Intro, AT, Emergency, Injury, and Rehab

Question 1

What are 3 stages of healing?

Answer 1

• inflammatory response phase
• fibrotic repair or proliferation phase
• remodelling or maturation phase

Question 2

How long does the inflammatory response phase last?

Answer 2

~ 7 days

Question 3

What does the injury look like in the inflammatory response phase?

Answer 3

• red
• big
• tender to touch

Question 4

What causes pain in the inflammatory response phase?

Answer 4

pressure​ ​of​ ​all​ ​the​ ​chemicals​ ​pushing​ ​on​ ​the​ ​skin​ ​and​ ​tissues

Question 5

Why is swelling necessary for the body to heal?

Answer 5

• body​ ​sending​ ​chemical​ ​mediators​ ​to​ ​injury​ ​area​ ​to​ ​help​ ​clean​ ​everything​ ​up​ ​(damage, debris​ ​tissue)
• goal​ ​is​ ​to​ ​get​ ​rid​ ​of​ ​all​ ​damaged​ ​tissue​ ​from​ ​area​ ​and​ ​bring​ ​all​ ​chemicals​ ​towards​ ​area that​ ​help​ ​with​ ​healing

Question 6

Why is lack of swelling bad?

Answer 6

you​ ​are​ ​not​ ​getting​ ​all​ ​the​ ​chemicals​ ​needed

Question 7

What is chronic inflammation?

Answer 7

• inflammation goes on for too long
• can​ ​be​ ​because​ ​you​ ​are​ ​continuing​ ​to re-aggravate​ ​the​ ​injury​ ​(more​ ​swelling)
• can​ ​be​ ​because​ ​you​ ​are​ ​not​ ​taking​ ​care​ ​of​ ​it (RICE)
• allows​ ​body​ ​to​ ​re-aggravate​ ​the​ ​swelling
• eventually becomes weaker joint

Question 8

What is the fibrotic repair or proliferation phase also called?

Answer 8

fibroblastic repair

Question 9

What is the timeframe of the proliferation phase?

Answer 9

weeks 2-3 (depends on injury)

Question 10

Describe what happens in the proliferation phase.

Answer 10

• subacute phase
• regain ROM, try to get strength back
• adding exercises
• important that we don’t cause more damage (safe exercises)
• people start feeling better, need to keep them from doing too much

Question 11

What is the goal of the proliferation phase?

Answer 11

• ​help​ ​repair​ ​the​ ​tissue​ ​that​ ​has​ ​been​ ​damaged,
• ​repair​ ​circulation
• get​ ​all debris​ ​tissues​ ​out​ ​of​ ​the​ ​way​ ​and​ ​bring​ ​in​ ​brand​ ​new​ ​tissue

Question 12

What is the timeframe of the remodelling or maturation phase?

Answer 12

• longest phase

- anything past 4 weeks, up to 18 months

Question 13

Describe what happens in the remodelling or maturation phase.

Answer 13

• chronic phase
• sports specific drills
• return to play/lifestyle

Question 14

What is the goal of the remodelling or maturation phase?

Answer 14

• strengthening the tissue

- needs to be as strong as possible

Question 15

How does chronic inflammation affect the remodelling or maturation phase?

Answer 15

• never​ ​get​ ​to​ ​this​ ​stage
• always​ ​going​ ​from​ ​stage​ ​1​ ​to​ ​stage​ ​2​ ​and back
• will​ ​always​ ​be​ ​weak​ ​unless​ ​they​ ​can​ ​go​ ​through​ ​all​ ​the​ ​phases​ ​properly

Question 16

What is Wolffs Law?

Answer 16

• Need​ ​to​ ​have​ ​stress​ ​on​ ​an​ ​injured​ ​tissue​ ​to​ ​force​ ​it​ ​to​ ​get​ ​better​ ​(regardless​ ​of​ ​what​ ​the
  tissue​ ​is)
• Need​ ​to​ ​be​ ​safe​ ​stress
• Without​ ​this​ ​you​ ​get​ ​chronic​ ​injury

Question 17

What is an application of Wolffs Law?

