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Tear & Care > Lecture 5 - Tissue Pathophysiology & Healing > Flashcards

Lecture 5 - Tissue Pathophysiology & Healing Flashcards

1
Q

define an injury

A
  • disruption of the continuity and/or function of tissue in the body
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2
Q

individual/intrinsic injury risk factors

A
  • strength
  • fitness
  • body comp
  • age
  • injury history
  • playing level
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3
Q

external/extrinsic risk factors

A

Human Factors
- team mates, opponents
Protective equipment
- helmets, shin guards
Sports Equipement
- skis
Environment
- weather
- floor/turf
- temperature

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4
Q

foundational concept of how does a tissue injury occur

A

the load exerted on the tissue exceeds the tissue capacity

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5
Q

main structures of a tendon

A
  • collagen microfibres and tropocollagen (type 1)
  • endotendon
  • epitendon
    SEE SLIDE 8
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6
Q

types of tendon injuries

A
  • tendinopathy (tendonitis; don’t really say this anymore)
  • tendon rupture
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7
Q

type 1 vs type 3 collagen role in tendon healing

A
  • type 3 is placed down half hazardly (not in same direction as muscle fibres, messy) which has more of an elastic component. type 3 is short term, not good tissue
  • type 1 then comes in for a real fix; type 1 is the base unit of tendons and is designed to deal with tensile load in tendons, muscles, and ligaments
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8
Q

list and explain the main stages of tendon healing

A
  1. inflammatory stage (up to 7 days)
    - phagocytosis of necrotic tissues (clears he way)
    - increase of vascular permeability, initiation of angiogenesis and tenocyte proliferation (increase)
  2. remodelling stage (1 - 6wks)
    - peak of type 3 collagen, will continue for a few more weeks
  3. Modeling Stage (6+ wks)
    3a. Consolidation (6-10 wks)
    - change from cellular to fibrous collagen, collagen is aligned in the direction of the stress
    3b. Maturation (10+weeks)
    - continues to remodel the tissue
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9
Q

list all parts of the muscle

A

see slide 11

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10
Q

muscle injuries are most common in which muscles

A

10-55% of athletic injures are muscle injuries
- hamstrings
- adductors
- quadriceps
- calf muscles

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11
Q

types of muscle injuries

A
  • contusions
  • sTrains (grade 1 - 3)
  • lacerations
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12
Q

explain different muscle strains

A

Grade 1
- strain usually causes stretching of a few muscle fibres
Grade 2
- more significant damage, more muscle fibres are torn or damaged (less than 50% of muscle)
Grade 3
- a complete (50%> or more) tear/rupture of the muscle

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13
Q

Different phases of muscle healing

A
  1. Destruction Phase
    - muscle injury > formation of hematoma > inflammatory response
  2. Repair Phase
    - phagocytosis of necrotic tissues
    - myogenic reserve cells (satellite cells) are activated and become myoblasts, then myoblasts fuse to myotubes
    - 5-6 days after the injury the myotube attach both ends of the stump
  3. Remodeling Phase
    - formation of contractile
    - fibroblasts become myofibroblasts which have contractile capabilities
    - scar is formed and becomes stronger over time
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14
Q

types of ligament injuries

A

sPrains
Grade 1
- minimal to moderate pain, minimal to swelling, strength or ROM deficit
Grade 2
- a lot of pain, moderate decreased strength and ROM, moderate swelling
Grade 3
- maybe a lot of pain or none, severe decrease in strength and ROM, severe swelling

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15
Q

phases of ligaments healing

A
  1. inflammatory phase
    - ligament tear
    - hematoma
    - phagocytosis
  2. Repair Phase
    - fibroblasts creates type 3 collagen and continues for a week
    - increase in glycoaminoglycans > increased water and ligament swelling
  3. Remodelling phase
    - formation of a scar
    - type 1 collagen replaces type 3
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16
Q

approximate tissue healing time lines

A

Muscle - 2 to 6 wks
Tendon - 2 to 6wks acute, 8-12 months chronic
Ligament - 3to12 months (T has 1/10th the BF as muscles)
Bone - 6-18wks

