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Developing Physiotherapy Practice 3 > L3 - MSK Rehabilitation > Flashcards

L3 - MSK Rehabilitation Flashcards

1
Q

what are the key principles of MSK

A

phase 1: control inflammation, control pain.
phase 2: restore ROM
phase 3: Develop muscle strength, power, & endurance
phase 4: Return to functional activity, sport, work

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2
Q

Why is the inflammatory process key to our decision making when designing a rehabilitation programme?

A
  • Understanding soft tissue healing process
  • Assess and choose appropriate treatment techniques to facilitate healing
  • Avoid treatment techniques that may aggravate or slow healing process
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3
Q

Why is pain key to our decision making when designing a rehabilitation program?

A
  • People respond differently to pain
  • Different factors can contribute to this including;
  • A lack of understanding & knowledge
  • Previous experience (themselves, family/friends, the internet etc)
  • Psychological factors (stress, anxiety etc)
  • Other comorbidities (diabetes etc)
  • Lifestyle factors
  • Work situations
  • Financial situations
  • These will influence your clinical reasoning and decision making when designing a rehab program
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4
Q

define chronic pain

A

Pain that continues after you would have expected the tissues to have healed is more related to other pain mechanisms i.e. you would not expect a “sprained ankle” to still be painful after 3 months so symptoms are more likely to stem from a neurological problem

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5
Q

what are physio interventions

A
  • Reduce Pain
  • Increase Range of Movement
  • Increase Strength/Stability/Length
  • Link to and increase function
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6
Q

why is the healing process so important

A
  • Healing is essential to the body’s survival and triggered by any form of tissue damage/bleeding.
  • A non specific defensive process induced by physical, chemical or biological assaults on the body.
  • Prevents the spread of injurious agents.
  • Disposes of cellular debris and pathogens
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7
Q

Why is pain key to our decision making when designing a rehabilitation program?

A

people respond differently to pain due to:
- a lack of understanding and knowledge
- previous experiences (themselves, friends or family members)
- psychological factors like stress/ anxiety
- other comorbidities like diabetes
- lifestyle factors
- work situations
- financial decisions

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8
Q

what is the Mature Orgaism Model

A

It suggests that pain is not just caused by tissue damage or injury, but also by how the brain interprets that damage based on several factors, such as past experiences, emotions, and the current environment.

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9
Q

explain in simple terms the Mature Organism Model

A
  1. Signals from the body: When something happens to the body, like an injury, signals are sent to the brain through the nervous system.
  2. Brain’s role: The brain doesn’t automatically assume pain just because of these signals. It checks various factors—like whether you’ve been injured before, how dangerous the situation seems, or what your emotions are at that moment.
  3. Brain decides: Based on this information, the brain decides whether or not to create the sensation of pain.
  4. Response: If the brain believes the body is in danger, it creates pain to get you to act (like moving away or stopping an activity). But if the brain thinks the situation is safe, it might reduce or ignore the pain.
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10
Q

which model explain why pain is experienced differently from person to person

A

the mature orgaism model

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11
Q

how can we modulate pain within our scope of practice

A
  • Advice and education - consider the Mature Organism Model
  • POLICE - Protection/rest, Optimal loading, Ice, heat, Compression, Elevation
  • Manual Therapy
  • Liaising with MDT ie GP, Consultant, Nurses etc.
  • Exercise Therapy
  • Physical Activity
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12
Q

What causes injury in tissues according to mechanotherapy?

A

Injury occurs when a tissue is stressed beyond its ability to cope, leading to deformation and eventually micro-failure.

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13
Q

What is the goal of physiotherapists during injury rehabilitation in mechanotherapy?

A

The goal is to make the tissue more load-tolerant by controlled tissue damage to shift the micro-failure point further along the graph.

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14
Q

How does tissue respond to loading in mechanotherapy?

A

Tissue deforms slowly at first, then more rapidly until micro-failure occurs. Beyond this point, injury happens as the load curve plateaus.

