced
What are the 5 elements of acupuncture and what organs do they represent
Wood - liver / gallbladder
Fire - heart, small intestine, tongue
Earth - spleen, stomach, muscle, digestion
Metal - lung, large intestine, skin
Water - kidney, bladder
What is zang fu in relation to acupuncture
The 2 organs of each element - zang is related to yin (interior) and fu is related to Yang (exterior)
What is acupuncture
Stimulation of specific locations in body to enact an energetic change, changing nerve conduction I hormone release, etc through meridians and acupoints
What are back shu points
Along bladder channel, where Qi moves internal to external
What are front mu points
Alarm points on chest and abdomen, where Qi gathers
Stagnation of qi leads to
Pain - use points to more Qi
Stress leads to (in termsof acupunchre)
Liver disharmony - use points that target the liver
For acupuncture, bone →, tendon/ligament → , muscle →
Bone → kidney
Tendon ligament → liver
Muscle → spleen
What are likely mechanisms of action of acupuncture
Nerve stimulation, local counter irritation, microtrauma , resulting in altered blood now and immune response
What are local effects of acupuncture
Activation of complement cascade and coagulation cascade, mast cell degranulation, results in increased blood flow to the area 1 local immune response and relaxation of muscles
What are systemic effects of acupuncture
Activate sensory nerves (pain or proprioceptive pathways), analgesic effect (endorphin release)/serotonin release
Describe tens units - transcutaneous electrical stimulation and its goal
Electrical current applied via surface electrodes to stimulate peripheral nerves for pain modulation - goal is to stimulate inhibitory interneurons at spinal cord to stop pain cycle and release endogenous endorphins within the CNS
What are the 2 modes of the tens unit
Conventional - acute pain, frequencies over 100, lower pulse duration
Acupuncture - chronic pain, frequencies less than 20, longer pulse duration, attached to acupuncture needles in large or focal muscle groups
What are indications for the tens unit
Acute or chronic musculoskeletal pain, stimulation of denervated muscles
What is the protocol for tens unit
30 minutes 2-3 times daily over painful region or electroacupuncture once daily 3 times a week
What is NMES - neuromuscular electrical stimulation; what is the goal
Lower frequency longer pulse duration with targeted depths of 6-8 inches deep - goal is to achieve full contraction and relaxation of larger muscle groups , stimulate sensory and motor nerves
Differentiate between a tens unit and a NMES unit
Tens - stimulates sensory nerves, can focus on focal areas
NMES - stimulate sensors and motor nerves, larger muscle groups
FES (functional electrical stimulation) is a form of NMES that does what
Electrodes placed diagonally in pairs across large muscle groups (back, neck, pelvis) - contract and relaxI hanging power supply
What are indications of NMES
Acute and chronic musculoskeletal pain, stimulation of denervated muscles , chronic muscle wasting, muscle spasticity
How often do you treat with nmes
2 treatments in 48 hours then 1 treatment once a week
What are contraindications for tens / NMES
Cardiac issues, pregnancy, treatment over the thoracic cavity
What PEMF - pulsed electromagnetic therapy
Uses electrical currents through a coiled wire to generate a magnetic field that produces secondary electrical currents in tissues that stimulates a cellular repair response - low frequency with short phase and short pulse duration to avoid heat generation
What are benefits of PEMF
Increase in nitric oxide to decrease information, reduce pain, stiffness improved function -increase vasodilation and blood flow
What are indications for PEMF
Increase blood now in superficial and deep tissues, decrease pain and muscle spasm , muscle relaxation I chronic or nonunion fractures / osteoarthritis
What is the protocol for PEMF
Range from 5-20 minutes per site
What contraindications for PEMF
Pregnancy , open wounds, cancer, infection I cardiac issues - we wouldn’t want to increase metabolic activity in these tissues
What is WBV - whole body vibration therapy
Uses vertical and horizontal vibrations (oscillations) at law frequency and low amplitude to mimic natural movement - used in astraunots to prevent osteoporosis and muscle wasting
What are risks to whole body vibration therapy
Prolonged exposure to high frequency and high amplitude vibrations can have deleterious effects (muscle fatigue , reduced muscle contraction force)
What are indications for WBV
Maintenance of fitness, promotion of blood flow, postoperative strength training, balance, proproception, core training, tendon and ligament injuries
How often do you do WBV
10 - 30 mins, 1-2x daily
What are contraindications for WBV
Acute fractures, laminitis - don’t want anything unstable on the plates
Describe cold therapy, when is it indicated, what are the goals
Indicated during the acute injury phase (first 24-48 hours), therapeutic effects occur when tissue temps are 10-15 °C - causes peripheral vasocastriction and decreased soft tissue perfusion to reduce edema, decrease nerve induction velocity to diminish pain, decrease metabolic rate of tissues to inhibit information
What is the protocol for cold therapy
20 -30 minutes every 2-3 hours for first 48 hours following surgery a injury, don’t do it over 30 minutes
What is most effective at lowering temperature to therapeutic levels
