Lecture 1 Flashcards
Classification of Injury: Acute
Just happened
0-72 hrs after injury
Inflammation and swelling
Classification of Injury: Subacute
3 days to 4 weeks after injury
No longer inflamed
Classification of Injury: Chronic
4-6 weeks to 1-5 years after injury
Note: Stages within “chronic”
Classification of Injury Rehabilitation stages
Inflammation Demolition Healing -Early -Mid -Late Remodelling/Return to Sport/Activity
Characteristics of the Inflammation stage
Warm to the touch -Heat is the only true test of inflammation -If there is no heat you are clear to move on to the next stage of rehab - heat is a good indicator of inflammation. Redness Pain to the touch Histamine reaction in the tissue Just suffered trauma to the area Direct blow, fracture, etc… Lasts up to 3 days post injury
Inflammation Phase: Aim of treatment
Guide inflammation -PIER -Ultrasound @ 20% duty cycle Treat the joint above and below Any time something becomes inflamed you must PIER it.
Demolition phase
- Need to move waste products out of the area before rebuilding starts
- If new material is laid down before removing all waste products, scar tissue develops
Demolition phase: Aims of Treatment
Guide residual swelling
- Massage (Effleurage)
- Elevation
- Electrical Stim
- Exercise (ROM, Stretching, foam rolling etc.)
Prevent secondary complications
- Scar tissue
- Decreased ROM
- Atrophy
Start pain free movement
-Get the moving early on to prevent further regression
Muscle Pump
-Relieve pain
Address joint above and below
-Don’t focus on just the injured area
Maintain or Increase cardiovascular fitness
-Don’t let other components lag just because a limb is injured - continue strengthening other areas
Educate/HP
Early Healing Phase - Muscle
- Isometrics in demo
- Concentrics in EH.
Early Healing Phase - Capsule
ROM
Early Healing Phase - Bone
Weight Bearing
Early Healing Phase - Fascia
Stretch
Early Healing Phase - Ligament
Heal short and strengthen muscles which support it
Early Healing Phase - Disc
Position and hydrate
Early Healing Phase - Meniscus
Position and Protect
Mid-Healing Important points
Stress the laying down of the right type of tissue and the correct properties for that tissue
Strengthening progresses from concentric to eccentric loading
Be sure to address joint above and below and the whole limb by this point
Mid-Healing Phase - Muscle
Isotonics (through ROM)
Mid-Healing Phase - Ligaments
Challenge it
Unstable surface
Weights
etc
Mid-Healing Phase - Bone
Aggressive weight bearing
Mid-healing Phase - Capsule
Proprioception to retrain joint
Mid-Healing Phase - Tendon
Greater ROM (stretch over two joints)
Mid-Healing Phase - Cartilage
Weight bear through more ROM
Late healing important points
Begin to gear to the demands of the athlete’s/patient’s sport and activities
Getting ready for the sport without actually doing it
Examples? (Hockey player scenario)
simulate hockey movements in the clinic w/ incorporation of equipment such as hockey stick
What components should be addressed in the Late healing - Vigourous heating and exercise phase?
CV fitness
- Eg. Run, ride, swim, etc.
- Ensure it’s the appropriate energy system
Muscle
-Eccentrics/Plyometrics
Ligament
-Complete ROM/Strengthening/Proprioception etc.
To get the athlete back to a competitive level in the REMODELING PHASE/RETURN TO SPORT/ACTIVITY phase what should you do for muscle and ligaments?
Muscle
-Plyometrics related to sport/activity
Ligament
-Plyometrics with direction changes
What should the therapist address REMODELING/RTS PHASE?
Address bracing / ergonomic aids
What criteria must the athlete meet to be in the REMODELING/RETURN TO SPORT/ACTIVITY phase?
Must have full ROM and strength
-Use a bilateral comparison to gauge
Must be physically and psychologically ready
How?
Test specific skills prior to allowing to practice with team or return to work/activity
What is the most important component of PIER?
Pressure
How do you Relieve pain?
- Ice
- Heat
- Massage
- Exercise
- Modalities