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15
Q

What is mobility

A

Mobility is the freedom of movement at articular segments through an appropriate anatomical range.

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16
Q

What factors govern motor control in skilled motor tasks?

A

Motor control is governed by a balance of mobility, passive stability (form closure), active stability, and neuromuscular control.

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17
Q

What is passive stability, also known as form closure?

A

Passive stability (form closure) refers to the stability provided by the structure and alignment of the joint, without muscular involvement.

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18
Q

How does mobility relate to motor control?

A

Mobility forms the basis of motor control, as it allows for proper movement and coordination at the joints.

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19
Q

What are common causes of loss of mobility in patients?

A
  • tissue remodeling
  • maladaptive mechanisms
  • or the body’s attempt to maintain function in the presence of stress
  • pain
  • failed motor control.
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20
Q

What are two therapeutic approaches used to restore mobility?

A

Therapeutic approaches include mobility exercises (dynamic and/or static stretches) and manual therapy (therapist-applied or patient-administered automobilisations).

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21
Q

What is proprioception?

A

Proprioception is the sensation related to the position and movement of joints, force and contraction, and the orientation of body segments and the body as a whole.

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22
Q

What sensory information is proprioception primarily related to?

A

joint position sense, force of muscle contractions, and body segment orientation.

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23
Q

Which mechanoreceptors are the primary source of proprioceptive information?

A

Muscle mechanoreceptors are the primary source of proprioceptive information, providing feedback about joint position and movement.

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24
Q

What role do ligamentous mechanoreceptors play in proprioception?

A

Ligamentous mechanoreceptors contribute to proprioception by providing feedback at the extremes of joint movement.

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25
Q

How can muscle atrophy affect proprioception and movement?

A

Muscle atrophy can reduce the sensitivity of muscle mechanoreceptors, impairing proprioception and affecting movement coordination.

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26
Q

What impact does joint inflammation have on movement?

A

Joint inflammation can disrupt proprioceptive feedback from mechanoreceptors, leading to reduced joint stability and impaired movement control.

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27
Q

What are the three main sources of sensory information for postural stability?

A

The three main sources of sensory information for postural stability are somatosensory feedback, vestibular feedback, and visual feedback.

28
Q

What is somatosensory feedback?

A

Somatosensory feedback provides information from the skin, muscles, and joints about body position and movement relative to the environment.

29
Q

What is vestibular feedback?

A

Vestibular feedback comes from the inner ear and provides information about balance and head position relative to gravity.

30
Q

How should the three sensory systems be considered for progression in movement training?

A

All three systems—somatosensory, vestibular, and visual feedback—should be considered and progressively challenged to improve postural stability and movement control.

31
Q

How do tissues adapt to physical stress?

A

Tissues alter their structure and composition to meet the mechanical demands of routine loading.

32
Q

What provides a stimulus for tissue adaptation?

A

Deviations from routine or steady-state loading provide a stimulus for tissue adaptation.

33
Q

What is achieved within certain thresholds during tissue adaptation?

A

Tissue adaptation occurs within the lowest and highest loads required to produce a specific tissue response.

34
Q

How many qualitative responses to physical stress are there?

A

There are five qualitative responses to physical stress depending on the level of load.

35
Q

what are the 5 qualitative responses to physical stress

A
  • permanent damage
  • injury
  • increases stress tolerance (atrophy)
  • maintenance (tissue homeostasis)
  • atrophy in response to reduce load
36
Q

What does tissue homeostasis refer to?

A

Tissue homeostasis is the balance between cellular breakdown and growth.

37
Q

How much load can uninjured biological structures handle while maintaining tissue homeostasis?

A

Most uninjured biological structures can handle loads ranging from below one to almost eight times body weight and still maintain tissue homeostasis.

38
Q

What is supraphysiological overload?

A

Supraphysiological overload is low-level cellular tissue damage caused by repetitive low load (e.g., distance running) or a single high load (e.g., a rugby tackle).