Answer 17

• walking casts/boots

- less casting

Question 18

Name 6 factors that impede healing.

Answer 18

• Continued​ ​re-aggravation
• Infection
• Not​ ​eating​ ​well
• Not​ ​enough​ ​rest
• Smoking
• Too​ ​much​ ​stress
• Same​ ​as​ ​when​ ​you’re​ ​sick

Question 19

Describe the timeframe for healing for cartilage injuries.

Answer 19

• In​ ​discs​ ​in​ ​back,​ ​meniscus​ ​in​ ​knee​ ​etc.
• No​ ​good​ ​blood​ ​flow
• 8-10​ ​weeks
• Some​ ​may​ ​never​ ​heal​ ​(no​ ​good​ ​blood​ ​flow,​ ​continued​ ​re-aggravation)

Question 20

Describe the timeframe for healing for ligament injuries.

Answer 20

• 6​ ​weeks​ ​for​ ​second​ ​degree​ ​or​ ​2​ ​ligaments

- 4​ ​weeks​ ​for​ ​first​ ​degree​ ​or​ ​1​ ​ligament

Question 21

Describe the timeframe for healing for muscle and tendon injuries.

Answer 21

• 6-8​ ​weeks
• Longer​ ​due​ ​to​ ​elasticity
• need​ ​to​ ​build​ ​up​ ​strength​ ​so​ ​that​ ​it​ ​can​ ​withhold​ ​the​ ​forces applied​ ​to​ ​it

Question 22

Describe the timeframe for healing for nerve injuries.

Answer 22

• Very​ ​slow​ ​(mm/year)
• Never​ ​fully​ ​regenerate/heal
• 2-3​ ​year,​ ​likely​ ​permanent

Question 23

Describe the timeframe for healing for bone injuries.

Answer 23

• Soft​ ​callus​ ​(physically​ ​attached)​ ​at​ ​2​ ​weeks
• Can​ ​start​ ​doing​ ​some​ ​exercise​ ​at​ ​2​ ​weeks
• Fully​ ​healed​ ​at​ ​6-8​ ​weeks

Question 24

What will affect timeframe for healing, regardless of the injury?

Answer 24

surgical repair

Question 25

What are the 3 phases of rehab?

Answer 25

- acute phase - subacute phase - chronic/restructuring/remodelling phase

Question 26

How long does the acute phase last?

Answer 26

from​ ​point​ ​of​ ​injury​ ​to​ ​3​ ​days​ ​(72​ ​hours)​ ​post-injury

Question 27

What occurs in the acute phase?

Answer 27

- need​ ​to​ ​baby the​ ​injury - RICE,​ ​take​ ​it​ ​easy - sets​ ​up​ ​inflammatory​ ​response

Question 28

How long does the subacute phase last?

Answer 28

3​ ​days​ ​post-injury​ ​for​ ​3-4​ ​weeks

Question 29

How long does the chronic/restructuring/remodelling phase last?

Answer 29

- from​ ​3-4​ ​weeks​ ​through​ ​18-24​ ​months - If​ ​the​ ​injury​ ​site​ ​was​ ​immobilized​ ​for​ ​some​ ​time,​ ​this​ ​process​ ​would​ ​be​ ​longer - If​ ​you​ ​had​ ​surgery,​ ​you​ ​have​ ​to​ ​restart​ ​the​ ​process

Question 30

Describe pain, and how it affects rehab.

Answer 30

- Perception​ ​of​ ​pain​ ​can​ ​be​ ​controlling​ ​factor​ ​injury​ ​healing​ ​with​ ​an​ ​athlete - Not​ ​the​ ​factor​ ​the​ ​starts​ ​or​ ​stops​ ​rehab - Happens​ ​when​ ​specific​ ​nerve​ ​fibres​ ​in​ ​our​ ​body​ ​get​ ​torn/damaged/impacted;​ ​Nociceptors are​ ​free​ ​nerve​ ​endings​ ​=​ ​what​ ​causes​ ​you​ ​pain

Question 31

What can you get pain from?