17
Q

rehab prinicples

A
  • restoring function
  • increasing ROM
  • increasing muscle strength
  • increasing sport endurance
    INCREASE CAPACITY
18
Q

what is the sequential and progressive multi-phase approach you should follow with injury rehab

A

Phase 1 - acute management/inflammation control
Phase 2 - restoring strength and ROM
Phase 3 - advanced strengthening
Phase 4 - functional/sport specific/return to play

19
Q

what do you do in Phase 1 of injury rehab

A

Acute Inflammation Stage
- immobilization for the first 3-6 days depending on the severity
- minimize effects of immobilization
- control pain, inflammation and bleeding (RICE, NSAIDS, etc)
- mobilization within pain, want to avoid re-rupture/tear
- isometric contractions after 3-6 days
MAIN GOAL: minimize damage done by the injury and inflammation

20
Q

Ice or Heat

A

ICE
- pain relief when on and continues when removed
- reduces inflammation and edema
- decreases tissue metabolism
Heat
- heat can penetrate deeper muscles but pain relief stops when heat is removed
- increase metabolic activity
- reduction of spasm
- facilitation of tissue healing

21
Q

best way to apply ice

A

10 mins ON - 10 mins OFF - 10 mins ON
*so you body doesn’t think it’s getting hypothermic and send more blood to cold area

22
Q

isometric training in rehab

A
  • heavy isometrics have show to decrease pain immediately and lasted for 45 minutes (patellar tendon)
  • used early in the management to build capacity and it’s important to stay in the limits of the plan
  • best to be used in early phase post injury
    WHY
  • fibroblasts (tenocytes, myofibroblasts, etc) respond to tensile stimulus; they will produce collagen after being stimulated
23
Q

what is mechanotransduction

A

Mechanotransduction describes the ability of a cell to actively sense, integrate, and convert mechanical stimuli into biochemical signals that result in intracellular changes, such as ion concentrations, activation of signaling pathways and transcriptional regulation (1)

24
Q

mechanotherapy

A

the employment of mechanotransduction for stimulation of tissue repair and modelling
- mechanical loading stimulates protein synthesis at the cellular level, leading to tissue remodelling

25
Q

steps of mechanotransduction

A

Mechanotransduction is a multistep process that includes
(1) mechanocoupling (transduction of mechanical forces into signals sensed by sensor cells)
(2) biochemical coupling (conversion of mechanical signal into a biochemical signal to elicit a cellular response such as gene activation) Ca2+ and IP3
(3) transfer of a signal from sensor to effector cells, and
(4) the effector cell response (protein synthesis)

26
Q

What do you do in Phase 2 of injury rehab

A

Intermediate phase
- isometric, concentric, eccentric exercises to increase tissue strength
- stretching and mobilization to increase ROM
- ensure to train the range that the tissue was injured in to make it stronger, decreasing the likelihood of future injury
- heavy resistance training and plyometrics can be added at the later point in this stage as you move closer to stage 3
MAIN GOAL: increase strength and ROM

27
Q

what do you do in phase 3 of injury rehab

A

Advanced Strengthening
- must be pain free, have full ROM, no tenderness with palpation, and at least 70% strength of the unaffected side
- begin adding more load to increase the capacity of the area
MAIN GOAL: increase the strength of the tissues

28
Q

what do you do in phase 4 of injury rehab

A

Return to play
- begin with short-specific training prior to match play
- 90%+ strength as well as be able to perform the required tasks in order to return to play
MAIN GOAL: return to play

29
Q

What happens if the relationship between load and capacity is unbalanced

A

Load > Capacity = injury
Load =< Capacity = Rehab
Load < < Capacity = Injury prevention

30
Q

Different types of exercises and their effects on injury prevention

A
  • Stretching showed least impact
  • Strength training showed the greatest impact
  • Proprioception was second most impactful
  • Multiple exposures was slightly below proprioception
    exercise in general decreased the amount of injuries

why…..
increase tissue strength = increase capacity = decreased likelihood of injury

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