39
Q

What happens when tissues are allowed sufficient recovery before repeated loading?

A

tissues adapt, become stronger and more tolerant to further loading

40
Q

What happens to tissues at the supraphysiological level?

A

Tissues are weakened, and if subjected to further repeated loads, they are likely to deteriorate and result in tissue failure.

41
Q

what is mechanotransduction

A

mechano transduction is the process by which cells convert mechanical stimuli into biochemical responses

42
Q

what are the steps of mechanotransduction

A
  1. mechanocoupling
  2. cell-to-cell communication
  3. the effector response
43
Q

describe the third step of mechanotransduction (the effector response)

A

increased protein synthesis and therefore the addition of tissue in response to stress loading.

43
Q

describe the first step of mechanotransduction (mechanocoupling)

A

physical load (often shear, tensile or compression) causes a physical perturbation to cells that make up a tissue.

44
Q

describe the second step of mechanotransduction (cell-to-cell communication)

A

This causes deformation of the cell that results in a cascade of chemical responses both within & between cells. The extent of the response depends on the magnitude & duration of the load.

45
Q

What is critical when balancing progressive tissue overload in strength training?

A

Finding the balance between progressive tissue overload and manipulating the training program (e.g., FITT principle) without causing reinjury.

46
Q

What is the result of exercise training over many weeks and months?

A

Increased muscular endurance, which enhances work capacity.

47
Q

How is strength-endurance targeted in strength training?

A

By exercising at 40-60% of 1 rep max (RM) for over 15 repetitions with short rest periods (<90 seconds).

48
Q

How often should strength training be performed for untrained individuals?

A

At 8-12 RM, 2-3 times per week.

49
Q

How should strength training be performed for trained individuals?

A

At 1-6 RM with 3-5 minute rest periods.

50
Q

What are the morphological responses to strength training?

A

Increases in cross-sectional area, muscle pennation angle, fascial length, and fiber type changes.

51
Q

What are the neurological factors involved in strength training adaptation?

A

Motor unit recruitment, firing frequency, motor unit synchronization, and intermuscular coordination.

52
Q

Why is a needs analysis important in strength training?

A

To set appropriate goals specific to the needs of the patient.

53
Q

what is phase 4 of msk rehabilitation

A

return to functional activity, sport and work

54
Q

What should be assessed regarding the person’s role or position in a sport or activity?

A

The person’s specific role or position within the activity or sport should be evaluated.

55
Q

What should be considered about performance duration?

A

The total duration of the person’s performance, along with the duration and frequency of training sessions.

56
Q

What needs to be assessed in terms of activity duration?

A

Whether the activity is continuous or involves bursts of varying intensity and duration.

57
Q

What types of physical activities should be considered in a training program?

A

Jumping, landing, sprinting, changing direction, kicking, throwing, lifting, and carrying.

58
Q

What should be considered about impact and contact in activities?

A

The involvement of impact, contact, and collisions in the sport or activity.

59
Q

What should be evaluated in terms of distances and directions in an activity?

A

The distances covered and the directions moved during the activity.

60
Q

What needs to be identified regarding muscle involvement?

A

The predominant muscle groups and muscle actions involved in the activity.

61
Q

What flexibility and range of motion (ROM) demands should be assessed?

A

The specific flexibility and ROM requirements of the activity.

62
Q

What motor skill requirements need to be considered?

A

The specific motor skill requirements needed for the person’s sport or activity.

63
Q

what are physiotheray interventions

A
  • reduce pain
  • increase ROM
  • increase strength, stability, length
  • link to increase function
64
Q

what is the importance of the healing process

A
  • Healing is essential to the body’s survival and triggered by any form of tissue damage/bleeding.
  • A non specific defensive process induced by physical, chemical or biological assaults on the body.
  • Prevents the spread of injurious agents.
  • Disposes of cellular debris and pathogens

Developing Physiotherapy Practice 3 (6 decks)

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