Continuous circulation of ice water slurry
Describe a saltwater spa
Supersaturated sea salt solution - combines anti inflammatory analgesic effects of cold with osmotic effects salt ( draw edema out) , compression of water has a hydrostatic effect to promote venous return and lumphahi drainage for reduced edema
What are the risks of saltwater spa
Risk of reduction of core temperature if water levels rise above the elbow
How often do you use saltwater therapy
15 - 20 mins 1-3 times a day until swelling has resolved
What are indications for cold water therapy
Acute information (heat, swelling, pain), acute soft tissue or muscle injury / post exercise
What are contraindications for cold water therapy
Prolonged application that lowers tissue temp to less than 50 its contraindicated
Describe heat therapy - when are therapeutic effects reached
Indicated after the acute inflammatory period, most helps prior to exercise - increases local circulation of tissues encouraging mile relaxation and tissue extensibility, increases oxygenation of tissues and metabolic rate - transpectic effects at 40-45 C
What is the risk of heat therapy
Over 45 can cause thermal injury and damage
For every 10° in temp we increase , we increase the metabolic rate -
2-3 times
What are the 2 forms of heat therapy
Superficial - less than 1 cm, hot pack, hot water hosing, etc
Deep - 3.5cm, continuous wave therapeutic ultrasound
Describe therapeutic ultrasound
Only generates heat et continuous form - absorption of sound waves results in transfer of energy to surrounding tissues and a localized increase in temp
Who is therapeutic ultrasound ideal for
Those with high protein or collagen content or tissue interfaces
What are the indications for heat therapy
Treat injury after acute inflammatory phase, increased local circulation of target tissues, chronic soft tissue or muscle injury, muscle relaxation, preexercise
When is heat therapy contraindicated
During acute inflammatory phase or if it hill raise temp over 45 C
Describe extra corporal shockwave therapy (eswt)
High energy sound waves, outside the body - defined by a high transient peak pressure (rapid rise for short duration) followed by a negative pressure drop
Describe the profile of a shockwave
Direct shear effects come from the compressive phase while indirect cavitation effects come from the tensile phase rapid rise to peak pressure
What is acoustic impedance
Resistance a sound wave encounters as it passes through tissues - can travel relatively unchanged through fluids and soft tissues but can’t pass through bone
Differentiate between shock wave and ultrasound
Shockwave - lower frequency (less than 20) higher peak pressures, minimal tissue absorption and no thermal effects
Ultrasound - higher frequency (over 20), lower peak pressures, some have thermal effects
What are benefits of eswt
Analgesia, neovasularization, stimulates tissue repair, increased growth factor and cellular activity osteogenesis, fibroblastic stimulation
Number of shock wave pulses influences the
Amount of energy delivered
What are indications for eswt
Pain relief, stimulation of tissue healing, osteoarthritis, subchondral bone pain, desmitis, tendonitis, back pain
What are contraindications of ESWT
Gas or air filled structures due to cavitation effects and during the acute inflammatory phase (like with heat therapy)
What is photobiomodulation
Form of northermal light therapy that elicits photochemical and photophysical events
Differentiate between lasers and led
Lasers - coherent, high power, deep absorption / collimated light
LED - noncoherent, divergent light, low power
Which classes of lasers are therapeutic
3B and 4B
Which penetrates tissues better - lasers or LED
Lasers, LED less able to penetrate
What are benefits of laser therapy
Analgesic, accelerated tissue repair, reduced scar tissue formation, accelerated nerve cell regeneration
Which classes of laser are an optical hazard
Class 3 and 4, over 500 mw
Differentiate between class 3 and class 4 lasers
Class 3 - up to 500, optical hazard, trespectic laser
Class 4 - greater the 500, optical and thermal hazard, trespectic and surgical laser
Describe very simply how lasers work
Excite electrons which emit photons that escape a partially reflective mirror to reach patients
- Tissue targets require - wavelength
Deeper tissue targets requires higher wavelengths
What is the therapeutic window of laser wavelength
800 - 1000; law wavelengths used for superficial areas, longer wavelengths for deeper areas
Wavelength alters - and -
Degree of penetration and absorption
Describe bluelight (465 wavelength)
Superficial skin depths, wounds, antibacterial
Describe red light (620 wavelength)
Subcutaneous depths, wounds, superficial edema , acupressure points
What wavelengths do deeper tissues require
Near infrared light over 800
What is the ideal equine patient for laser therapy
Pink skin with SDFT injury
Differentiate between power output and dose of a laser
Power output - rate that energy is emitted , high power loses deliver same energy in less time
Dose - precise amount of photos delivered to an area (impacted by weight, body type, skin color, etc )
Does pulsing the laser limit energy penetration
No - just prevents thermal damage
Higher energy from the laser reduces- but may cause-
Reduces treatment time but may case undesired effects if used incorrectly
When shard uw be laser on contact? Off contact?