Answer 31

- pressure​ ​(swelling) - burning​ ​(thermo-type​ ​receptor) - cooling

Question 32

What are the 4 categories of pain?

Answer 32

- cutaneous pain - pain from muscles/ligaments/tendons - bone pain - internal organ pain

Question 33

Describe cutaneous pain.

Answer 33

​- at​ ​surface​ ​of​ ​skin - usually​ ​sharp​ ​or​ ​burning​ ​sensation - very​ ​localized, easy​ ​to​ ​point​ ​out

Question 34

Describe pain from muscles/ligaments/tendons.

Answer 34

​- deeper,​ ​aching​ ​feel - ​bleeding​ ​=​ ​throbbing - ​vague location

Question 35

Describe bone pain.

Answer 35

- ​deep,​ ​“deep​ ​aching​ ​toothache” - generally​ ​creates​ ​nausea - ​more​ ​intense​ ​pain

Question 36

Describe internal organ pain.

Answer 36

- generally​ ​referred​ ​pain​ ​(ex.​ ​Heart​ ​attack:​ ​shoulder/arm​ ​hurts) - either really​ ​dispersed​ ​area,​ ​or​ ​area​ ​far​ ​away - Pain​ ​=​ ​lack​ ​of​ ​oxygen

Question 37

What is acute pain?

Answer 37

- ​lasts​ ​less​ ​than​ ​6​ ​months​ ​(into​ ​the​ ​first​ ​part​ ​of​ ​maturation​ ​phase) - Normal​ ​to have​ ​pain​ ​and​ ​discomfort​ ​with​ ​some​ ​activity

Question 38

What is chronic pain?

Answer 38

- past​ ​6​ ​months | - generally​ ​have​ ​other​ ​issues​ ​going​ ​on​ ​beyond​ ​physical injury

Question 39

How can we control pain?

Answer 39

- Manual​ ​therapy - ultrasound/razor - Currents​ ​(used​ ​mainly​ ​for​ ​pain​ ​and​ ​swelling,​ ​gate​ ​control​ ​theory)

Question 40

What is gate control theory?

Answer 40

- Body​ ​can​ ​only​ ​feel​ ​one​ ​sensation​ ​from​ ​one​ ​area​ ​at​ ​a​ ​time - Touch​ ​over​ ​top​ ​of​ ​pain​ ​spot​ ​will​ ​force​ ​the​ ​brain​ ​to​ ​feel​ ​the​ ​touch​ ​instead​ ​of the​ ​pain,​ ​because​ ​touch​ ​changes

Question 41

What is referred pain?

Answer 41

- Cross​ ​over​ ​of​ ​nerves,​ ​pain​ ​travels​ ​farther​ ​away - The​ ​farther​ ​the​ ​pain,​ ​the​ ​worse​ ​the​ ​condition - Pain​ ​from​ ​farther​ ​away​ ​can​ ​eventually​ ​become​ ​a​ ​second​ ​injury;​ ​Pain​ ​= body​ ​treats​ ​it​ ​like​ ​something​ ​is​ ​wrong,​ ​muscles​ ​spasm - Pain​ ​from​ ​far​ ​away​ ​can​ ​distract​ ​from​ ​real​ ​injury

Question 42

Name 6 things that make you more susceptible to injury.

Answer 42

- Tired - Smoking - Improper​ ​form - Improper​ ​posture - Improper​ ​warm​ ​up/cool​ ​down - Genetic​ ​factors​ ​(conditions,​ ​weaker​ ​ligaments,​ ​tall/short,​ ​muscle​ ​fibre​ ​types,​ ​lifestyle)

Question 43

How can we speed up healing?

Answer 43

- Medications​ ​(decrease​ ​pain,​ ​decrease​ ​swelling,​ ​decrease​ ​spasm) - Modalities - Exercise

Question 44

Name 6 modalities.

Answer 44

- cryotherapy - thermotherapy - contrast bath - ultrasound - laser - electric current

Question 45

What is the general rule for heat and cold?

Answer 45

- pain = ice - stiff = heat - if you can't tell, go with ice. It won't make anything worse

Question 46

Describe cryotherapy.

