Injury, Inflammation, Healing, And Repair Flashcards
T/f: inflammation occurs the same in all body tissues
False, inflammation is different in different tissues
What is Wolff’s law?
Bones remodel based on stress and disuse
What can aberrant or excessive forces lead to?
Enlargement of prominences or spurs
At any point in time, what percentage of our total bone mass is being recycled?
5%
What are the signs of inflammation (inflammatory components)?
Heat, redness, swelling, pain, loss of fxn
What are some stimuli of inflammation?
Pathogens, toxins, trauma, allergens, irritants, microbials
What are the goals of the inflammatory process?
To eliminate the cause, clear out damaged tissues, and facilitate tissue repair
The inflammatory process starts with what cells in the tissues?
Mast cells or macrophages
What do macrophages do in the inflammatory process?
They are the garbage pails of the body that eat up pathogens
They act on endothelial cells of the nearby capillaries to create separation
What do mast cells contain?
Inflammatory mediators (histamine, serotonin, cytokines, leukotrienes, and prostaglandins)
What do endothelial cells do in the inflammatory process?
They increase vascular permeability and release nitric acid to vasodilate (balloons up the area)
What are the first leukocytes to be recruited in acute inflammation?
Neutrophils
What do neutrophils do?
They gobble up pathogens via phagocytosis and then commit suicide to destroy itself and all the pathogens it consumed
What process causes pus and wound drainage?
Neutrophils going through phagocytosis
What are T lymphocytes?
T cells produced in the thymus for immune protection
T/f: T lymphocytes are also recruited to fight off pathogens in inflammation
True
If there is a wound, what in the plasma helps clot blood to stop the bleeding and prevent pathogens from entering the blood?
Platelets and clotting factors
Small injuries replace the damaged tissue with ____
Restoring the original tissue integrity
Large injuries replace damaged tissue with _____
A fibrous scar
What signals the body to stop the healing process?
Injury current of one polarity changing to another
What is a sign of dysfunction in the healing process where the body doesn’t know when to stop?
Keloids
T/f: nutrition is a huge factor for both prevention and healing of wounds
True
T/f: calcium and vitamin D can decrease fx risk 15-30%
True
What vitamin/mineral is important to cartilage?
Sulfur
What vitamin is retinol?
Vitamin A
What does vitamin A do?
Help with collagen regeneration, tissue repair, and cell division
Can also prevent injury by contributing to elasticity and strength of connective tissue
What vitamin is ascorbic acid?
Vitamin C
What does vitamin C do?
It contributes to formation of collagen fibers (early angiogenesis) and has anti-inflammatory properties
What is the sunlight vitamin?
Vitamin D
What does vitamin D do?
Contributes to bone health and has immune properties to manage inflammation and cell proliferation
What does vitamin E do?
It influences tissue healing via expression of 2 enzymes that increase vessel dilation and inhibit platelet aggregation (thins blood)
T/f: status of protein and carbs at the time of surgery is important
True
How much protein is a good amount pre and post surgery to restore muscle mass and exercise tolerance?
1.6-3.0 g/kg of body weight
How much carbs are good pre and post surgery to maximize glycogen stores?
8g/kg of lean mass
What do glucosamine and chindroitan do?
Reduce pain, stiffness, and swelling equal to NSAIDs w/o the side effects
What is the recommended daily dose of glucosamine and chondroitan that should be taken for its benefits?
0.5-3.0g/day for at least a month
What does vitamin K1 do?
Clotting
What does vitamin K2 do?
Contributes to bone health
T/f: anti-biotic cement coated plates post op have been shown to be effective for management of infected fxs
True
T/f: going into surgery well nourished leads to better outcomes post-op
True
What pathologies can affect muscle tissue?
Inflammation, fiber splitting, enzyme efflux, sarcomere disruption, pain, stiffness, cytoskeletal changes, swollen fibers, membrane damage, EC uincoupling, loss of motion, tenderness, fibrosis, central nuclei lead to loss of force
What is the length tension relationship of a muscle?
The force a muscle is able to generate is determined by the length of the muscle prior to contraction
In what part of the range is a muscle the strongest?
Mid range
Why is TB maybe not the greatest way to strengthen a muscle through its range?
