Interventions Final Flashcards
grade 1 tissue injury
- pain at time of injury or within first 24 hours
- mild swelling local tenderness
- pain when tissue stressed
grade 2 tissue injury
- moderate pain, requires stopping of activity
- stress and palpation causes pain
- ligaments – some fibers may be torn, possibly increased joint mobility
grade 3 tissue injury
near complete or complete avulsion/ tear with severe pain
stress to torn tissue usually painless - torn ligament may result in instability of joint
goal of acute stage and how long the stage lasts
protection, allowing healing process to occur
~1-6 days
UNLESS perpetuation of injury
acute stage tissue response and characteristics
vascular changes exudation of cells and chemicals clot formation phagocytosis, neutralization of irritants early fibroblastic activities
acute stage tissue response and characteristics
vascular changes exudation of cells and chemicals clot formation phagocytosis, neutralization of irritants early fibroblastic activities
clinical signs of acute stage
inflammation and pain before tissue resistance (empty end feel)
signs of inflammation
swelling, redness, heat, pain at rest (irritating nerves), loss of function
phase 1 of acute stage
control effects of inflammation (PRICE)
prevent deleterious effects of rest
- nondestructive movements
what interventions can be done in the acute stage?
PROM
massage
muscle setting (w caution)
what interventions can be done in the acute stage?
PROM
massage
muscle setting (w caution)
how to control effects of inflammation
- if it hurts, don’t do it*
- patient education
- protection with splint/ sling, AD for walking
- 24-48 PRICE
- edema control
- massage
- gentle grade 1 joint mobilization
- facilitate wound healing
- maintain normal function of unaffected tissues
strain
stretching or tearing of muscle fibers or tendon
sprain
tearing of ligament fibers
subluxation
partial dislocation
muscle/tendon rupture or tear
partial or complete tear
tendinopathy/ tendinous lesions
degeneration of collagen protein that forms tendon
synovitis
inflammation of synovial membrane
hemarthrosis
bleeding in joint cavity
ganglion
abnormal benign swelling on tendon sheath
bursitis
inflammation of bursae in joints – painful
contusion
region of damaged tissue where blood vessels have ruptured; bruise
contracture
condition of shortening and hardening of muscles, tendons, or other tissues – makes joint and other structures rigid and deformed
adhesion
bands of scar-like tissue that form between 2 surfaces inside the body and cause them to stick together
purpose of PROM in acute
maintains mobility of tissue and fluid dynamics in joint
purpose of massage in acute
moves fluid and prevents adhesions
purpose of muscle setting in acute
pumping action increases circulation without causing joint compression
gentle, low intensity isometric contraction
low dosage joint mobilization - purpose in acute
grade 1-2 distraction and glide
improves fluid movement and maintains cartilage health
reflexively inhibits pain and decreases muscle guarding
precautions in acute stage
if movement causes pain, either too high of dosage and/or too high intensity
contraindications in acute stage
NO stretching
NO resistance exercises for inflamed or swollen tissue
subacute stage - goals and how long it lasts
proliferation, repair, and healing (moderate protection and controlled motion)
~7-21 days post injury, could last up to 6 weeks
tissue proliferation, repair and healing in subacute
- collagen synthesis and deposition – bonds created are becoming stronger
- tissue granulation
- excessive fibroblast activity
- new immature CT is FRAGILE but needs (safe) loading
clinical signs of 2nd phase subacute
- decreasing inflammation
- pain with stress or at end range
- ROM restrictions due to immobilization (might have muscle guarding)
- muscle weakness and functional restrictions may be present due to disuse or pain (bc limited by healing of tissues)
management guidelines subacute
- moderate protection
- controlled motion
- non-destructive activities
- patient education
- management of pain and inflammation
- initiation of active exercises
- initiation and progression of stretching
- correction of contributing factors
criteria for initiating active exercises and stretching
- decreased swelling
- no constant pain
- pain not exacerbated by motion in available range
what should you educate pt on during the subacute stage?
- expectations (how long process will be, signs to be aware of)
- HEP
- resuming normal, non-exacerbating activities (ex: weening off ADs slightly)
when you are initiating active exercises, what types of exercises should they be?
- multiple angle, sub maximal isometric exercises (high reps, low load)
- AROM
- muscular endurance exercises
- protected WB exercises
- concentric only
contraindications of active exercise in early subacute
do NOT do eccentric or heavy resistance exercises
which type of muscle fibers atrophy faster?
slow twitch muscles
what must be done during/ before stretching?
muscles must be warm
pt must relax
use the new ROM after stretching
signs of excessive stress
- soreness greater than 4 hours and not resolved after 24 hrs
- pain earlier or increased
- progressively increased stiffness (inc edema, muscle guarding) or decreased ROM between sessions
- swelling, redness, warmth in healing tissue
- decreased functional use
chronic stage - goals and time frame
- minimal to no protection/ return to function
- maturation and remodeling
- ~21 days to 18 months
tissue response during chronic stage
- collagen fibers become THICKER and reorient in response to stress — much stronger
- improvement in collagen quality
after _____, scars become resistant to remodeling
14 weeks
clinical signs of 3rd phase chronic
- no signs of inflammation
- limitations in ROM due contractures/ adhesions not pain (not chronic if there is an empty end feel)
- decreased muscle performance
- decreased usage of involved part of inability to participate normally in expected activities
chronic stage management guidelines
- minimal protection
- ** return to function
- patient education
- exercise progression
- stretching progression
- progressing muscle performance: control, strength, endurance
- return to high - demand activities (athletics, job skills)
- progressive exercise (flexibility, strength)
- use controlled forces
- monitor, progress, modify
what should you be educating pt on during chronic stage?
- HEP
- self-monitoring **
- establishment of guidelines to safe return to work/ play with PT
if tightness persists in joint, do…
joint mobilization
if there is a limitation in muscle length, do…
stretching
if limitation in strength, do…
strengthening in controlled manner
if limitation in higher level activities, do…
work or sport specific training
ways of progressing exercises
- from isolated, unidirectional –> complex and multidimensional
- strengthening to simulate demands – OKC/ CKC, eccentric/ concentric
phase IV is ____ and includes ____
return to high demand activities
includes plyometrics, agility training, and skill development
add distractions, doing many things at once, etc.
cumulative trauma is…
“roundabout” of chronic recurring pain – injury, stress, inflammation
tissue response for cumulative trauma
state of prolonged inflammation
fibroblast activity during chronic inflammation
proliferation of fibroblasts with increased collagen production (dumping fibroblasts but they are not being laid down)
degradation of mature collagen – overall weakening of tissue
myofibroblastic activity may lead to progressive limitations in ROM
causes of chronic inflammation
overuse, cumulative trauma, repetitive straining
- trauma (i.e. surgery, not following WB restriction)
- reinjury of “old scar”
- contractures or poor mobility
contributing factors to chronic inflammation
- imbalance between length and strength
- rapid or excessive repeated eccentric demand (doing too much too fast)
- muscle weakness
- bone malalignment or weak structural support
- change in usual intensity or demands
- returning to activities too soon after injury
- sustained awkward postures or motions (ergonomics)
- environmental factors
- age related factors
- training errors
clinical signs of chronic inflammation
- PAIN* in involved extremity during and after repetitive activity that may prevent completion and is continued and unremitting
- contractures or adhesions that limit normal ROM or joint play
- weakness and imbalance, lead to biomechanics dysfunction
- faulty movement patterns (due to substitutions)
- decreased use
key things to look for during chronic inflammation
- progressive loss of ROM
- muscle guarding
- pull back if there are any problems with interventions in subacute or chronic, or they do not improve symptoms
