Final Exam Flashcards
Mechanical massage
alter underlying tissues to hasten the recovery period of muscle or skin
Reflexive
alter emotional status to induce relaxation (pain, circulation, metabolism)
How massage controls pain
stimulates receptors to carry input along large diameter afferents to stimulate the production of endorphins
How massage affects circulation
mechanical movement of lymph and edema
How massage affects metabolism
enhances removal of waste
Mechanical effects of massage
stretch a muscle
elongate fascia
Mobilize soft tissue
4 ways to change dosage of a massage
type of stroke
pressure applied
duration
frequency
Effleurage
Also known as stroking. Pass palmar surface of hand over body segment
Stroke in the direction of venous flow and major muscle groups
Petrissage
Also known as kneading. Circular movement while picking up and or compressing the tissue
Tapotement
Percussing with a slightly cupped palmar surface with pulmonary problems or to loosen mucous in lungs
Hacking
ulnar surface of therapist’s hands strikes the part in a rapid fashion
Tapping
tips of all fingers simultaneously strike as the hands are in an alternate motion
Slapping
flattened palm is used in a rapid rhythmic manner
Beating
half clenched fist strikes the part
Manual vibrations
hand placed flatly on surface with elbows slightly extended as the entire arm shakes from the shoulder
Friction
circular rolling of the underneath tissue or perpendicular motion, skin does not move
transverse friction massage
place tendon on stretch and exert pressure perpendicular to tendon. Perform for 7-10 minutes. No lubrication.
Four layer model of acupressure points
Superficial layer
Deep layer
Craniosacral system
Emotional field
Creation of trigger point
muscle fiber rupture release of calcium sustained contraction area becomes ischemic metabolic wastes accumulate short, stiff, irritable trigger point
Myofascial release
technique used to relieve soft tissue from the abnormal grip of tight fascia. Small amount of lubrication needed
Connective Tissue Massage
Pulling technique with no lubricant. Can be used for scars, circulation problems
Rolfing
balance of the body
Dense regular tissue
ligaments and tendons in parallel arrangement
Dense irregular tissue
periosteum, joint capsule, dermis of skin; multidirectional arrangement
Loose irregular
fascial sheaths; sparse multidirectional arrangement of collagen
Western massage techniques
effleurage, petrissage, friction, tapotement, vibration
Contemporary massage techniques
myofascial, trigger point, lymphatics
Response of tendons and ligaments to traction
respond slowly so slow loading is more effective for change because high load increases the resistance. Need low/moderate load for change.
Response of muscle to traction
lengthen tight muscles
proprioception
gate pain
What does intermittent traction stimulate?
Mechanoreceptors to gate pain
Overall effects of traction on spine
Increase intervertebral space Tension on posterior and anterior ligaments exerts a force at the back of the joint Suction draws protrusion to the center Flatten back when applied in flexion Distracts joints
Response of joints to traction
Decompress articular cartilage to allow synovial fluid exchange
Decrease pain from degenerative changes
Increase proprioceptive responses
Uses of static traction
Disc
Extension or side lying
Uses of intermittent traction
Muscle
Joint
Flexion to restriction
Indications for traction in flexion
muscle and joint problems
Indications for traction in extension
disc protrusion
Indications for traction in side-lying
lateral disc protrusion
(if pt leans away from painful side, apply to painful side. If pt leans toward painful side, apply traction to non-painful side)
Traction duration for lumbar disc problem
below 20 minutes (8-10). do static or static-like (60:20)
Traction duration for lumbar facet problems
30-40 minutes. Intermittent
Frequency of lumbar traction
3-5 times a week
Force needed to be exerted for lumbar traction
25%-50% body weight to start
25% for muscle spasm and disc pathology
50% for vertebral separation
Patients who benefit from traction and an extension based intervention
Presence of sciatica
Signs of nerve root compression
Peripheralization with extension movements or positive crossed SLR
Hold/Relax times for cervical traction
Initial/acute (static) Joint distraction (15/15) Muscle spasm (5/5) Disc problem or soft tissue stretch (60/20)
5 variables to determine whether patient would benefit from cervical traction
Peripheralization with lower cervical spine mobility testing Positive shoulder abduction test Over 55 yo Positive upper limb tension test A Positive neck distraction test
Angle of pull to straighten cervical lordotic pressure
24-25 degrees
Minimum pull time for intermittent traction? Why?
6 seconds - to overcome GTO response reflex
Effectiveness of light is determined by
reflection, refraction, and scattering
Most critical factor effecting efficacy is
Absorption of the photoenergy of the appropriate wavelength and energy density
What does LASER stand for
light amplification by stimulated emission of radiation
What does LED stand for
light emitting diode
What does SLD stand for
supraluminous diodes
Biophysical characteristics of laser
Monochromatic (one color)
Coherence (phased)
Collimated (radiation goes in one direction)
Photobiostimulation is for…
Wound healing (use lower dose of laser)
Photobioinhibition is used for…
Pain reduction (use higher doses of laser)
Electromagnetic radiation is categorized according to its…
Frequency and wavelength
Intensity of electromagnetic radiation is greatest when
energy output is high, radiation source is close to patient, bean is perpendicular to the surface of the skin
Wavelength that can penetrate human tissue
600-1300 nm (red or IR)
Most lasers used for treatment have a power between
5 and 500 mW
Equation for energy
Energy = Power x Time
Energy density
amount of power per unit area
Depth of penetration is dependent on
Wavelength and power
Which light source is thermal? Athermal?