Bc it does change resistance at stronger or weaker point in the muscle’s range, it will be too easy or too hard at certain points
When is there max tension in a muscle?
When the zone of overlap extends from the edge off the H zone to one end of the thick filament (literally no clue what this means but it’s on the slide so idek)
T/f: overstretch of a muscle decreases overlap and reduces force of contraction
True
At what percentage of a muscles length is there no overlap and the tension is zero?
At 170%
Why is there a reduced force of contraction when a muscle is understretched?
Bc there is crimping of the thick filaments by a discs
What muscle contraction occurs when the load applied exceeds the force produced by the muscle resulting in lengthening?
Eccentric contraction
T/f: eccentric loads are greater than max concentric strength
True
Does eccentric or concentric training lead to greater overall strength gains?
Eccentric
With increased contraction velocity is there greater or lesser increases in eccentric strength gains?
Greater gains
T/f: there is less energy needed for eccentric training
True
Is muscle force greater with eccentric or concentric contraction?
Eccentric
Is more or less tissue needed for eccentric contraction?
Less tissue is needed
T/f: eccentric carries over to concentric but concentric doesn’t carry over to eccentric
True
Eccentric training tend to induce greater increases in _____ muscle, while _____ muscle hypertrophy occurs to a greater extent with concentric training
Distal, mid
Does max tension force and stress occur with eccentric or concentric muscle contractions?
Eccentrics
When do strains occur?
During eccentric activities mostly its biarticulate muscles (but can occur in uniarticulate muscles)
How should we train muscles that have been strained?
By doing the problematic actions
Are contusions to a relaxed or contracted muscle more likely to cause a bone bruise? Why?
Relaxed bc there is nothing to absorb the force so it goes directly to the bone
T/f: we should aggressively stretch early on with a bone bruise
False
do fast twitch fibers lead to specific or global pain and inflammation?
Global
Do fast or slow twitch fibers lead to global or specific pain and inflammation?
Specific
What is the typical treatment for a sprain?
PRICE
Protect
Relative rest
Ice
Compression
Elevation
Why do we use relative rest with a strain?
To prevent further damage and allow healing to “jump start”
Why do we use ice for a strain?
To reduce the size of the hematoma
Why do we use compression for a strain?
To reduce blood flow
T/f: you shouldn’t take NSAIDs too early bc it can stop early inflammation that is needed to heal
True
What are some characteristics of a strain?
Tenderness
Loss of motion
Pain
Palpable defect
Detectable swelling
When does loss of motion, palpable defect, and detectable swelling start in strains?
Grade 2
What is the “golden hour” of healing?
The time to replace nutrients and restore tissues post exercise
What are the 4 Rs of “golden hour”?
Refuel/rehydrate
Replenish glycogen
Reduce damage
Rebuild muscle protein
What is the ideal carb to protein ratio for post exercise?
4:1
What are some supplements for inflammation and nutrition?
Boswellia
Curcumin (turmeric)
Omega-3 (fish oil)
Ginger
GLA (gamma linolenic acid)
What things cause DOMS?
Unaccustomed activity
Overuse
Eccentric activity
Is DOMS a lactic acid problem?
NO!
What is the etiology of DOMS?
Cell membrane damage leads to disruption of calcium homeostasis in the injured fibers and necrosis
Products if macrophage activity and intracellular contents accumulate in the interstitium which stimulates free nerve endings of sensory neurons in the muscle
What is DOMS?
Sensation of pain and stiffness in muscles
When does DOMS occur?
2-3 days after the unaccustomed activity
When does DOMS peak b4 it begins to subside?
48-72 hours after the activity
T/f: DOMS results in a transient decrease in ROM and decrease in muscle tone
True
What is the treatment for DOMS?
Concentric activity
Repeated exposure
Why are concentric activities used to treat DOMS?
Bc high speed concentric increase blood flow to the area to decrease stiffness and keep ROM
What is the repeated bout effect?
The more expose you have to an activity the less DOMS will occur
T/f: the longer be exposures to activities, the more likely your are to experience the same soreness
True
What is the most likely cause of DOMS discomfort?
Microfiber damage
Does a ligament or tendon attach muscle to bone?
