Frictions, Sprains & Strains

Question 0

Indications for frictions:

Answer 0

Fibrosis (mm, lig, capsule, tendon)
Tendonitis
Bursitis
Ligament sprain
Attachment release 
Injury and overuse

Question 1

Should you friction referred pain?

Answer 1

Good god, no.

Question 2

What stage of healing is appropriate for frictions?

Answer 2

Late subacute and chronic

Question 3

How to position for frictions: without synovial sheath

Answer 3

Relaxed shortened position (softens fibres)

Question 4

How to position for frictions: tendon with synovial sheath

Answer 4

Maximum stretch (so tendon and sheath will slip across each other)

Question 5

How to position for frictions: ligament

Answer 5

Shortened Position.

Question 6

What direction should you friction?

Answer 6

Cross fibre UNLESS THE TENDON HAD A SYNOVIAL SHEATH (in which case friction longitudinal)

Question 7

General friction technique

Answer 7

Prepare tissue with Swedish etc.

2-5 cycles/second
90 seconds gentle, 90 seconds moderate, 90 seconds deep

More effleurage.
Reassess
Mobilize and/or stretch.

Ice ice baby.

Question 8

How long for the analgesic effect of frictions to occur

Answer 8

1-2 minutes.

Question 9

Intent of frictions

Answer 9

Restore or maintain mobility of structure with respect to adjacent tissues and to increase the extensibility of the structure under normal load.

Restores mobility in muscles like joint mobs free joints.

Question 10

Frictions: CI’s

Answer 10

Bacterial and rheumatoid-type tendonitis/tenosynovitis/tenovaginitis

Calcification and ossification of soft tissue

Disorders of nerve structure

Skin problems

Hematoma

Acute bursitis

Question 11

Follow frictions by:

Answer 11

Minor muscle tears: active movement
Ligamentous tears: passive movement
Pain avoidance: tendinous lesions

And ice, ice, baby

Question 12

Strain

Answer 12

Overstretch injury to a musculotendinous unit.

Caused by overstretching or extreme contraction against heavy resistance.

Question 13

Joint effusion

Answer 13

Occurs when injury is severe enough to inflame the synovium.

Increased production of synovial fluid, causing swelling.

Question 15

Hemarthrosis

Answer 15

Bleeding into the synovial space. Causes immediate swelling (20-60 minutes)

Question 16

Grade 1 Strain

Answer 16

Minor stretch or tear (0-20%)
Minimal loss of strength
Can continue activity with discomfort
Local edema, heat and bruising

Question 17

Grade 2 Strain

Answer 17

20-70% damage
Snapping sensation or sound
Palpable gap
Difficulty continuing due to pain
Moderate edema,heat and bruising

Question 18

Grade 3 Strain

Answer 18

70-100% damage
Possible complete rupture or avulsion
Snapping sound or sensation
Palpable and possibly visible gap
Cannot continue activity
Bruising is red, black and blue

Question 19

Sprain

Answer 19

overstretch injury to ligament

Question 20

Most common sprain locations:

Answer 20

anterior talofibular (inversion sprain – ankle)
acromioclavicular ligament (shoulder)
palmar and collateral radiocarpal ligaments (wrist)
ACL, MCL, LCL (knee)

Question 21

Grade 1 Sprain

Answer 21

minor stretch and tear to ligament
stable during PROM
can continue with actives with some discomfort

Question 22

Grade 2 Sprain

Answer 22

tearing of ligaments (20-70%)
snapping sound/sensation, and joint gives way
joint is hypermobile but stable with PROM
difficulty continuing activities due to pain

Question 23

Grade 3 Sprain

Answer 23

complete rupture or avulsion
snapping sound/sensation, and joint gives way
significant instability and extreme end point with PROM
cannot continue activities

Question 24

For acute sprains and strains, what are the limitations on movement testing?

Answer 24

pain free AROM only

Question 25

How to test a subacute or chronic sprain?

Answer 25

AROM
PROM (direction of injury last)
Ligamentous stress test
Chronic: RROM

Question 26

Estimated return to activity for sprains?

Answer 26

Grade 1 sprain: four to five days.
Grade 2 sprain: seven to fourteen days.
Grade 3 sprain: immobilization is generally removed at six to eight weeks

Total healing up to six months