Answer 46

- cold​ ​(ice​ ​pack,​ ​ice​ ​bath,​ ​ice​ ​massage) - Reduce​ ​swelling​ ​(vasoconstriction:​ ​constricting​ ​blood​ ​vessels​ ​so​ ​that​ ​you can’t​ ​get​ ​circulation​ ​to​ ​the​ ​area) - 4​ ​sensations:​ ​cold​ ​(skin),​ ​burn​ ​(nerves),​ ​ache​ ​(deeper​ ​tissues),​ ​numb (nothing)​ ​(typically​ ​takes​ ​7​ ​minutes​ ​to​ ​get​ ​through​ ​all​ ​4,​ ​all​ ​structures)

Question 47

What is the general prescription (time) for cryotherapy?

Answer 47

- General​ ​rule:​ ​20​ ​minutes​ ​on,​ ​1​ ​hour​ ​off | - 1​ ​hour​ ​off​ ​=​ ​everything​ ​comes​ ​back​ ​to​ ​feeling​ ​before​ ​doing​ ​it​ ​again​ ​to avoid​ ​frostbite

Question 48

Describe thermotherapy.

Answer 48

- Heat​ ​(hot​ ​pack,​ ​hot​ ​bath,​ ​infrared​ ​lights) - Vasodilation:​ ​bring​ ​blood​ ​to​ ​area - Muscle​ ​spasm,​ ​try​ ​to​ ​flush​ ​out​ ​what​ ​is​ ​causing​ ​the​ ​spasm

Question 49

What is the general prescription (time) for thermotherapy?

Answer 49

no time limit for heat

Question 50

Describe contrast bath.

Answer 50

- combination of hot and cold, back and forth - back and forth between constricting and dilating - creates muscle pump = tight, relaxing - For​ ​too​ ​much​ ​swelling​ ​or​ ​swelling​ ​has​ ​been​ ​there​ ​for​ ​too​ ​long

Question 51

When do we use contrast bath?

Answer 51

- Commonly​ ​after​ ​days​ ​3-5​ ​when​ ​there​ ​is​ ​still​ ​too​ ​much​ ​swelling - Will​ ​not​ ​use​ ​a​ ​contrast​ ​bath​ ​before​ ​day​ ​3​ ​(we​ ​want​ ​inflammation​ ​up​ ​to​ ​that point)

Question 52

What is the general prescription (time) for contrast bath?

Answer 52

- generally​ ​1​ ​min.​ ​and​ ​hot,​ ​1​ ​min.​ ​in​ ​cold,​ ​and​ ​back​ ​and​ ​forth​ ​for​ ​15 minutes - need​ ​to​ ​put​ ​area​ ​up​ ​after​ ​15​ ​minutes​ ​to​ ​drain

Question 53

Describe ultrasound.

Answer 53

- Sound​ ​wave​ ​that​ ​goes​ ​into​ ​tissue - creates​ ​heat​ ​from​ ​the​ ​inside​ ​out - vibrates​ ​cells​ ​(helps​ ​break​ ​down​ ​scar​ ​tissue) - Tends​ ​to​ ​be​ ​subacute​ ​modality - Should​ ​never​ ​feel​ ​anything

Question 54

When shouldn't we use ultrasound?

Answer 54

- head​ ​injuries​ ​or​ ​bone​ ​injuries​ ​(fractures,​ ​breaks) - in​ ​acute​ ​phase​ ​of​ ​injury​ ​because​ ​we​ ​do​ ​not​ ​need​ ​any​ ​more heat

Question 55

Describe laser.

Answer 55

- Gives​ ​energy​ ​to​ ​the​ ​cell​ ​that​ ​are​ ​damaged - Turns​ ​all​ ​the​ ​cells​ ​that​ ​aren’t​ ​working​ ​back​ ​on - Helps​ ​speed​ ​healing - Should​ ​never​ ​hurt,​ ​may​ ​feel​ ​warm

Question 56

When shouldn't we use laser?

Answer 56

- ​in​ ​eyes - in​ ​cancerous​ ​tumor​ ​to​ ​avoid​ ​giving​ ​it​ ​more​ ​energy​ ​than they​ ​already​ ​have

Question 57

Describe electrical current.