Tendon
T/f: tendons generate and absorb tension
True
T/f: tendons include a fascial layer that envelopes the muscle belly and gathers together at either end to form a tendon as one continuous tissue
True
What is a tendinopathy?
Non rupture in the tendon or peritendon (aggregated by mechanical load)
What is tendinitis?
Acute cell mediated inflammatory response
What is tendinosis?
Chronic degenerative tendon pathology (abundant fibroblasts, vascular hyperplasia, and unstructured collagen)
What are the intrinsic factors for tendon injury?
Age and weight
T/f: actual body weight determines risk for tendon injury
False, it is the adiposity of body weight that is the issue
Why is adiposity a risk factor for tendinopathy?
Excessive intake of cholesterol results in accumulation of oxidized LDL in the load-bearing region of the tendon where it may impair type 1 collagen production (increase type 3 which isn’t strong enough to withstand forces) and reduce tendon strength and energy storing capacity
What are the characteristics of tendon failure?
Hypercellularity
Microtearing
Loss of tightly bundled collagen
Increased proteoglycan content
Neovascularization
Absent/minimally inflammation
Healthy tendons are composed of type ___ collagen
1
What increases the ratio of type 3 collagen to type 1 collagen in the extracellular matrix of tendons?
Substance p
What is the most common intervention for tendon injuries?
Corticosteroids
T/f: corticosteroids interfere with tissue repair and can increase the risk of tendon ruptures
True
If corticosteroids are used as a treatment for tendon injury, what should be done?
Use the lowest possible dosage to still be effective
What are the 2 interventions for tendon injury other than corticosteroids?
Isometrics and eccentrics
What is the point of isometrics as an intervention for tendon injury?
It abates pain
What is the point of eccentrics as an intervention for tendon injury?
Eccentric exercise facilitates collagen regrowth and remodeling
What is the best way to challenge a tendon?
With eccentrics
What does eccentric exercise do for tendon healing?
Induces inflammatory mediated increase in type 1 collagen turnover
Increases tendon stiffness
Decreases neovascularization
Decreases pain
Is a decline or incline squat good for training the patellar tendon?
Decline squat
Is a decline or incline squat good for training the Achilles tendon?
Incline squat
T/f: it is better to cluster sets of exercises for tendon injury exercises
False, as long as the form is good the result of doing small sets or all at once are similar
What is the fibrous connective tissue connecting 2 bones?
Ligament
What is the goal of interventions for tendon injury?
To give frequent dose of mechanical stimulus to the tendon cells
What is the fxn of ligaments?
To limit motion to prevent damage to the joint
What are the characteristics of a grade 1 sprain?
No ligament damage
Minimal loss of fxn
Minimal pain
Minimal swelling
Usually no ecchymosis
No difficulty with WBing
What are the characteristics of a grade 2 sprain?
Partial ligament damage
Some loss of fxn
Moderate pain
Moderate swelling
Ecchymosis may occur
Usually problems with WBing
What are the characteristics of a grade 3 sprain?
Complete ligament injury
Great loss of fxn
Severe pain
Severe swelling
Ecchymosis
Almost always problems with WBing
What does recovery look like with a grade 1 sprain?
Usually heals within a few weeks but max ligament strength can take 6 weeks for collagen fibers to mature
What does recovery look like with a grade 2 sprain?
It commonly takes 6-12 weeks for full return to activity
What does recovery look like with a grade 3 sprain?
It may require surgery and can take 3-4 months to recovery to full activity
Can take up to 12 months
What is the only body part that can’t repair itself?
Teeth
What does repairing mean?
Either regrowing what was lost or replacing it with scar tissue
T/f: the brain can’t regrow damaged brain cells but can repair an area by laying down other scar type tissue
True
What is the only organ that can regenerate itself.
The liver
T/f: hepatocytes of the liver multiply and work like stem cells
True
T/f: a liver can regrow to normal size even after up to 90% of it has been removed
True
Even after 70% if the liver is removed, it can regenerate within how many weeks?
2 weeks
How can the body repair clogged arteries?
By growing new ones or enlarging existing ones
How can diet help repair blood vessels?
By improving diet, the body can reabsorb plaque in vessels
Can the skin repair itself?
Duh