On contact for musculoskeletal, off contact for wounds
Differentiate between point to point and repetitive laser techniques
Point to point- stationary over target area until full dose administered
Repetitive - scorning horizontally and vertically over and over
What are the 3 phases of laser treatment? Describe
Induction - aggressive series of treatment until clinical response is noted
Transition - gradually reduce frequency of treatment to see nav offer is needed to maintain clinical response
Maintenance - long term series of treatments to maintain clinical response
What are contraindications for laser therapy
Pregnancy, active physis, hemorrhage, testicles, thyroid gland, malignancy, locally injected medication
Describe pneumatic compression therapy
Active pneumatic compression device with forward airflow to alleviate edema and enhance lymphatic flow, designed to target the lymphatic system of the upper and lower limb (hoof to stifle/elbow)
Why was the pneumatic compression device created
Because the lack of musculature in the limbs en impede lymphatic return in cases of edema
What is the protocol for the pneumatic compression device
60 minty for 60 minutes daily
What are indications for the EQ press
Prevention or treatment of standing limb edema during layup, cellulitis, lymphangitis, recovery post exercise
Describe equine blood flow restriction
Used to reduce muscle atrophy or stimulate muscle hypertrophy - low impact exercises performed with BFR Are equivalent to high impact exercise , increases blood supply to affected area in distal limb for faster healing
What are benefits of water therapy
Reduce ground reaction forces and unload tendons, joints, etc to reduce stress on musculoskeletal system I helps increase range of motion and fitness when and exercise is contraindicated - improves side length / postural stability, muscle tone and function
What are contraindications of water therapy in horses
Skin infections, open wounds, unstable fractures, fresh surgical sites, heart disease
Are horses natural swimmers
No - distressed I extend neck and have extreme lordosis of their back (make sure no back pain or upper limb lameness before swimming )
What are benefits of linear pools over circular pools
Linear gives the horse a break, circular is nonstop
Describe buoyancy as a benefit of water therapy
Lifting force that reduces axial loading of joints by minimizing vertical ground reaction forces - the feeling of weightlessness in the water / unweights soft listen, joints and bones
Depth of water is inversely related to
Vertical ground reaction forces - the deeper the water the less ground reaction forces
Describe the influence of viscosity in water therapy
Viscosity is the resistance of fluid to motion, influenced by temp, turbulence and drag - the lower the temp the higher the viscosity and the move turbulence / drag the higher the viscosity
How does viscosity influence rehab
Increased resistance results in increased muscle activation and improves muscle strength motor control and joint stability
Describe hydrostatic pressure in water therapy
Sum pressure exerted on all surfaces of the body immersed in water at a given depth las depth increases so does the hydrostatic pressure
How does hydrostatic pressure benefit the horse
Enhances neuromuscular function, increase joint stability and protect the joint from abnormal loads / circumferential compression promotes venous return and lymphatic damage
What are risks of excessive hydrostatic pressure
On cause respiratory distress Or compromise (deeper water affects lung volume)
How is thermoregulation in water different than air
Can’t dissipate heat by sweating, heat conductance in water is 25 times greater than air and core temps are easily influenced by water
Older temps lead to
Peripheral vasoconstriction that decreases perfusion and nerve conduction to cause an analgesic effect
Warmer temps lead to
Vasodilation, increased tissue perfusion and analgesia
What water temps are optimal for different exercises
Lower temps for high activity, higher temps for low activity
Describe water osmolality in water therapy
Number of solute particles per kg of solvent - high osmolatily (higher solute) has antinflammatory ,osmotic and analgesic effects, pulls water from tissue to reduce edema - like with saltwater spas
How does water depth affect stride length and qualify
As depth increases , stride number decreases and stride length increases (fewer longer strides)
At what water depth should you walk horses to improve stride quality and strength
Walk at carpus or ulna heights
How does water therapy affect horses with carpal OA
Anti inflammatory effects
Describe the acclimation period of water therapy
1-2 dans, start with no water, slowly add little water, then to the treadmill
Describe the first week of water therapy
Once a day for 5 working minutes 3-5 times a week, water level target, slow speeds
Describes weeks 2+ of water therapy
Increase speed by I each week and add 5 mins each week
