Frictions, Sprains & Strains Flashcards
Indications for frictions:
Fibrosis (mm, lig, capsule, tendon) Tendonitis Bursitis Ligament sprain Attachment release Injury and overuse
Should you friction referred pain?
Good god, no.
What stage of healing is appropriate for frictions?
Late subacute and chronic
How to position for frictions: without synovial sheath
Relaxed shortened position (softens fibres)
How to position for frictions: tendon with synovial sheath
Maximum stretch (so tendon and sheath will slip across each other)
How to position for frictions: ligament
Shortened Position.
What direction should you friction?
Cross fibre UNLESS THE TENDON HAD A SYNOVIAL SHEATH (in which case friction longitudinal)
General friction technique
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.
How long for the analgesic effect of frictions to occur
1-2 minutes.
Intent of frictions
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.
Frictions: CI’s
Bacterial and rheumatoid-type tendonitis/tenosynovitis/tenovaginitis
Calcification and ossification of soft tissue
Disorders of nerve structure
Skin problems
Hematoma
Acute bursitis
Follow frictions by:
Minor muscle tears: active movement
Ligamentous tears: passive movement
Pain avoidance: tendinous lesions
And ice, ice, baby
Strain
Overstretch injury to a musculotendinous unit.
Caused by overstretching or extreme contraction against heavy resistance.
Joint effusion
Occurs when injury is severe enough to inflame the synovium.
Increased production of synovial fluid, causing swelling.
Hemarthrosis
Bleeding into the synovial space. Causes immediate swelling (20-60 minutes)
Grade 1 Strain
Minor stretch or tear (0-20%)
Minimal loss of strength
Can continue activity with discomfort
Local edema, heat and bruising
Grade 2 Strain
20-70% damage Snapping sensation or sound Palpable gap Difficulty continuing due to pain Moderate edema,heat and bruising
Grade 3 Strain
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
Sprain
overstretch injury to ligament
Most common sprain locations:
anterior talofibular (inversion sprain – ankle)
acromioclavicular ligament (shoulder)
palmar and collateral radiocarpal ligaments (wrist)
ACL, MCL, LCL (knee)
Grade 1 Sprain
minor stretch and tear to ligament
stable during PROM
can continue with actives with some discomfort
Grade 2 Sprain
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
Grade 3 Sprain
complete rupture or avulsion
snapping sound/sensation, and joint gives way
significant instability and extreme end point with PROM
cannot continue activities
For acute sprains and strains, what are the limitations on movement testing?
pain free AROM only
How to test a subacute or chronic sprain?
AROM
PROM (direction of injury last)
Ligamentous stress test
Chronic: RROM
Estimated return to activity for sprains?
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