Answer 57

- TENS:​ ​buzzing​ ​sensation | - Muscle​ ​stimulation:​ ​creates​ ​contraction​ ​in​ ​muscle,​ ​used​ ​post​ ​surgery​ ​or spinal​ ​cord​ ​injury

Question 58

What is interferential current?

Answer 58

- 4​ ​pads​ ​on​ ​at​ ​1​ ​time - Decreases​ ​pain​ ​(gate​ ​control theory) - Can​ ​be​ ​turned​ ​up​ ​high​ ​enough​ ​to​ ​create​ ​muscle​ ​contraction (decrease​ ​spasm,​ ​make​ ​a​ ​muscle​ ​fire,​ ​fatigue​ ​a​ ​muscle) - Has​ ​effect​ ​on swelling,​ ​can​ ​make​ ​it​ ​move.

Question 59

Name the order of rehab exercises.

Answer 59

1. ROM 2. isometrics 3. isotonics 4. isokinetics 5. functional patterns 6. cardio 7. flexibility 8. proprioception

Question 60

Describe ROM for rehab exercises.

Answer 60

getting full motion at the joint

Question 61

Describe isometrics for rehab exercises.

Answer 61

- strengthening - no​ ​movement​ ​of​ ​the​ ​joint​ ​(decreased​ ​risk​ ​of​ ​re-injury) - pushing against​ ​something​ ​in​ ​a​ ​stationary​ ​way

Question 62

Describe isotonics for rehab exercises.

Answer 62

- ​strengthening - like every​ ​exercise​ ​at​ ​the​ ​gym​ ​(ex.​ ​Bicep​ ​curls) - closer​ ​to​ ​full​ ​ROM

Question 63

Describe isokinetics for rehab exercises.

Answer 63

- strengthening - same​ ​speed - need​ ​particular​ ​machines​ ​(same​ ​tension,​ ​same movement​ ​throughout​ ​exercise)

Question 64

Describe functional patterns for rehab exercises.

Answer 64

- add​ ​back​ ​exercises​ ​that​ ​look​ ​closer​ ​to​ ​sport​ ​specific - need​ ​to​ ​have enough​ ​movement​ ​and​ ​strength​ ​for​ ​safety

Question 65

Describe cardio for rehab exercises.

Answer 65

- many ​different​ ​ways - cardio​ ​is​ ​needed​ ​to​ ​keep​ ​them​ ​at​ ​a​ ​level​ ​they​ ​need​ ​to​ ​participate without​ ​causing​ ​further​ ​damage

Question 66

Describe flexibility for rehab exercises.

Answer 66

need​ ​to​ ​be​ ​able​ ​to​ ​stretch​ ​the​ ​muscles​ ​around​ ​the​ ​damaged​ ​area

Question 67

Describe proprioception for rehab exercises.

Answer 67

- balance - both​ ​legs​ ​and​ ​arms - lose​ ​this​ ​immediately​ ​after​ ​injury,​ ​needs​ ​to be​ ​retrained

Question 68

What is return to play/activity?

Answer 68

involves​ ​gradual​ ​progression​ ​of​ ​functional​ ​activities,​ ​increasing​ ​stress​ ​on​ ​injured structure

Question 69

What are the 5 pieces of return to play?

Answer 69

1. Full,​ ​pain​ ​free​ ​ROM 2. At​ ​least​ ​90%​ ​strength​ ​of​ ​the​ ​injured​ ​area 3. Need​ ​to​ ​be​ ​able​ ​to​ ​safely​ ​do​ ​the​ ​functional​ ​pieces​ ​of​ ​your​ ​sport 4. Need​ ​to​ ​be​ ​psychologically​ ​ready​ ​to​ ​rejoin​ ​sport​ ​(feel​ ​ready​ ​to​ ​rejoin) 5. Re​ ​train​ ​to​ ​do​ ​the​ ​activity​ ​that​ ​got​ ​you​ ​injured​ ​(body​ ​remembers​ ​how​ ​you​ ​were​ ​injured)