Thermal - LED
Athermal - laser
Three reactions that take place with laser radiation
- photodynamic action on membranes accompanid by intracellular calcium increase and cell stimulation
- photoreactivation of CuZn superoxide dismutase
- photolysis of metal complexes of NO with release of vasodilator
Chromophores
molecular structures that absorb light
Primary receptors for photo bio-stimulation
Primary reaction in light pathway
Absorption of energy by chromophores
Conditions treated by laser
Wound healing
Fracture healing
MS injuries
Pain control
UVA
320-420 nm
Greatest depth of penetration
Tanning with PUVA
UVB
280-320 nm Tanning Erythema production Epidermal hyperplasia Vitamin D
UVC
185-280 nm Bactericidal Enhances epithelialization and sloughs necrotic tissue Almost no tanning Vitamin D
UV biological effects
Vasodilation Stratum corneum thickening Increased vitamin D production bactericidial effect Pigmentation augmentation
Wavelength of UV for bactericidal effects
UVC at or near 254 nm
Treat with doses less than MED
Effects of NO
Increase circulation Decrease inflammation Reduce edema Decrease pain Tissue remodeling Wound healing
Five cardinal signs of inflammation
Swelling Redness Warm Pain LOF
Time span for Inflammatory Response Phase
1-6/10 days
Margination
process of leukocyte migrating from blood vessels to perivascular tissue. Helps clean up debris
Inflammatory Phase vascular reaction
vascular spasm, formation of platelet plug, blood coagulation, growth of fibrous tissue
Clot formation process
thromboplastin is released which causes the breakdown of prothrombin into thrombin. Thrombin causes fibringoen to unwind into individual fibrin elements. These fibrin monomers deposit themselves over the damaged vessels.
Time span for proliferation phase
Up to 20 days
4 processes to close wound in proliferation phase
epithelialization
collagen production
wound contracture
neovascularization
Fibroplasia
Scar formation where there is an increased granulation tissue and type III is replaced with type I collagen
Tissue sensitivity from highest to lowest
Periosteum - Subchondral bone - muscles and cortical bone - synovium and articular cartilage
Mesinner’s corpuscles
Light touch skin mechanoreceptors
Pacinian corpuscles
Deep pressure skin mechanoreceptors
Merkel’s corpuscles
deep pressure but slower skin mechanoreceptors
Ruffini corpuscles
Proprioceptors and thermotherapy
Krause’s end bulb
decrease in temperature and touch
Nocioceptors
pain or noxious stimuli
Proprioceptors
Muscle spindles, GTO (stretch and balance)
A delta fibers
Initial acute pain and sharp pain
Brief, well localized, well matched to stimuli
Cfibers
Chronic pain
Aching, throbbing, burning
What is the main pain receptor?
Lateral spinothalamic
Substantia Gelatinosa
Inhibits whats coming in from periphery. Facilitated by A beta fibers and inhibited by C and and delta fibers
Enkephalins
block the transmission of impulses traveling along small C fibers with the dorsal horn T cell
Galvanotaxis
Movement of cells toward the electric field
What type of current is iontophoresis
Direct current
How does iontophoresis maintain the pH
release of Silver Silver Chloride (prevents hydrolysis from occurring)
What does biofeedback measure?
electrical activity of the muscle, not muscle contraction
Characteristics of high volt waveform
twin peak monophasic
Denervated muscle parameters
Asymmetrical biphasic with pd less than 1 msec first 2 weeks
DC interrupted square wave with frequency of 10 Hz after first two weeks
Resistance
opposition to movement of charged particles
Conducatnace
ease of movements of particles
Impedance
Frequency dependent opposition to EC flow
Reactance
Opposition to curren flow
Capacitance
capacity for storing charge (potential difference between terminals)
Ohm’s Law
V = IR
Series current
a circuit in which there is only one path for current to get through from one terminal to the other. Resistance is just added up
Parallel current
Two or more routes for the current to pass. Resistance total is reciprocal
Rheobase
Find the intensity to get the sensation you want with an infinite duration
Chronaxie
Double the intensity of the rheobase and get the duration
Cycle of cross contamination
Reservoir for organism Method of exit Method of transmission Method of entry for organism Susceptible host Infection develops
Medical asepsis
reduce the number and contain microbes
Surgical asepsis
area is free of microbes and all things must be sterile
Contact isolation
gloves, gown, private room
Droplet isolation
Mask, private room, no gown
Airborne isolation
use mask with respirator
Sterilization
Process to destroy pathogens and spores
Disinfection
Destruction or removal of pathogens, but not necessarily their spores
Arndt-Schultz
no reaction will occur if not enough energy is absorbed
reflection
bounces off body
transmitted
goes to next level
SATA for 1 MHz
0.1 or 0.2
SATA for 3 MHz
0.07
absorbed
absorbed and converted in the body
refracted
bent at the next level
Gotthus-Draper
Energy that is not absorbed is transmitted
Cosine law
optimal radiation occurs when the source is perpendicular to the center of the area being treated
Specific Heat
amount of energy required to raise the temperature of a given weight of a material by a given number of degrees
Conduction
Direct contact
Convection
transfer of heat by movement of a medium
Radiation
transfer of energy without the use of a medium or a contact
Evaporation
Heat loss by changing liquid to gas
Conversion
Nonthermal form of energy changed into heat (US, SWD)
Fluidotherapy
110-126 (116)
Parrafin Wax bath
124-130 (128-129)
Canvas Hot pack
158-168
Normedical hot back
135
Ultrasound works through
Reverse pizoelectric (adding electric to crystal to create sound wave)
Rarefactions
Low density
Compression
high density
SWD Parameter
27.12 MHz, 11 m
Capacitance
high frequency AC gives electromagnetic energy from 2 electrodes that are oppositely charged (part of electric field). Use for ligaments, tendons, cartilage, fat, cartilage
Inductance
strong magnetic field created in body (most efficient in low imedence tissues that have high electrolytes and water contents: blood, muscle, sweat)
Pulsed lavage parameters
4-15 psi
